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NBDHE Nutrition Study Guide
Nutrients - Substances obtained from food and used by the body to promote growth, maintenance, or repair Six classes of nutrients include - Carbohydrates Proteins Lipids Vitamins Minerals Water Carbohydrates - Organic compounds made up of carbon, hydrogen and oxygen Provide most abundant energy during metabolism Yield 4 kilocalories/gram Include monosaccharides, disaccharides and complex polysaccharides Monosaccharides - Single Sugars;
- Glucose
- Fructose
- Galactose Glucose - Blood Sugar/Dextrose
- Main fuel for brain and needed for RBCs
- Major carbohydrate found in bloodstream
- Sources include many foods, such as grapes, oranges, corn and carrots Fructose - Levulose/Fruit Sugar
- Sweetest Monosaccharide
- Sources include fruits, honey, and corn syrup Galactose - Component of Milk Sugar
- Body converts glucose to galactose in mammary tissue during lactation; makes lactose in breast milk
- Sources include milk/dairy products Disaccharides - Double Sugars; made up of two monosaccharides
- Sucrose
- Lactose
- Maltose Sucrose - Table Sugar - furnishes 1/3 of total COH intake in the average western diet
- Made up of glucose and fructose
- Sources incude sugar beets, sugar cane or maple syrup, fruits and vegetables Lactose - Milk Sugar
- Made up of glucose and galactose
- Sources include milk products Maltose - Plant Sugar
- Made up of 2 glucose molecules
- Appears whenever starch is broken down Polysaccharides - Complex
- Starch
- Glycogen
- Fibers Starch - Plant storage form of glucose (amylase and amylopectin)
- Nutritionally most important carbohydrate
- Stores energy
- Digestible/breaks down at a slow rate
- Sources include rice, potatoes, pasta and legumes Glycogen - Provides 12 to 24 hours of stored energy
- Animal equivalent of starch
- Provides a food storage system in animals/humans (glycogenesis) a. In liver, it regulates blood sugar for brain b. In muscle, it serves as an energy source for muscle contraction
- Not significant as a food source Fibers - Should be consumed 20-35 grams/day
- Dietary - cellulose/hemicellulose a. good source of fiber, not digestible (insoluble in water) b. increased peristalsis c. sources include bran, fruits, legumes, and all vegetables
Xylitol - A 5-carbon sugar alcohol (polyol); sucrose is a 6-carbon sugar Absorbed slowly and completely by the small intestines- little or no insulin is metabolized during the absorption process Antimicrobial - S. mutans are attracted to xylitol over other sugars; however, the bacteria cannot metabolize xylitol and therefore die Artificial Sweeteners - Non nutritive sweeteners; non carbohydrates and non caloric; the following are approved by FDA as additives:
- Saccharin
- Aspartame
- Acesulfame-K
- Sucralose
- Neotame Saccharin - Active ingredient in Sweet N Low Used in soft drinks and table sweeteners Aspartame - Active ingredient in NutraSweet and Equal Composed of amino acids, phenylanine and aspartic acid and methanol Not stable in heat, therefore, not suitable for cooking; used in beverages and chewing gum Adverse effects: headaches, dizziness and seizures Provides calories, but little is needed for sweetening Must carry PKU warning Acesulfame-K - Active ingredient in Sunette and Sweet One Stable in heat Used in chewing gums, nondairy creamers, and gelatin puddings Sucralose - Active ingredient in Splenda Stable in heat Neotame - Approved in 2002 by the FDA; often blended with other sweeteners
- no amino acids are absorbed, therefore does not need to carry PKU warning
- stable in heat Diabetes Mellitus - Metabolic disorder characterized by high blood glucose levels due to insufficient or ineffective insulin function
When glucose levels are elevated in the blood and cells, tissue damage will result. (Normal [random] glucose levels are between 70 and 125 mg/dl) Type 1 Diabetes - Insulin-dependent (IDDM) Involves the minority of diabetes mellitus cases - 5 - 10% Occurs primarily in children and young adults; usually between 10 and 14 Islets of Langerhans in pancreas cannot synthesize insulin Onset associated with a viral infection or genetics Characterized by weight loss with increased appetite Type 2 Diabetes - Non insulin dependent (NIDDM) Most common type of diabetes - 90% Usually develops in people over 40 and is associated with obesity Results from insufficient insulin or improper use Characterized by weight gain with increased appetite Diabetes Signs and Symptoms - Hyperglycemia - abnormally high blood glucose lvl Acetone breath - fruity odor on breath (ketosis) Ketonemia - ketones in blood Ketonuria - ketones in urine Polydipsia - increased thirst Polyuria - frequent urination Polyphagia - increased appetite due to need for energy Chronic Complications for Diabetes - Increase in PD disease - 3 times more likely to get periodontal disease; overall an increase in infections Xerostomia, increase in decay Loss of sight Poor circulation Loss of kidney function Heart disease - most frequent cause of diabetes-related death Hypoglycemia - Low blood glucose levels (remember, the brain is fueled entirely by glucose) - less than 70mg/dl Symptoms:
