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Flashcards in KIN 346 Deck (324):
1

What factors influence what we eat?

Individual factors (personal) < social environment (networks) < physical environment (settings) < macro-level environments (sectors)

2

What is nutrition?

The science of foods and the nutrients they contain, and of their action within the body (including ingestion digestion, absoprtion, transport, metabolism, and excretion). Also includes the study of the social, psychological, economic, and cultural factors of what we eat and the implications of what we eat

3

Clinical work deals with?

Special populations such as cancer or diabetes

4

Community work deals with?

Nutrition of populations, planning programs and initiatives

5

Sports nutrition work deals with?

Attaining the highest level of human performance

6

Nutrigenomics deals with?

Genetics and what we eat and how what we eat affects our genes

7

2 reasons why studying nutrition is important?

1. Nutrition affects health (the WHO estimates that 2.8% of deaths every year are due to lack of fruits and veggies, and 4 out of the top ten leading causes of death are related to nutrition) 2. Nutrition is important for exercise and sport performance

8

What are nutrients?

Chemical substances acquired from food and used by the body to provide energy and structural materials and support growth, maintenance, and repair of body tissues and metabolic function. Nutrients can also decrease the risk of some diseases

9

What are essential nutrients?

Indispensable nutrients...the body cannot make in adequate quantities to meet needs, therefore, they must be supplied by the diet

10

How many essential nutrients are there for humans?

40 essential nutrients

11

What are some examples of essential nutrients?

Omega 3 and omega 6 FAs, vitamins and minerals, and some amino acids

12

What are non-essential nutrients?

Nutrients that the body can make from other materials...like glucose

13

6 major classes of nutrients?

Carbs, lipids, proteins, vitamins, minerals, water

14

What are the macronutrients?

carbs, fats, proteins

15

What are the roles of macronutrients?

Broke down for energy and used for other roles in the body such as structures, enzymes, etc.

16

Of the 6 major classes of nutrients which are organic?

Fats, proteins, carbs, vitamins

17

Of the 6 major classes of nutrients. which are micronutrients?

Vitamins and minerals

18

Of the 6 major classes of nutrients, which are inroganic?

Water and minerals

19

What is energy?

The capacity to dod work

20

Imperial unit for energy?

Kilocalories...measure of heat

21

What is the SI unit for energgy?

Joules or kJ

22

Conversion for kCals to kJoules?

x 4.2

23

Kcal/g for protein?

4

24

Kcal/g for fat?

9

25

Kcal/g for carbs?

4

26

Kcal/g for alcohol?

7

27

Energy density?

Measurement of how energy a food provides in relation to the quantity of food (kcal/grams of food)

28

Micronutrients?

Essential, non-energy yielding nutrients, needed in small quantities

29

How many essential vitamins are there?

13

30

Two major classes of vitamins?

Water soluble and fat-soluble

31

Water soluble vitamins?

B vitamins (thiamin, riboflavin, niacin, biotin, pantothenic acid, vitamin B6, foalte, vitamin B12), and Vitamin C

32

Fat soluble vitamins?

A, D, E, K

33

Can vitamins be destroyed easily?

YES due to light, chemicals, and heat

34

Minerals?

inorganic, essential nutrients found in bones, teeth, and body fluids

35

Major minerals?

More than 100 mg/day...Ca, P, K, Na, Cl, Mg, S

36

Trace minerals?

< 100 mg/day...Fe, I, Zn, Cr, Se, Fl, Cu, Mn, Mo

37

Can minerals be destroyed?

No, BUT they may be bound to other substances and consequently may not be properly absorbed into the body (iron in legumes) OR they can be lost via refining and cooking processes (leeched away in the water and discarded)

38

Nutrient density?

Measurement of the nutrients a food provides in relation to the amount of energy it provides

39

% of adult body made up of water?

60%

40

Role of water?

Takes part in metabolic reactions, transport of nutrients to cells and waste away from cells, plus many other functions including lubricating joints and temperature regulation

41

Tips for separating fact from quack?

