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Flashcards in Community Medicine Deck (143):
1

What is the role of nutrition?

Follow an eating pattern
Lower fat, higher fibers, moderate caloric intake Diet.

2

Nutrition deals with

Food consumption and nutritive value.
Qualitative and quantitative values for different age groups and other levels.
Food metabolism and dynamics.

3

Food vs diet

Food is oral
Diet is oral and parenteral

4

Staple food

The food that is frequently used for in a given region.
It is the diet basis in term of quantity, frequency of consumption and provides highest proportion of energy.

5

How many nutrients are known?

45-50 chemical entities required by humans.

6

Organic compounds

Protein
Carbohydrates
Fats
Vitamins

7

Inorganic compounda

Water
Minerals

8

Basic food groups

1. Milk gp
2. Meat gp
3. Bread and cereal gp
4. Vegetables gp
5. Fruits gp
6. Fats and oils gp
7. Water

9

DFG pyramid
Milk gp:
Meat gp:

2-3 servings

10

DFG pyramid
Fruits:

2-4 servings

11

DFG pyramid
Vegetables:

3-5 servings

12

DFG pyramid
Bread group:

6-11 servings

13

DFG pyramid
Sweets and oils:

As minimum as possible

14

Serving size for bread & cereal

50 gm bread (a toast)
3/4 cup boiled rice or pasta
1 medium potato
1 pancake

15

Serving size for fruits

1 medium fruit
1 cup of fruit

16

Serving size for vegetables

1 cup of vegetables

17

Serving size for meat

3 oz meat
1 egg

18

Serving size for dairy products

1 cup of milk or yogurt
1 oz of cheeze

19

Serving size for fat oil and sweet

1 tsp butter
1 oz small snack = 1 handful

20

Functions of dietary proteins

1. Anabolic processes
2. Energy source
3. Transportation of fat
4. Enzymes hormones and other secretions, Hb
5. Immune system, Ab
6. Blood clotting, fibrin and collagen
7. Stored as fat if in excess

21

Protein in excess is stored as

FAT

22

Deficiency of essential amino acids leads to .................. nitrogen balance.

NEGATIVE

23

Cereals lack .............
Legumes lack .............
Mixing both sources called ...........

Lysine aa
Methionine aa
Complementarity of food protein

24

Nitrogen balance =

Nitrogen intake - Nitrogen output (urine,feces,sweat)


Positive in growth, some hormones, athletes
Negative in old age, in stress, in disease, in injury

Neutral in healthy adults and in ORDINARY EXERCISE.

25

Recommended protein intake
1. Adults
2. Infants

1. 0.8 g/Kg IBW — 12-15% of total energy intake.

2. 2.2 g/Kg For <6 m of age
35% of total energy intake.


* in the form of a.a.

26

Protein intake should not be more than ........
What are the harms?

Not more than twice the RDA

- it increases deamination or converted to fatty acids (ketosis).
- it produces rapid weight loss due to fluid loss.
- it increase the risk of GIT cancer because they discourage eating carbs (pre-cancerous activity reducers) foods.

27

How do fibers prevent constipation?

They normalize the intestinal transit time.
They increase the fecal bulk, thus reducing the intra luminal pressure of the colon.
They act as substrate for colonic fermentation & gas production to move fecal materials.

*without sufficient water they cause dry stool and hemorrhoids.

28

How do fibers reduce cholesterol?

1. They bind to cholesterol and bile salts so they prevent re absorption.
2. They increase the fecal bulk, thus they reduce the intestinal exposure to bile salts.
3. Bacteria reduce soluble fibers into short chain fatty acids, which blocks cholera synthesis in liver.

29

Role of fibers in diabetics

Hypoglycemic role.

30

Benefits of fibers?

Prevent constipation
Cholesterol lowering effect
Hypoglycemic role
Prevent colon cancer
Stimulate chewing saliva and gastric juice
Management of obesity
Prevention of diverticulae

31

Lactose has a ............ effect in the colon.

Laxative

32

Recommended intake of CHO

50-60% of total energy intake.

Refined sugar 5-10%

Minimum intake 50-100g/d to prevent ketosis.

Fibers 25-35g/d

33

Nutrients displacement?

It is losing important nutrients and replacing them by empty energy foods especially by the over-consumption of refined sugar.

