Unit 1-Intro to Nutrition and Digestive System//Unit 2- DRI, Dietary Guidelines and Nutritional Labeling Flashcards
Unit 1: Intro to Biochem Nutrit. and the Digestive System
Basis of health = ??
- Free from ________
- Optimal state of the ________
- physical and mental
What is Nutrition?
Nutrition is the science of _______
disease
body
FOOD
Unit 1: Intro to Biochem Nutrit. and the Digestive System
“For the health provider, ______ ______is the first step in the nutrition care process. To implement a successful
nutrition plan, the _________ must include key elements of the patient’s clinical or medical history, current complaint, anthropometric measurements, biochemical
and laboratory values, information on medication and herbal supplement use for potential food-drug interactions, plus a thorough food and nutrition intake history.”
nutrition assessment
assessment
Unit 1: Intro to Biochem Nutrit. and the Digestive System
\_\_\_\_\_\_\_\_\_- a substance that provides nourishment essential for growth and the maintenance of life EX. 1-Basal metabolism 2-Growth 3-Health maintenance 4-Disease prevention 5-Reproduction
NUTRIENT
Unit 1: Intro to Biochem Nutrit. and the Digestive System
Macronutrients: daily requirement in ___
EX. Carbohydrates– Proteins–Fat –Water
• Micronutrients: daily requirement in _________
EX. Vitamins–Minerals
grams
Unit 1: Intro to Biochem Nutrit. and the Digestive System
Micronutrients: Vitamins
Fat soluble: Vitamins A, D, E, K
Water-soluble:
B-complex X 8???
Vitamin C (ascorbic acid)
B1(thiamin) B2(riboflavin) B3(niacin) B5(pantothenic acid) B6(pyridoxine) B7(biotin) B9(folate) B12 (cobalamin)
Unit 1: Intro to Biochem Nutrit. and the Digestive System
Micronutrients: Minerals
Ions, salts, and organic compounds
Major minerals: X 7 =????
Daily requirement > 100 mg
Accounts for > 0.03% total body weight
Ca, P, Na, K, Mg, S, Cl
Unit 1: Intro to Biochem Nutrit. and the Digestive System
Trace minerals: X 17!!
Daily requirement =??
Accounts for
Unit 1: Intro to Biochem Nutrit. and the Digestive System
Three-step model of nutrition =??
- Ingestion
- Digestion
- Utilization
Unit 1: Intro to Biochem Nutrit. and the Digestive System
Gastrointestinal Tract (GIT)
• ______ macronutrients (protein, carbohydrates, lipids, water, and ethanol) from ingested foods and beverages
• _______ necessary micronutrients and trace elements
• Serves as a physical and immunologic barrier
• Is one of the largest organs; has the greatest _____ ______and the greatest number of________ cells
Extracts
Absorbs
surface area
immune
Unit 1: Intro to Biochem Nutrit. and the Digestive System
The Health of the Body Depends on the Health of the GIT
• After only a few days of starvation, the GIT _______
• The cells lining the GIT have a lifespan of only 3
to 5 ______
• Due to their high metabolic activity, the cells lining the GIT are more susceptible to________ by:
– Nutrient deficiency
– Damage from toxins and irradiation
– Disruption in blood flow
• Optimum function of the GIT depends on a __________ supply of foods, rather than on consumption of large amounts of foods interrupted by prolonged fasts
atrophies
days
damage
constant
Unit 1: Intro to Biochem Nutrit. and the Digestive System
The Digestive System= __% to __% of the diet is absorbed
___ ________: key role in digestion and absorption
*Intestines: __ m long-Villi and microvilli or brush border
92 97
Small intestine
7
Unit 1: Intro to Biochem Nutrit. and the Digestive System
Sites of Secretion, Digestion, and Absorption —1
1–Stomach
- _____secretions contain hydrochloric acid, pepsin gastric lipase, mucus, intrinsic factor, and gastrin
- Food becomes ______ _________ (50% H2O)
- ______ reduces the number of microorganisms (pH 1-4)
- Solid meal empties in 2 to 3 hours
WHICH ORDER??