Look at who is providing the info, where it is coming from, when it was made available, why it is being relased, and what is the message being presented.

42

DRI?

Dietary Reference Intake...a set of scientifically based nutrient refernence values for healthy populations. Can be used for assessing and planning diets for populations and individuals

43

DRIs are used to determine levels of intake that will...

prevent deficiency, support good health and prevent chronic disease, and avoid harmful effects of excess intake.

44

What are DRIs specific for?

Age, gender, and life stage

45

4 reference values fro nutrient intakes?

EAR, RDA, AI, and UL

46

EAR?

Estimated Average Requirement...average daily intake of a nutrient needed to meet the needs of 50% of healthy individuals

47

RDA?

Recommended Dietary Allowance...daily intake of a nutrient needed to meet the needs of 97-98% of healthy individuals. Calculated from teh EAR (2 SD above), and can be used as a goal for individuals

48

AI?

Adequate Intake...established when there is too little data to establish and EAR/RDA. Based on average amount consumed by healthy individuals, can be used as a goal for an individual

49

UL?

Tolerable Upper Intake Level...highest regular intake from ALL sources likely to pose no risk of adverse health effects for most healthy individuals

50

In what range do you want to keep your DRIs?

Between the RDA.Ai and the UL

51

2 reference values for energy intakes?

Estimated Energy Requirement (EER) and Acceptable Macronutrient Distribution Range (AMDR)

52

EER?

Estimated energy requirement...average energy intake needed to maintain energy balance and good health for a healthy person

53

AMDR?

Acceptable Macronutrient Distribution Range...recommened ranges of carbs, fats, protein intake as a % of total energy. Meeting the AMDRs will help to ensure adequate energy and nutrients while decreasing the risk of chronic diseases

54

AMDRs for adults?

45-65% energy from carbs, 20-35% energy from fat, and 10-35% energy from protein

55

4 possible uses of DRIs by Health Canada?

1, assessments of diets of individuals and groups 2. design and evaluation of diets in a variety of institutions 3. creation of nutrition guidelines and education programs 4. development of regulations around the nutritional quality of the food supply

56

Points to consider when using the DRIs?

1. DRIs apply to healthy individuals 2. Recommendations are for the majority 3. Goals should be met through a variety of foods 4. Recommendations are for average daily intakes and day to day variability is expected

57

Metabolism?

Process by which nutrients are broken down to yield energy or used to make body structures

58

Nutrigenomics?

the science of how nutrients affect the activities of genes

59

Nutrigenetics?

How genes affect the interactions between diet and disease

60

Examples of epidemiological studies?

Cross sectional studies, case control sutdies, cohort studies

61

What are epidemiological studies?

Determine the incidence and distribution of disease in a population

62

Strengths and weaknesses of epidemiological studies?

Strengths: can narrow down possible causes, can raise questions to pursue through other types of studies Weaknesses: cannot control variables that may influence the development of the prevention of the disease, cannot prove cause and effect

63

Examples of experimental trials?

Laboratory based studies and human intervention/clinical trials

64

What are lab based studies?

explore the efects of a specific variable on a tissue, cell, or molecule. Conducted in test-tubes (in vivo) and on animals (in vivo)

65

Strengths and weaknesses of lab based studies?

Strengths: can control conditions and can determine effects of a variable Weaknesses: cannot apply results from test tubes or animals to human beings

66

Human intervention or clinical trial strength and weaknesses?

Strengths: can control conditions for the most part and can apply findings to some groups of human beings Weaknesses: cannot generalize findings to all human beings, cannot use certain treatments for clinical or ethical reasons

67

Adequacy?

Diet provides al essential nutrients, fibre, and energy in amount sufficient for health

68

Balance?

Foods and food groups are obtained in appropriate proportions

69

Energy control?

Energy in is balanced with energy out

70

Nutrient density?