34

Chemical Properties of fat

1. The length of the fatty acid chain the longer it is the more solid it is.
2. Degree of saturation
A. saturated f.a. steanic acid, solid at room temperature
B. Unsaturated
- monounsaturated linolenic acid.
- polyunsaturated linoleic acid

35

What are the essential fatty acids?

Omega-6 = linoleic acid
They decrease total chol. LDL & HDL.
(Sunflower and corn oil, soybeans)

Omega-3 = alpha-linolenic acid
They decrease total chol., LDL, serum TG.
They increase HDL.
(Olive oil, avocados, fish, sardines, peanuts and almond oil).

36

Scaly dry skin & eczema in neonates?

Essential fatty acid deficiency

37

What are trans fatty acids?
What are their harms?

They are mono unsaturated or poly unsaturated fatty acids + hydrogen atoms


They increase LDL and total chol.

38

Recommended intake of cholesterol?

300mg/day

39

How many kilo calories does a gram of lipids provide?

9Kcal

40

High intake of dietary cholesterol increases s. Chol. by ........ mg/100ml.


High intake of saturated f.a. Increases chol. by ............ mg/100ml.

Few
40-50mg/100ml

41

Recommended intake of fats

30% of total energy intake
Then ÷ 9Kcal.
In a 1:1:1 ratio
Saturated:monoUnS:polyUnS

42

Vitamins synthesized in body if their precursors are supplied?

Vitamin A
Vitamin B3 niacin.

43

Vitamins produced by microorganisms in GIT?

Vitamin K
Vitamin B7 biotin (vitamin H)
Bitamin B9 folacin (folic acid)
Vitamin B12

44

Vitamin synthesized in the skin from cholesterol?

Vitamin D

45

What are the anti-oxidant vitamins?

Vitamin A

46

Recommended intake of vitamin A?

5000 IU/day for adult male (=1000 micrograms)
4000 IU/day for adult female (=800 micrograms)
6000 IU/day for lactating women

47

Increase in morbidity & mortality of children <5yrs in Vitamin A deficiency.........

Because of infections

48

Functions of vitamin A

Maintains health of specialized tissue such as retina, mucous membranes and has a part in immunity.

49

Vitamin D deficiency

Rickets in children
Osteomalacia in adults

50

Minerals percentages

All 4-5% of body weight
50% of them are calcium and phosphate.

51

Macro and micro-minerals?

Macro: RDA > or equal 10mg/day (Ca,PO4,Na,Cl,S,K,Mg)

Micro: RDA <100mg/day (Fe,Zn,Ni,Mn,F,cu..etc)

52

Biological functions of Ca?

Bone mineralization. (Osteoporosis and osteomalacia with VDD)
CNS functions (nerve impulse). (Irritability of nerve fibers) (tetany)
Blood clotting
Blood pressure (hypertension)

53

RDA for calcium?

800mg/day for male
1200mg/day for female and old age

54

RDA of iron?

10mg/day for male
15mg/day for female

*absorption increased by vitamin C
*absorption decreased by binders, tannins, cont. use of antacids.

55

RDA of Iodine ?

150 micrograms for males&females
175 micrograms for pregnant
200 micrograms for lactating


*absorption decreased by cabbage and cauliflower. Inactivated by cooking.

56

How much increase in water intake in lactating women?

600-700ml

57

RDA for Water?

For adult: 1ml/Kcal or 35ml/kg
For children: 50-60ml/kg
For infants: 1.5ml/Kcal or 1.5ml/Kcal

58

Iraqi national program for prophylactic doses of vitamin A

100,000 IU with measles vaccine at 9th month.
200,000 IU with 1st booster of DPT vaccine at 18th month.
200,000 IU during 1st primary school year.

59

Prophylactic dose is for Iron deficiency anemia?

Pregnant: <20% prevalence, 1 tab/d
>20% prevalence, 2 tab/d
*Iraqi NP 2-3 tab/d

Lactating: 2-3 tab/d for 1st 6 weeks after delivery.

LBW and premature babies: Iron drops 2mg/Kg/d for 3-12 months.

60

Interchange of energy sources during exercise depends on:

1. Intensity of exercise
2. Length of exercise
3. Person’s fitness level
4. Type of food eaten

61

Sedentary person breaks glycogen faster,

Because athletes can store more glycogen. So they can have more capacity to do short term high intensity workouts.