Gastric
semiliquid chyme
Acid
(Liquid-C-P-F-Fiber)
Unit 1: Intro to Biochem Nutrit. and the Digestive System
Sites of Secretion, Digestion, and Absorption–2
2–Small Intestine
*Primary organ of _____ and ______absorption, _____
neutralization
*Surface area is increased by length, folds, villi, and microvilli
*Fats are emulsified, digested, and absorbed in ____
nutrient
water
acid
micelles
Unit 1: Intro to Biochem Nutrit. and the Digestive System
Sites of Secretion, Digestion, & Absorption—3/3
3–Large Intestine
*____ m long: cecum, colon, and rectum
*Nutrients formed here: vitamin __, Biotin (vitamin B7),
cobalamin (vitamin B12), thiamin (vitamin B1), riboflavin
(vitamin B2)
*Bacterial action to produce ______ and organic acids
*Colonic salvage: SCFA production through fermentation
*________ reabsorption
1.5
K
gases
Water
Unit 1: Intro to Biochem Nutrit. and the Digestive System
2 TYPES OF Transport Pathways Through the Cell Membrane
- DIFFUSION = SIMPLE DIFFUSION AND FACILITATED
- ACTIVE TRANSPORT = REQUIRES ATP
KNOW
Summary of Enzymatic Digestion and Absorption
SECRETION–Saliva in mouth
ENZYME–Ptyalin (salivary amylase)
SUBSTRATE–Starch
ACTION–Hydrolysis of α1–4 glycosidic bonds
FINAL PRODUCT–Dextrins, oligosac- charides
S--Gastric juice in stomach (HCl) E--Pepsin S--Protein A--Hydrolysis of peptide bonds F--Poly- peptides, amino acids &
E–Gastric lipase
S–Fats
A–Hydrolysis
F–Free fatty acids
Study slide 18–21
Asap
Hormones and Gastrointestinal Function x6
1–Gastrin–is a peptide hormone that stimulates secretion of gastric acid (HCl) by the parietal cells of the _______ and aids in gastric motility. It is released by ___ cells in the pyloric antrum of the stomach. duodenum, and the pancreas.
stomach
G
Hormones and Gastrointestinal Function x6
2–Secretin–is a hormone that regulates water homeostasis throughout the body, and influences the environment of the duodenum by regulating secretions in the stomach and pancreas. Secretin is produced in the __cells of the __________, which are located in the crypts of Lieberkühn.
S
duodenum
Hormones and Gastrointestinal Function x6
3–Cholecystokinin (CCK)–s synthesized by __cells in the mucosal epithelium of the small intestine and secreted in the ________, the first segment of the small intestine, and causes the release of digestive enzymes and bile from the pancreas and gallbladder, respectively.
I
duodenum
Hormones and Gastrointestinal Function x6
4–GIP–It is synthesized by __cells, which are found in the mucosa of the _______ and the _________ of the gastrointestinal tract.
K
duodenum
jejunum
Hormones and Gastrointestinal Function x6
5–Motilin– is secreted by endocrine __cells (these are not the same M cells that are in Peyer’s patches) that are numerous in crypts of the small intestine, especially in the _________ and __________
M
duodenum
jejunum
Hormones and Gastrointestinal Function x6
6–Somatostatin–Somatostatin is secreted in several locations in the digestive system:
1–stomach
2–intestine
3–delta cells of the pancreas
Somatostatin will travel through the portal blood system, to the heart, then to systemic circulation, where it will exert its digestive system effects. In the stomach, somatostatin acts on the acid-producing parietal cells via G-coupled receptor to reduce secretion. Somatostatin also indirectly decreases stomach acid production by preventing the release of other hormones, including gastrin, secretin and histamine which effectively slows down the digestive process.
Know
Neuropeptide Hormones x7
• There are more than 100 peptide hormones
1– _________relaxes esophageal sphincter
2– _________decreases motility, contracts sphincters, inhibits secretions
3– __________increases motility, relaxes sphincters, stimulates secretions
4– ___________inhibits gastric emptying
GABA
Norepinephrine
Acetylcholine
Neurotensin
Neuropeptide Hormones x7
5– _____ ________regulates blood flow, gastric motor activity
6– _________facilitates secretion and peristalsis
7– _________increases peristalsis
Nitric oxide
Serotonin (5-HT)
Substance P
Focal Points
• Humans can consume a wide variety of foods in random combinations without significantly affecting _____.