Nutrients provides by a food relative to the amount of energy provides

71

Empty calorie foods?

Foods that provide a lot of energy (kcal) but not any nutrients

72

Moderation?

Avoiding excess

73

Variety?

eating a wide selection of foods

74

What are the 6 principles of diet planning?

Adequacy, balance, energy control, nutrient density, moderation, and variety

75

What are food group plans?

Diet planning tools that sort foods into groups based on nutrient content and other common attributes (e.g. commodity group, common use) and then specify that people should eat certain amounts of foods from each group

76

Eating Well with Canada's Food Guide provides guidance on both the ____ and ____ of food choices?

Quantity and Quality

77

Eating Well with Canada's Food Guice is designed to meet?

DRIs

78

Following Eating Well with Canada's Food Guide will help people to?

Get enough vitamins, minerals, and other nutrients. Reduce the risk of obesity, type II diabetes, heart disease, certain types of cancers, and osteoporosis. Achieve overall health and vitality.

79

Four food groups for EWWCFG?

Veggies and Fruit. Grain Products. Milk and alternatives. Meat and alternatives.

80

Serving size for fresh, frozen, or canned veggies?

125mL of 1/2 C

81

SS for leafy cooked leafy veggies?

125 mL or 1/2 C

82

SS for leafy raw veggies?

250 mL or 1 C

83

SS for fresh, frozen, or canned fruit?

1 fruit or 125 mL or 1/2 C

84

SS for 100% juice?

125 mL or 1/2 C

85

SS for bread?

1 slice or 35 g

86

SS for bagels?

1/2 bagel or 45 g

87

SS for flat breads?

1/2 pita and 1/2 tortilla or 35 g

88

SS for cooked rice, bulgur, or quinoa?

125 mL or 1/2 C

89

SS for cold cereal?

30 g

90

SS for cooked cereal?

175mL or 2/4 C

91

SS for cooked pasta or couscous?

125 mL or 1/2 C

92

SS for milk or powdered milk?

250 mL or 1 C

93

SS for canned milk?

125 mL or 1/2 C

94

SS for fortified soy beverage?

250 mL or 1 C

95

SS for yogurt?

175 g or 3/4 C

96

SS for kefir?

175 g or 3/4 C

97

SS for cheese?

50g or 1.5 oz

98

SS for cooked fish, shellfish, poultry, lean meat?

75 g/2.5 oz or 125 mL/0.5C

99

SS for cooked legumes?

175 mL or 3/4 C

100

SS for tofu?

150 g or 175 mL or 3/4 C

101

SS for eggs?

2 eggs

102

SS for peanut butter or nut butters?

30 mL or 2 Tbsp

103

SS for shelled nuts and seeds?

60 mL or 1/4 C

104

How much unsaturated fats should be included in your diet each day?

20 to 40 mL or 203 Tbsp. This includes oils used for cooking, salad dressings, margarine, and mayo. Limit butter, hard margarine, and shortening/lard.

105

How many glasses of lower fat milk should you drink each day?

500 mL or 2 cups

106

How much of your grains should be whole grain?

About half

107

What 3 things should you liimit in your diet?

Fat, added sugars, and sodium

108

What should you eat at least one of each day?

One dark green (vitamin A and folate) and one orange vegetable (beta carotene)

109

How many food guide servings should you have a fish each week?

2...choose fatty fish like herring, char, salmon, etc.

110

2 overall recommendations from EWWCFG?

Enjoy a variety of foods from the four groups and satisfy your thirst with water

111

How much moderate to vigorous activity is recommended for adults?

2.5 hours per week

112

Mandatory nutrition info on a food label?

Nutrition facts table and ingredient/allergen list

113

5% daily value is considered?

A little

114

15% DV is considered?

a lot

115

Ingredients are listed in the ingredient list by what?

By weight, from the most to the least

116

What must be clearly displayed on the food ingredients list?

Food allergens, sulphites, and gluten

117

Exchange lists?

diet-planning tools that organize foods by their proportions of carbs, fats, and protein. Foods on any single list can be used interchangeably.