- shakiness
- dizziness
- sweating
- headaches
- irritability
- hunger
indispensable - body cannot synthesize; must obtain from the diet; 9 are essential Nonessential Amino Acids - dispensable - body synthesizes as long as nitrogen is present; not required in the diet; 11 are nonessential Complete Proteins (high quality) - Foods that consist of all 9 essential amino acids in sufficient amounts Sources include animal sources (fish, meat, eggs, cheese, milk) and soybeans* Incomplete Proteins (low quality) - lack one or more essential amino acids (ex plant proteins) Complementary Proteins - Need to combine two or more proteins to compensate for deficiencies in amino acid content Use of whole grains is important Protein Physiology - digestion begins in the stomach Nutritional Management of Deficiency and Disease - Phenylketonuria (PKU) Protein-energy (calorie) Malnutrition (PCM) Phenylketonuria (PKU) -
- inborn error or metabolism
- Liver cannot metabolize essential amino acid phenyl aline into nonessential amino acid tyrosine
- Must restrict phenylalanine in the diet (need just enough to support normal growth); avoid aspartame (NutraSweet/Equal) Protein-energy (calorie) Malnutrition (PCM) - Marasmus Kwashiorkor Marasmus -
- "to waste away" (chronic condition) [body's adaptation to starvation] a. inadequate food intake such as protein and calorie deficiency over a long period of time b. common in children 6-18 months in impoverished nations; impairs brain development and learning c. muscles waste and weaken (no edema)---skin and bones d. poor growth, if any Kwashiorkor -
- "evil spirit that infects the first child when second child is born" (acute condition) a. severe protein deficiency b. begins at approximately 18 months to 2 years of age c. edema in legs, abdomen, and face d. child fails to grow and gain weight e. delayed eruption and hypoplasia of teeth Good examples of complete proteins include - Meat, eggs and cheese Aspartame should NOT be consumed by individuals with - Phenylketonuria Lipids (Fats) - includes triglycerides (95% fats and oils), phospholipids, and sterols (cholesterol); organic compounds composed of carbon, hydrogen and oxygen. Types of Lipids - Saturated fatty acids Monounsaturated fatty acids Polyunsaturated fatty acids Essential (polyunsaturated) fatty acids Saturated fatty acids - Carry maximum number of hydrogen atoms (hydrogenation) Remain solid at room temperature Increase serum cholesterol levels Sources include beef, lard, and animal fats Monounsaturated fatty acids - Contain a point of unsaturated linkage (double bond) with no hydrogen atoms Viscous in form Maintain serum cholesterol levels Sources include canola and olive oils Polyunsaturated fatty acids - Contain two or more points of unsaturation (double bond) Liquid in consistency Decrease serum cholesterol levels Sources include vegetable oils Essential (polyunsaturated) fatty acids - Must be obtained from diet. Includes:
- LinoLEIC fatty acid - omega 6, source includes vegetable oils, such as sunflower and safflower
Sunlight - body makes its own vitamins D through exposure to sunlight (90%) Fortified milk - human milk has no vitamin D Fish liver oils Vitamin D Deficiency and Disease - Rickets - in children, softening o bones due to failure to calcify normally; symptoms include bowed legs, enlarged head, joints and rib cage, and deformed pelvis Osteomalacia - in adults, calcium is taken from bone sot make up for insufficient absorption in intestine; symptoms include bowed legs, bent posture and pain in the ribs, pelvis and legs Osteoporosis Vitamin E (tocopherol) - Function - antioxidant Sources include vegetable oils (corn and safflower oils), green leafy vegetables, and whole grains Toxicity interferes with blood coagulation - a function of vitamin K Vitamin K - Functions - aids in the formation of blood clotting factor prothrombin and helps increase bone density Sources include green leafy vegetables and synthesized by the intestine Which vitamin can interfere with the function of Vitamin K? - Vitamin E Which vitamin in essential for the absorption of calcium and phosphorus? - Vitamin D Water-Soluble Vitamins - Include all B vitamins and C Easily absorbed and excreted; therefore it is unlikely to reach toxic levels Main functions include metabolism of carbs, fats, proteins and blood formation (hemopoiesis) Deficiency of these vitamins affects the mouth (cheilosis and glossitis) Thiamin (B1) - Function - helps provide energy to the brain, heart and CNS Nutritional Deficiency and Disease - Beri Beri; damages nervous and cardiovascular systems Sources include pork, enriched whole grains, milk, legumes, nuts and peas Riboflavin (B2) - Functions - essential for growth and production of RBCs; prevents cheilosis and glossitis, and anemia Sources include milk, green leafy vegetables, nuts and legumes