• The ____ is one of the largest and most metabolically
active organs.
• The nature of _______ changes in amount and type to accommodate the foods consumed.
• The GIT has ____________ mechanisms for coordinating digestive, secretory, absorptive, and immunologic functions.
• A transient disruption of these ________ mechanisms may occur as a result of dietary extremes; more long-term dysfunction can result from malnutrition, disease, surgery, or trauma.
digestion
GIT
secretions
self-regulating
homeostatic
How to evaluate a nutritional claim: Fun and ridiculous claims!
Claim: Our natural liquid vitamin and mineral formula has a 98 percent absorption rate.
Fact: Putting nutrients in liquid form does NOT increase their absorption to this extent. Major brands of vitamin and mineral pills are designed to dissolve into liquid form
shortly after entering the stomach.
Claim: This liquid supplement bypasses the digestive system and goes DIRECTLY into the blood stream and into cells within a matter of minutes.
Fact: The only way to bypass the digestive system is by
INJECTING the liquid into a blood vessel or using
suppositories.
KNOW IN CASE IT IS ADDED TO QUIZ
How to evaluate a nutritional claim
Claim: Our nutrient formula is absorbed within a matter of
minutes, which SAVES body energy on digestion.
Digestion utilizes more energy than any other system
in the body.
Fact: Most vitamins and minerals in supplements simply
DISSOLVE and are ABSORBED – they are NOT digested.
At any rate, digestion of nutrients in food uses less than
10 percent of the body’s total energy expenditure. If
digestion really used up so much energy, we would be
able to lose weight by simply eating more!
KNOW
How to evaluate a nutritional claim
Claim: Our product contains 121 essential nutrients.
Fact: Fewer than 50 ESSENTIAL nutrients have been identified by the National Academy of Sciences.
Claim: Several major cultures in the world never get sick and live 30 to 40 years longer than average because they CONSUME 100 times the Recommended Dietary Allowance of everything.
Fact: Anyone who attempts to consume 100 times the RDA for vitamins or minerals will get very sick quickly and likely die. Consuming 100 times the RDA for protein would provide more than 20,000 calories per day in protein alone.
KNOW
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Main focus is primary prevention (health promotion)
- –as opposed to secondary = (goal of risk reduction),
- — or tertiary = (rehabilitation efforts)
KNOW
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
(HACCP) STANDS FOR:?????
• A systematic approach to identify, evaluate, and
control food safety hazards
• Identifies any biologic, chemical, or physical agent
that may cause illness or injury
• Used by food processors, restaurants, and health
care facilities
Hazard Analysis Critical Control Points
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_ = (NCP) • Established by the American Dietetic Assoc. as a standardized process for the provision of nutrition care • Includes 4 steps: 1– Nutrition \_\_\_\_\_\_\_\_ 2– Nutrition \_\_\_\_\_\_\_\_\_ 3– Nutrition \_\_\_\_\_\_\_ 4– Monitoring and \_\_\_\_\_\_\_\_\_ The patient is the central focus!
Nutrition Care Process
assessment
diagnosis
intervention
evaluation
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Nutrition Screening and Assessment
• Nutrition screening is a process that identifies those
who would benefit from a ____ nutrition assessment
– Screening should be quick, simple, and easy to administer
• _______ at regular intervals
• ___________occurs when screening has identified a
patient at risk
full
Rescreen
Assessment
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Nutrition Diagnosis: Analysis (Problem Identification)
• Assess using all available data
• ______,______ AND _______ problems in medical
record
• Nutrition diagnosis includes— problem, etiology, and
symptoms (PES) in a clear and simple statement
Identify, prioritize, and document
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Nutrition Intervention
• Translate assessment data into ________ or actions to
meet established objectives
• Interventions should be ________: what, where, when,
how – Should address each problem in assessment
• Amend plan as patient’s condition _________
strategies
specific
changes
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Monitoring and Evaluation of Nutrition Care
•_____________ impact of interventions
• Determine indicators and they should match signs and
symptoms in assessment
– Ex. If excess Na+intake was identified during assessment, then an evaluation of Na+ intake is needed at a follow-up
• Revise care plan if objectives are not met
– Determine reasons for unmet objectives and determine new strategies
• Goal is to meet _______ ________ of patient!