118

Processed foods?

Foods that have been treated to change their physical, chemical, microbiological, or sensory properties

119

Fortified foods?

The addition to a food of nutrients that were NOT originally present or present in insignificant amounts.

120

Refined?

The process by which the coarse parts of a food are removed. When wheat is refined into flour, the bran, germ, and huse are removed, leaving only the endosperm.

121

Bran?

protective coating around the kernel that is rich in nutrients and fibre

122

Germ?

seed that grows into a wheat plant, so it is especially rick in vitamins and minerals to support new life

123

Endosperm?

contains mostly starch and some protein

124

Enriched?

The addition to a food of nutrients that were lost during processing so that the food will meet a specified standard

125

Whole-grain?

A grain that maintains the same relative proportions of starchy endosperm, germ, and bran as the original

126

Examples of whole grains?

amaranth, barley, buckwheat, bulgur, corn, couscous, millet, oats, qunioa, rice, whole rye, whole wheat

127

Substitute foods?

Foods that have the same nutritional value as another food, but are not physically similar, such as stimulated egg products

128

Imitation foods?

Foods that substitute for and resemble another food in flavour, texture, appearance, and nutritional value. Must appear on food label.

129

Diet related nutrient claims?

Statements that characterize the quantity of a nutrient in food

130

Diet related claims?

statements that characterize the relationship between a nutrient or other component in a food and a disease or health related condition

131

Disease risk reduction claims?

These statements make clear well-established links between a nutrient or other component in a food and reduction in risk of developing a diet-related disease in the context of the total diet

132

Function claims?

these statements claim well-established benefits from consuming a nutrient or other component in a food on normal biological functions in the body

133

General health claims?

These are broad claims that provide dietary guidance or promote general health through healthy eating.

134

When you want to decrease the quantity of specific nutrients, look for...

Free, Low, Lower/Reduced, and Light

135

WHen you want to increase the quantity of specific nutrients, look for...

Source, High or good source, Very high or excellent course, and more or higher

136

What is a nutritional assessment?

Info used to determine the health status of an individual or population, as influences by their intake and utilization of nutrients

137

4 key components of a nutritional assessment?

Historical info, anthropometric measures, physical examinations, and lab tests

138

3 parts of historical infor

1. Health history (disease/ilness, family, lifestyle factors) 2. Drug/Supplement History (OTC/prescribed/street) and Supplements 3. Socioeconomic history (education, income, occupation, ethnicity, food availability, number of people in household, etc)

139

Examples of some diet assessment methods?

24 hr recall, food frequency questionnaire, food records, observation, and duplicate portion analysis

140

Data obtained in a diet assessment are then analyzed against what standards?

Canada's Food Guice and DRIs

141

24 hour recall?

Individuals are asked to recall all foods and beverages consumed in the previous 24 hour period...self administered or dietitian/health professional/researcher administered

142

Food Frequency Questionnaire?

Uses a scale to report how often an individual eats or drinks certain items over a specific time...collects data on usual consumption patterns over longer periods of time...may focus on specific food categories

143

Food records?

A detailed lsit of all foods consumed (including type, amount, preparation method over a designiated period of time)...can be completed on paper or electronically and estimated or weighed

144

Limitations of Diet Assessment Methods?

Recall error, inaccurate estimation of portion sizes, poor food preparation knowledge (restaurant foods), response bias due to factors such as underrporting and participant burden

145

Strategies to overcome limitations in diet assessment?

1. Prompts to assist with memory 2. Visuals to assist with portion size estimation 3. Multiple pass technique 4. Multiple days 5. Detailed instructions and sample day 6. Ensure anonymity and confidentiality

146

What are anthropometrics?

Body measurements

147

What are the purposes of anthropoemetrics?

1. Assess gorwth (infants, children, adolescents, and pregnant women) 2. Detect under/over nutrition 3. To track changes over time

148

Anthropometric measures can be compared to?