62

Energy sources in different activities?

Short term high intensity: CHO
Low to moderate intensity: Both CHO & Fat
Long term activity: Fat primarily.

63

Total energy requirement TER =?

BMR + Physical Activity + TEF

*other factors like pregnancy and lactation can be added.

64

How to measure adequate diet?

The intake of more than two thirds of the R.I of nutrients is considered as adequate.

65

In pregnancy, increase all nutrients RDA except:

Vitamin A, D, Ph, F.

66

Caffeine for pregnant?

300 mg/day or 2 cups.

*coffee 45-155mg/cup
*cola 30-65mg/cup
*tea 9-50mg/day

67

Changes in food guide pyramid in pregnancy & lactation?

Same food guide pyramid + 1 serving

68

Essential fatty acids in pregnancy and lactation?

In pregnancy: 4.5% of caloric intake.

In lactation: 3-5gm/day

69

When is it a good time for women to reduce weight?

It is a good time to reduce weight during lactation and NOT pregnancy.

70

Nutritional requirements of infants in the 1st 6 months

Breastfeeding as he/she wants = 8x/d
Energy 120kcal/d
Protein 35% of total caloric intake 2-2.5g/kg/d

71

Major source of CHO in infants? Why?

Lactose. It promotes Ca and Mg absorption.
Because amylase enzyme is not present so starchy CHO should be avoided.

72

Vitamins and minerals requirements in infants?

Vitamin K 0.5-1 mg IV or oral.

Vitamin D supplements is not necessary if breastfeeding and sun exposure are adequate.
If no sunlight exposure, 400 IU/day

Vitamin A 100,000 IU with measles vaccine.

Iron 1mg/kg/d

Fluoride from diet and fortified water.

73

Water for infants 1st 6 months?

1.5 ml/Kcal
Usually breast milk is sufficient.

74

All nutrients are present in breastmilk except?

Vitamin D.
*supplements may be recommended after 6 months.

75

Cow milk is not recommended for babies. Why?

Proteins are poorly digested in newborns.
High in sodium
Low in iron and vitamin C

76

When is the optimal time to start complementary feeding?

After 6 months.
*rice is best to begin with. Fruits and vegetables are added next.

77

Adverse reactions to foods in infants?

Milk allergy
Wheat allergy (celiac disease)
Lactose intolerance (lactase enzyme deficiency)

78

What changes happen to energy and protein requirements during childhood?

The total intake is increased but the RDA/Kg is decreased.

79

Assessment of a growth during childhood years?

1st year = 1/month
2nd year = every 2 months
3rd year = 4 times/year
4th & 5th = 2 times/year

80

When does rapid growth in adolescence for girls and boys happen?

10-13 year for girls
12-15 year for boys

*lasts for 3 years

81

Energy requirement to during adolescence?

Boys:
11-14y = 2500
15-18y = 3000
19-24y = 2900

Girls:
11-24 = 2200

82

Calcium requirement during adolescence?

1200mg/day = 4 cups of dairy products/day

83

Changes in energy requirement in elderly?

51-75y = decrease in 10% of energy intake of a young adult.

>75y = decreases in another 10% (total 20% decrease in total caloric intake)

84

Protein requirements in elderly?

12-14% of total energy intake.

85

Most nutrients are the same for elderly except?

Riboflavin B2 and thiamine B1
Vitamin D
Ca absorption decrease. So, Ca 1200mg/d

86

General advice is for elderly?

Several small non-fatty meals (5-6)
Keep physically active avoid dehydration

87

Evaluation of a nutritional status?

Anthropometric measurements
Dietary evaluation
Clinical evaluation
Lab assessment

88

What are the anthropometric measurements?

1-Weight.
2-Length (infants & young children) or height( ≥2 years)
3-Head circumference (infant & young children <2 years).
4- Mid upper arm circumference.
5- Skin–fold thickness: triceps, supra-iliac, sub scapular skin–fold thickness.

89

Normal ranges of body mass index?

For both male &female.
-BMI 20-24.9 is normal or desirable weight range
-BMI 25-29.9 is low relative risk (over weight).
-BMI 30-40 is moderate risk (moderate obesity) = grade I&II
-BMI > 40 is high risk (morbid obesity)=grade III

90

Where is mid arm circumference measured at?