Measures
nutritional needs
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Intervention: Nutrition Education
• Important part of medical nutrition therapy
• Goal is to help patient acquire _____ AND _______
to make changes, including modifying behavior
• Benefits of successful dietary change
– Control of disease or symptoms
– Improved health status and quality of life
– Decreased health care costs
knowledge and skills
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Focal Points
- The astute dietetics professional provides nutrition care in a _______, stepwise manner to provide services that meet the needs of clients.
- Use of the “Nutrition Care Process” provides the dietetics professional with a _________ to develop and maintain optimum nutrition care, support, and service.
- Use of the model ADIME (__ ____ ___ ___ ___) helps in achieving the best possible outcomes for patients and their families.
predictable
framework
assessment, nutrition diagnosis, intervention, monitoring, and evaluation
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Determining Nutrient Needs
• DRI = _________ ________ __________
– How much of each nutrient is needed DAILY
– Created by Food and Nutrition Board (FNB) of the
Institute of Medicine of the National Academy of Sciences
– History of DRI
• FNB published 1st Recommended Dietary Allowance (RDA) in 1941, updated every 5 years until 2002
• Beginning 1993, the DRI was developed to expand on ____.
Dietary Reference Intake
RDA
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
DRIs
• Specific purposes for individuals or populations
• Age and sex groups
• Body Weight
• Estimated Safe and Adequate Daily Dietary Intakes
(ESADDI)
– Used when data is ________ to establish a recommended intake, but nutrient is known to be ________ for life and health
insufficient
essential
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Dietary Reference Intake Components X 4
1–__________________: a nutrient recommendation assumed adequate based on observed or experimentally determined approximation of nutrient intake by a group of healthy people when an RDA or EAR cannot be determined.
Ex. Calcium
.
Adequate Intake (AI)
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Dietary Reference Intake Components X 4
2–_________________: the average requirement
of a nutrient for healthy individuals. It is the amount of a
nutrient with which ~50% of individuals would have their
needs met.
Estimated Average Requirement (EAR)
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Dietary Reference Intake Components X 4
3–__________: the amount of a nutrient needed to meet the requirements of almost all (97-98%) of the healthy population.
Recommended Dietary Allowance (RDA)
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Dietary Reference Intake Components X 4
__________: the highest level of daily nutrient intake that is unlikely to have any adverse health effects on almost all individuals in the general population. As intake increases above the UL, the risk of adverse effects increases.
Tolerable Upper Intake Level (UL)
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Between the ____ and the____, the risk of inadequacy and of excess are both estimated to be close to 0.0. Above the UL, the risk of adverse effects increases.
RDA
UL
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Units of Nutrients • Weight/mass units – Gram (g) – Milligram (mg) – Microgram (μg)
\_\_\_\_\_\_\_\_\_\_\_\_\_– For vitamins with different active chemical forms with different potencies (VITAMERS)
• International Units (IU)
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
IU conversions to memorize–1
Vitamin A – 1 RAE (Retinol Activity Equivalent) = \_\_\_\_\_\_ IU • 1 μg retinol • \_\_ μg β-carotene • \_\_ μg α-carotene
3.33
12
24
– RDA for adult male: 900 RAE
• 900 RAE x 3.33 = 3000 IU
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
IU conversions to memorize–2
Vitamin D
– One μg vitamin D2 or D3 =___ IU
(Calciferol equivalent)
40
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
IU conversions to memorize–3
Vitamin E
– 1 mg D-α-tocopherol =___ IU
(α-tocopherol equivalent)
1.5
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
IU conversions to memorize–4
Niacin (aka nicotinic acid, Vit B3)
– 1 mg niacin =__ mg tryptophan
60
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
IU conversions to memorize–5
Folate (aka folic acid, Vit B9)(Dietary folate equivalent)
– 1 μg food folate = 0.6 μg in fortified food
= 0.5 μg supplemental folate
• Which is more potent?
Natural or synthetic folate?
synthetic folate
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Acceptable Macronutrient Distribution Ranges Table 12-1
Reference Daily Intakes Table 12-3
Daily Reference Values Table 12-4
DRIs from inside front cover of book
PRINT ASAP!!!!