Growth charts (adolescents/children), WHO BMI cutoffs (for adults), and other measures measures taken on the same individual

149

Is training necessary to take anthropometric measures?

YES!

150

What are growth charts?

Used in children 0-19 to compare anthropometric measures to a reference population of the same sex and age. Used to track growth and development. WHO growth charts adapted for use in Canada.

151

Key anthropometric measures?

Length/height (length for children 2y), weight, and head circumference

152

What is BMI?

Body Mass Index...kg/m^2

153

What are some issues with using BMI?

1. Doesn't distinguish between fat and muscle 2. DOesn't give info on fat distribution

154

Increased risk for obesity related diseases happens at what waist circumference for men and women?

Men is > or equal to 102 cm. Women is greater than or equal to 88 cm

155

Components of a physical examination?

1. External check (hair, eyes, posture, teeth and gums, tongue, glands, skin, nails) 2. Internal check (heart rate, blood pressure, digestive function, reflexes, mental status) 3. Muscle and Bone

156

What types of lab tests are there?

1. Blood (glucse, blood lipids, hemoglobin, retinol binding protein, albumin, vitamin and mineral status) 2. Urine (nitrogen losses) 3. Feces (fat malabsoprtion)

157

Primary deficiency caused by inadequate diet is revealed by?

Diet history

158

Secondary deficienct caused by problem inside the body is revealed by?

Health history

159

Declining nutrient stores (subclinical) or Abnormal functions inside the body (covert) are made known by?

Lab tests

160

Physical signs and symptoms (overt) are made known by?

Physical exams and anthropometric measures

161

Nutrition screening?

Used to identify individual who may be malourished or at risk fro malnutrition

162

Digestion?

Breaking down food into smaller pieces/units which can then be absorbed by the body (Food --> Nutrients)

163

Absorption?

The uptake of nutrients into the blood and lymph via intestinal cells for transport to other cells around the body

164

What is the digestive systeM?

Tube that goes from the mouth to rectum/anus as well as other organs/glands which allows food/drink to be ingested and digested and its nutrients to be absorbed

165

Lumen?

Space inside the GI tract

166

DIgestive enzymes?

Proteins secreted throughout the digestive system that help break down food into absorbable units (and nutrients)

167

Carbohydrase?

Pancreatic enzyme that breaks down carbs

168

Lipase?

Breaks down fats

169

Pepson and Protease?

Breaks down proteins

170

Mastication, and what it does?

Chewing, the teeth mechanically break down food which increases its surface area (this allows digestive enzymes to have better access to the food)

171

Salivary glands?

Secretes saliva (mix of water, salts, mucus, and ezymes) which provides lubrication/fluid and helps to iniate carbohydrate digestion

172

Tongue's job?

Contains taste buds, helps move food around in the mouth, and assists with chewing and swallowing

173

Swallowing?

Movement of the bolus (lump of food swallowed at one time) from the mouth (via the pharynx) to the esophagus

174

What closes to prevent food/liquids from entering the trachea/choking?

The epiglottis

175

What is the esophagus?

Tube that passes the bolus of food from the mouth to the stomach. Upper and lower esophageal sphincters (bands of muscles) regulate flow and prevent backflow)

176

Job of the stomach?

Muscular sack that churns and grins foods to a semi-liquid mass and adds gastric juices (water, enzymes, HCl) that is secreted by the gastric glands in the stomach (pH = 2)

177

What is the stomach a key site for?

Protein digestion...the acid ucoild proteins to allow digestive enzymes to better access the protein and activates a key protein digestive enzyme called Pepsinogen, which is cleaved into Pepsin (the active enzmye)

178

What is the main site for digestion and absoprtion?

The small intestine

179

3 segments of small intestine

Duodenum, jejunum, and ileum

180

What does the pancreas secrete into the small intestine via the pancreatic duct?