MAC is measured at midpoint of the left upper arm.

91

Where is skin fold thickness measured?

By lange skin fold caliper.
Supra-iliac
Triceps
Biceps
Sub-scapular

**A fold of skin in the posterior aspect of non dominant arm midway between shoulder & elbow in a relaxed position is grasped gently &pulled a way from the underlying muscle.
**Average of 3 readings taken

92

Methods of dietary assessment?

24 hour dietary recall
One week dietary record
Weighed inventory
Food frequency

93

Compare protein status in marasmus and kwashiorkor ?

In marasmus, serum protein is normal.

In kwashiorkor, serum protein is low with normal MAC.

94

Functions of dietary proteins

1. Anabolic processes
2. Energy source
3. Transportation of fat
4. Enzymes hormones and other secretions, Hb
5. Immune system, Ab
6. Blood clotting, fibrin and collagen
7. Stored as fat if in excess

95

Protein in excess is stored as

FAT

96

Deficiency of essential amino acids leads to .................. nitrogen balance.

NEGATIVE

97

Cereals lack .............
Legumes lack .............
Mixing both sources called ...........

Lysine aa
Methionine aa
Complementarity of food protein

98

Nitrogen balance =

Nitrogen intake - Nitrogen output (urine,feces,sweat)


Positive in growth, some hormones, athletes
Negative in old age, in stress, in disease, in injury

Neutral in healthy adults and in ORDINARY EXERCISE.

99

Recommended protein intake
1. Adults
2. Infants

1. 0.8 g/Kg IBW — 12-15% of total energy intake.

2. 2.2 g/Kg For <6 m of age
35% of total energy intake.


* in the form of a.a.

100

Protein intake should not be more than ........
What are the harms?

Not more than twice the RDA

- it increases deamination or converted to fatty acids (ketosis).
- it produces rapid weight loss due to fluid loss.
- it increase the risk of GIT cancer because they discourage eating carbs (pre-cancerous activity reducers) foods.

101

How do fibers prevent constipation?

They normalize the intestinal transit time.
They increase the fecal bulk, thus reducing the intra luminal pressure of the colon.
They act as substrate for colonic fermentation & gas production to move fecal materials.

*without sufficient water they cause dry stool and hemorrhoids.

102

How do fibers reduce cholesterol?

1. They bind to cholesterol and bile salts so they prevent re absorption.
2. They increase the fecal bulk, thus they reduce the intestinal exposure to bile salts.
3. Bacteria reduce soluble fibers into short chain fatty acids, which blocks cholera synthesis in liver.

103

Role of fibers in diabetics

Hypoglycemic role.

104

Benefits of fibers?

Prevent constipation
Cholesterol lowering effect
Hypoglycemic role
Prevent colon cancer
Stimulate chewing saliva and gastric juice
Management of obesity
Prevention of diverticulae

105

Lactose has a ............ effect in the colon.

Laxative

106

Recommended intake of CHO

50-60% of total energy intake.

Refined sugar 5-10%

Minimum intake 50-100g/d to prevent ketosis.

Fibers 25-35g/d

107

Nutrients displacement?

It is losing important nutrients and replacing them by empty energy foods especially by the over-consumption of refined sugar.

108

Chemical Properties of fat

1. The length of the fatty acid chain the longer it is the more solid it is.
2. Degree of saturation
A. saturated f.a. steanic acid, solid at room temperature
B. Unsaturated
- monounsaturated linolenic acid.
- polyunsaturated linoleic acid

109

What are the essential fatty acids?

Omega-6 = linoleic acid
They decrease total chol. LDL & HDL.
(Sunflower and corn oil, soybeans)

Omega-3 = alpha-linolenic acid
They decrease total chol., LDL, serum TG.
They increase HDL.
(Olive oil, avocados, fish, sardines, peanuts and almond oil).

110

Scaly dry skin & eczema in neonates?

Essential fatty acid deficiency

111

What are trans fatty acids?
What are their harms?

They are mono unsaturated or poly unsaturated fatty acids + hydrogen atoms


They increase LDL and total chol.

112

Recommended intake of cholesterol?

300mg/day

113

How many kilo calories does a gram of lipids provide?

9Kcal

114

High intake of dietary cholesterol increases s. Chol. by ........ mg/100ml.