Properties - sensitive to light (milk should be stored in cardboard/opaque containers) Niacin (B3) - Function - needed for RNA and DNA synthesis Nutritional Deficiency and Disease - pellagra (4Ds-dementia, diarrhea, dermatitis, death) Sources include meat, fish, enriched grains and green leafy vegetables Properties - amino acid tryptophan can be converted to niacin equivalents Folate (Folacin, Folic Acid) - Function - assists in forming DNA and RNA, and RBC formation Nutritional Deficiency and Disease - megaloblastic anemia, glossitis, diarrhea, birth defects spina bifida) Sources include, liver, dark green leafy vegetables, and citrus fruits Cobalamin (Cyanocobalamin - B12) - Function - helps build tissues, maintain nerve cells, and essential for RBC development; also needed for folate metabolism Nutrition Deficiency and Disease - found in strict vegetarians, pernicious anemia (weakness, sore tongue, and apathy) Sources include animal (organ meats) and fortified foods Properties:
- Intrinsic factor; protein made in stomach; needed for absorption of B
- Extrinsic factor; must be obtained through foods Vitamin C (Ascorbic Acid) - Functions - promotes synthesis of protein collage (connective tissue); acts as an antioxidant Nutritional Deficiency and Disease- Scurvy; ruptured blood vessels; swollen and bleeding gingiva; delayed wound healing Sources incluse strawberries, broccoli, cantaloupe, citrus fruits, potatoes, and tomatoes Properties - no extensive storage, smokers have an increased need Which Vitamin promotes the synthesis of collagen? - Vitamin C Minerals - Macrominerals - major minerals present in amounts greater than 5 grams in the body
- Calcium
- Sodium Calcium - Most abundant mineral in body (all cells need calcium) Functions - forms and matins bones and teeth, coagulates blood
Anorexia Nervosa Characteristics - Dramatic weight loss; 20-40% below desirable body weight Excessive exercise Aversion to food and altered eating habits; eats 300-600 kcal/day Amenorrhea - absence of menstrual cycle due to hormonal changes Lanug0 (hirsutism) fine, soft hair Decrease heart rate caused by slowing of metabolism Anorexia Nervosa Tx - Dietary - increase food inane to raise metabolic rate back to normal Psychological - therapist determines underlying issues for eating disorder About half of those who survive recover within 6 years Bulimia - Episodes of binge eating followed by purging (vomiting, use of laxatives and purgatives, or diuretic abuse) to prevent weight gain Bulimia Behavior Profile - Age of onset is typically 20 to 24 Weight is at or slightly above normal Turns toward food for comfort Aware behavior is abnormal Low self-esteem and impulsive Bulimia Characteristics - Vomits at least 2 times per week Eats 15,000 calories in a binge Calluses on knuckles due to digital purging (vomiting) Often clinically depressed Bulimia Oral Manifestations - Dental Erosion (perimolysis) found on the lingual surfaces of the maxillary teeth due to constant exposure to acid Erosion (restorative) - restorations appears 'raised' from adjacent teeth Thermal sensitivity Enlarged parotid glands can occur unilaterally or bilaterally Cheilosis associated with the loss of moisture and protective qualities of saliva Pharyngeal tears and erythema of the palate, pharynx and posterior tongue can result from use of objects or fingers to induce gagging/regurgitation Bulimia Treatment - Dietary - establish regular eating patterns Sodium fluoride rinses to aid with remineralization Sodium bicarbonate (baking soda) rinses help neutralize acids caused from vomiting Chewing sugar-free gum to stimulate saliva flow
Psychological - team approach; easier to treat because bulimic is aware of abnormal behavior Pica - Consumes non-nutritive substances (soil, paper, paint chips) or has an abnormal appetite for some things that may be considered foods (raw potatoes, ice cubes, flour) Causes are related to biochemical or iron/zinc deficiency Tx includes psychosocial, environmental, and family guidance approaches Microminerals - Required in the diet in amounts < or equal to 100mg/day Iron Copper Iodine Zinc Iron - Helps manufacture amino acids and hormones Deficiency/disease - anemia, oral lesions, patchy tongue, brittle bones and fatigue Sources - organ meats (liver), dried beans, and nuts (NOT found in milk) Copper - Formation of hemoglobin Deficiency/disease - lesions within connective tissues and bone that results in failure to grow Sources include shellfish, oysters, crab, liver and legumes Iodine - Helps regulate BMR (Thyroid gland) Deficiency/disorder - goiter Source - salt Zinc - Wound healing;aids in cell and immune system function Properties - highest concentration found in bones Deficiency - skin disorders Sources include seafood, tofu, milk, eggs and whole grains