Pancreatic juice into duodenum through the pancreatic duct which contains pancreatic enzymes to help break down macronutrients (carbs, fat, and protein) AND sodium bicarb to neutralize the chyme to a pH of 8

181

What is bile, where is it produced, and where is it stored?

Bile is produced in the liver and stored in the gallbladder and is delievered via the bile duct to the small intestine in response to the presence of fat. It emulsifies fat to allow enzymes to break it down. Intestinal cells also produce some digestive enzymes on their surfaces.

182

How is the chyme broken down and moved through the GI tract?

Peristalsis (churning) and Segmentation (moving)

183

PRocess of absorption?

Process by which simple nutrient components produced by digestion migrate out of the GI tract, to the cells lining the GI tract, into the blood or lymph, to the cells of the body

184

What are features of the SI surface that provide huge surface area for absorption?

Circular folds, villi, microvilli

185

3 ways nutrients can be absorbed?

Simple diffusion, facilitated diffusion, active transport

186

Steps in water soluble substance absorption?

Lumen --> intestinal cell --> capillaries --> hepatic portal vein --> liver --> circulation

187

Steps in fat soluble substance absorption?

Lumen --> intestinal cell (repackaged into chylomicrons) --> lymph --> enter bloodstream near the heart --> circulation

188

Large intestine?

Lower portion of the intestine (aka the colon)...separated from the small intestine by the ileocecal sphincter

189

What is the large intestine the main site for?

Water and mineral re-absorption, left with semi-solid waste containg fibre, some bile acids, minerals, additives and contaminants which leave the GI tract via the rectum and anus

190

What does fibre do?

Helps hold water --> softer fecal mass and increased fecal bulk, binds some minerals, additives, contaminants, fat, and cholesterol

191

Role of bacteria in the colon?

Can ferment some fibre producing gas, short chain fatty acids, which are used for local energy in the colon cells. Also, can produce small quantities of vitamin K and some B vitamins

192

Gut processes are regulated by?

1. GI bacteria 2. Nerves 3. Hormones

193

Pathway of food once it enters the mouth?

Mouth --> down the esophagus --> through the upper and lower esophageal sphincters to the stomach --> through the pyloric sphoncter --> to the small intestine --> on through the iliocecal sphincter --> large intestine --> past the appendix to the rectim ---> the anus...Along the way, secetions from the salivary glands, stomach, pancreas, liker (via the gallbladder), and glands in the wall of the small intestine deliver fluids and digestive enzymes

194

What does gastrin respond to?

Food in the stomach

195

Where is gastrin secrete from?

Stomach wall

196

What stimulates the release of gastrin?

Stomach glands

197

What does gastrin do?

HCl acid secreted into the stomach

198

What does secretin respond to?

Acidic chyme in the small intestine

199

Where is secretin secreted from>

Duodenal wall

200

What stimulates secretin release?

Pancreas

201

What does secretin do?

Releases bicarb-rich juices into the small intestine

202

What does cholecystokinin respond to?

Fat or protein in the small intestine

203

Where is cholecystokinin secreted froM?

intestinal wall

204

What does cholecystokinin stimulate?

The galbladder to secrete bile into the duodenum. The pancreas to secrete bicarb and enxyme rich juices into the small intestine. Also slows gut motility to allow for fat and protein digestion because they take longer.

205

What separates the small and large intestine?

The iliocecal sphincter

206

What is the role of the large intestine?

Site for water and mineral re-absoprtio...left with semi-solid waste containg fibre, some bile acids, minerals, additives and contaminants which will leave the GI tract via the rectum and anus

207

What does fibre do?

Helps hold water, which leads to softer fecal mass and increased fecal bulk. Binds some minerals, additives, contaminants, fat, and cholesterol

208

What do the bacteria in the large intestine do?

Can ferment some fibre producing water, gas, short chain fatty acids, which is used for local energy for colon cells. Also produce some vitamin K and B vitamins

209

What regulates the GI tract?