High intake of saturated f.a. Increases chol. by ............ mg/100ml.

Few
40-50mg/100ml

115

Recommended intake of fats

30% of total energy intake
Then ÷ 9Kcal.
In a 1:1:1 ratio
Saturated:monoUnS:polyUnS

116

Vitamins synthesized in body if their precursors are supplied?

Vitamin A
Vitamin B3 niacin.

117

Vitamins produced by microorganisms in GIT?

Vitamin K
Vitamin B7 biotin (vitamin H)
Bitamin B9 folacin (folic acid)
Vitamin B12

118

Vitamin synthesized in the skin from cholesterol?

Vitamin D

119

What are the anti-oxidant vitamins?

Vitamin A

120

Recommended intake of vitamin A?

5000 IU/day for adult male (=1000 micrograms)
4000 IU/day for adult female (=800 micrograms)
6000 IU/day for lactating women

121

Increase in morbidity & mortality of children <5yrs in Vitamin A deficiency.........

Because of infections

122

Functions of vitamin A

Maintains health of specialized tissue such as retina, mucous membranes and has a part in immunity.

123

Vitamin D deficiency

Rickets in children
Osteomalacia in adults

124

Minerals percentages

All 4-5% of body weight
50% of them are calcium and phosphate.

125

Macro and micro-minerals?

Macro: RDA > or equal 10mg/day (Ca,PO4,Na,Cl,S,K,Mg)

Micro: RDA <100mg/day (Fe,Zn,Ni,Mn,F,cu..etc)

126

Biological functions of Ca?

Bone mineralization. (Osteoporosis and osteomalacia with VDD)
CNS functions (nerve impulse). (Irritability of nerve fibers) (tetany)
Blood clotting
Blood pressure (hypertension)

127

RDA for calcium?

800mg/day for male
1200mg/day for female and old age

128

RDA of iron?

10mg/day for male
15mg/day for female

*absorption increased by vitamin C
*absorption decreased by binders, tannins, cont. use of antacids.

129

RDA of Iodine ?

150 micrograms for males&females
175 micrograms for pregnant
200 micrograms for lactating


*absorption decreased by cabbage and cauliflower. Inactivated by cooking.

130

How much increase in water intake in lactating women?

600-700ml

131

RDA for Water?

For adult: 1ml/Kcal or 35ml/kg
For children: 50-60ml/kg
For infants: 1.5ml/Kcal or 1.5ml/Kcal

132

Iraqi national program for prophylactic doses of vitamin A

100,000 IU with measles vaccine at 9th month.
200,000 IU with 1st booster of DPT vaccine at 18th month.
200,000 IU during 1st primary school year.

133

Prophylactic dose is for Iron deficiency anemia?

Pregnant: <20% prevalence, 1 tab/d
>20% prevalence, 2 tab/d
*Iraqi NP 2-3 tab/d

Lactating: 2-3 tab/d for 1st 6 weeks after delivery.

LBW and premature babies: Iron drops 2mg/Kg/d for 3-12 months.

134

Interchange of energy sources during exercise depends on:

1. Intensity of exercise
2. Length of exercise
3. Person’s fitness level
4. Type of food eaten

135

Sedentary person breaks glycogen faster,

Because athletes can store more glycogen. So they can have more capacity to do short term high intensity workouts.

136

Energy sources in different activities?

Short term high intensity: CHO
Low to moderate intensity: Both CHO & Fat
Long term activity: Fat primarily.

137

Total energy requirement TER =?

BMR + Physical Activity + TEF

*other factors like pregnancy and lactation can be added.

138

How to measure adequate diet?

The intake of more than two thirds of the R.I of nutrients is considered as adequate.

139

In pregnancy, increase all nutrients RDA except:

Vitamin A, D, Ph, F.

140

Caffeine for pregnant?

300 mg/day or 2 cups.

*coffee 45-155mg/cup
*cola 30-65mg/cup
*tea 9-50mg/day

141

Changes in food guide pyramid in pregnancy & lactation?

Same food guide pyramid + 1 serving

142

Essential fatty acids in pregnancy and lactation?

In pregnancy: 4.5% of caloric intake.

In lactation: 3-5gm/day

143

When is it a good time for women to reduce weight?

It is a good time to reduce weight during lactation and NOT pregnancy.