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Recommendations on Macronutrients as % of daily energy needs
Dietary Goals 1--Carbs = 60% 2--Protein = 10% 3--Total Fat = 30=% 4--Saturated Fat = 10% 5--MONO-UNSATURATED = 10% 6--POLY-UNSATURATED = 10% 7--Cholesterol = >300MG
KNOW
What is a “nutritious” food?
A; A nutritious food must provide at least 2 nutrients AND
the total INQ is no less than 4
**Index of Nutrient Quotient = (INQ):
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Key Recommendations for the General Population, 2010 • Food Groups to Encourage – Fruits and Vegetables •\_\_ cups fruits & \_\_cups veggies per day (based on 2000 kcal intake) • Variety; select from all 5 subgroups –Dark greens, Orange, Legumes, Starchy vegetables, Others • Less fruit / more veggies –Fruit: 60 kcal energy / serving –Veggies: 25 kcal energy / serving
2
3
Key Recommendations for the General
Population, 2010
1–Whole grains
• 3+ ounce-equivalents per day
2–Milk or milk equivalents
• 3 cups per day
–To absorb calcium, your body needs vitamin D. Be sure to eat foods that contain vitamin D, such as eggs, liver, and certain kinds of fish like salmon and tuna. Also, getting enough sun helps your body make vitamin D.
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Omega-6:Omega-3 = _______
1–Western diets the ratio is 15/1—16.7/1.!!!
2–a ratio of 4/1 was associated with a 70% decrease in total mortality.
3–the optimal ratio may vary with the disease under consideration.
.
4:1 or less
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Dietary fiber is all parts of a plant that can’t be absorbed or digested by the body
_______ fiber- dissolves in water to form a gel-like material. It can help lower blood cholesterol and glucose levels. Soluble fiber is found in oats, peas, beans, apples, citrus fruits, carrots, barley and psyllium.
______ fiber- does not dissolve in water. It promotes the movement of material through your digestive system and increases stool bulk, so it can be of benefit to those who struggle with constipation or irregular stools. Whole-wheat flour, wheat bran, nuts, beans and vegetables, such as cauliflower, green beans and potatoes, are good sources of insoluble fiber.
Soluble
Insoluble
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Recommendations by the American Heart Assoc.
Population Goals:
1–Appropriate body weight BMI 40 mg/dL men
3–A _________ is a plant component that has
disease-protective properties
Major Guidelines =
KEY = Match energy intake to energy needs!
.
23
phytochemical
SEE TABLE 12–5 OF KRAUSE
FYI—Categories of food additives X 8
Antioxidants Nutrients Coloring agents Preservatives Emulsifiers Flavoring Moistening agents Miscellaneous
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Food labeling: Dietary Supplement and Health Education Act (DSHEA)
In ______, the US Congress passed the Dietary Supplement and Health Education Act (DSHEA)
Allows herbs to be considered ‘dietary supplements’
Obviously controversial!!
Some herbs have beneficial compounds (i.e. antioxidants), but the active principles in most herbs are either pharmacological or unknown. Long-term effects often unknown.
1994
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Food Additives—The DELANEY CLAUSE (1958): Food Additive Amendment proposed by CongressmanDelaney
- “No additive shall be deemed safe if it is found to induce cancer when ingested by man or animal.”
- Every new additive must be tested for safety in several species of animals, including one non-rodent mammal, for a specified period of time
- ________________ Refers to over 700 additives in use before the passage of this clause. They are exempt (e.g. sugar, salt, pepper, cinnamon, MSG, BHA)
GRAS (Generally Recognized As Safe):
Health Claims
Strict guidelines:
1. They cannot state the degree of risk reduction
2. Can only use “may” or “might” in discussing the relationship.
3. They must state that other factors play a role in the disease.
4. Claims must be phrased so that consumers can understand the relationship and the nutrient’s role in a daily diet.
Example of an appropriate claim:
“While many factors affect heart disease, diets low in
saturated fat and cholesterol may reduce the risk of this
disease.”
Unit 2: DRI, Dietary Guidelines and Nutritional Labeling
Megadoses are appropriate under 2 conditions ONLY:
- Early stage of treating a _____ _________ disease
- As a drug to treat ______ (supported by research and law)
nutritional deficiency
disease