1. Gastrointestinal bacteria 2. Nerves 3. Hormones

210

Factors that can influence intestinal flora?

Diet, pH, peristalsis, other microorganisms, antibiotics

211

What are prebiotics?

A non digestible food component which can be used as fuel for bacteria in the large intestine to promote their growth and/or activty

212

What are fructo-oligosaccharides?

Prebiotics that contain inulin such as chicory root, onions, bananas, asparagus, artichokes, leeks, barley, and rye

213

What are galacto-oligosaccharides?

Prebiotics that are fermented dairy products such as yogurt and kefir

214

What are probiotics?

Live microorganisms which when adminisztered in sufficient quantities confer a health benefit on the host

215

What do probiotics do?

Able to survive "on the shelf," in the GI tract, and can grow in the lower GI tract. Proposed health benefits are that they improve constipation, diarrhea, lactose itoelrance, inflammatory bowel disease, increase GI immune function, colon cancer protection, all of which vary depending on the probiotic type

216

What do GI hormones do?

GI tract releases >20 hormones, they assist with digestion/absorption as well as satiation

217

Underweight?

BMI <18.5

218

Normal weight?

BMI 18.5-24.9

219

Overweight?

25.0-29.9

220

Class I obesity?

30-34.9

221

Class II obesity?

35-39.9

222

Class III obesity?

> or equal to 40

223

Super obesity and super, super obesity?

greater than or equal to 50, greater than or equal to 60

224

What is bariatric surgery?

Surgical treatment to manage obesity

225

Who is bariatric surgery considered for?

For individuals with a BMI greater than or equal to 40 or greater than or equal to 35 with comorbidities, cannot achieve enough weight loss with diet and exercise therapy, can comply with the post-surgical plan, no medical and psychological contraindications

226

What principles doe bariatric surgeries work on?

Restriction of food intake and/malabsorption

227

What are the benefits of bariatric surgery?

Weight loss 20-32% in year 1, 12-25% at 10 years. Huge improvements in diabetes, blood lipids, and BP control

228

What is laparoscopic adjustable gastric banding?

A type of bariatric surgery...an adjustable band is placed in the upper portion of the stomach, drastic reduction in food intake. Reversible, works the worst of all the options

229

What is a sleeve gastrectomy?

A type of bariatric surgery in which 60-80% of the stomach is removed, pyloric sphincter remains intact, and there is a drastic restriction in the amount of food a person can eat. Also decreases ghrelin.

230

What is roux-en-Y gastric bypass?

A type of bariatric surgery in which a small stomach pouch is created and attached to the lower part of the jejenum (duodenum and part of jejunum is bypassed). Restricts the amount of food a person can eat and causes malabsorption in the small intestine.

231

Dietary considerations following bariatric surgery?

Diet progression after surgery (liquids --> pureed foods --> soft foods --> normal foods). Eating and drinking at the same time can be problematic. Nutrient deficiencies are common (lifelong careful dietary planning and monitoring is neede dto ensure nutrient needs are met, and lifelong vitamin/mineral supplementation is needed)

232

What is lactose intolerance?

The inability to digest and absorb lactose due to a deficiency in lactase

233

What decreases lactase activity?

Age, but may also decrease due to damage of the villi from medications, malnutrition, and disease

234

What is the prevalence of lactose intolerance?

approx. 70%. Varies depending on ethnicity (10% for Northern Europeans, and 80% for Southeast Asians)

235

What are the symptoms of lactose intolerance?

Undigested lactose molecules in the intestine attract water and cause bloating, gas, abdominal discomfort and siarrhea. Tolerance varies widely: some small amounts of dairy and/or fermented dairy products (yogurt) tolerated by some. Hard cheeses and cottage cheese often well tolerated, too.

236

Treatment for lactose intolerance?

Avoidance of lactose or use of lactase. Need to ensure adequate source of calcium, vitamin D, and riboflavin

237

Some hidden sources of lactose?

Luncheon meats and sausages, biscuits, bread, medications, protein concentrate, whey

238

What is celiac disease?

An autoimmune disoder that causes inflammatory injury to the mucosa of the upper small intestine caused my gluten.

239

What is gluten?

A storage prtein found in wheat, barley, rye and helps give structure to baked goods. Wheat: gliadin. Barley: hordein. Tye: Secalin

240

Pathology of Celiac's disease?

Mucosa lining usually appears flat with atrophy or total loss of villi, loss of mircovillous brush border, and decreased surface area for nutrient absoprtion. Increased # of intraepithelial lymphocytes. Diffuse inflammation of the mucosal lining of the small intestine.

241

How is Celiac disease diagnosed?

Intestinal biopsy

242

Complications from Celiac disease?

Osteoporsis, gut lymphoma, increased risk of other autoimmune diseases

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Treatment for Celiac disease?

Lifetime withdrawl of gluten from diet (no wheat barley, or rye products and caution with oats, medications, food additives, emulsifiers). May need to avoid foods containing lactose. Careful of cross contamination. Ensure adequate nutrients and fiber (many gluten free products are low in nutrients and fibre and may not be fortified)

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Non-celiac gluten sensitivity?

A sensitivity to gluten where both celiac disease and wheat allergy have been ruled out. Gluten can trigger similar symptoms to individuals with celiac disease, but without the intestinal damage and immune response. Same treatment as celiac disease.

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What are carbohydrates?

Molecules containing carbon, hydrogen, and oxygen and usually have the ratio of 1:2:1.

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Main sources of carbs?

grains, legumes, veggies, fruit, and dairy

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Primary role of carbs?

Supply the body with energy

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Two major categeories of carbohydrates?

Sugars (mono and disaccharides) and polysaccharides (starch, fibre, glycogen)

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What are the monosaccharides?

Glucose, fructose, galactose

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What are disaccharides?

Composed of pairs of monosaccarides all containing glucose...

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What is maltose?

glucose + glucose

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What is sucrose?

Glucose + fructose

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What is lactose?

Glucose + Galactose

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How are disaccharides formed?

Condensation reaction

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How are disaccharides broken apart?

Hydrolysis reaction

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What are some sources of naturally occurring sugar?

Sugars that occur naturally as part of foods...milk, fruit, veggies, grain

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What are some sources of added sugars?

Sugars that are addded during processing and preparation of foods, and sugars eaten by themselves or added at the table

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In North America, how much of our sugar intake is added?

50%

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1 tsp of sugar = how many grams?

4g

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What are the DRIs about sugar?

DRI for added sugar is less than 35%, WHO recommends added sugars should be <10% of energy. Canadian Diabetes Association recommends added sugars should be less than 10% of energy for people with diabetes provided they maintain good blood glucose and lipid control

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What are the health risks surrounding added sugars?

They can displace intake of important nutrietnts, cause cavities, and contribute to obesity.

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What are polysaccharides?

Chains of many (>10) glucose units attached together

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What are the polysaccharides?

Glycogen, starch, and fibre

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What is glycogen?

Storage form of glucose in animals...stored in liver and muscles as highly branched chains and allows for quick energy release when needed. Not obtained in the diet.

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What is starch?

Storage form of glucose in plants. Long, branched or unbrahced chains

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What is amylose?

Long, unbranched chains of starch

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What is amylopectin?

Long, branched chains of starch

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Primary dietary sources of starch?

Grains, legumes, tubers, and root crops

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DRIs for total digestible carbs?

RDA: 130 g/day MIIMUM recquirement...AMDR: 45-65% energy

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What is fibre?

Non-starch polysaccharide...provides structure to plants, chains of glucose molecules joined together, but they differ from starches because their bonds cannot be hydrolyzed by digestive enzymes (i.e. nondigestible)

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2 major sources of fibre?

soluble and insoluble fibres

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What is soluble fibre?

dissolves in water, forms gels and can be fermented by bacteria...gums and pectin

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Dietary sources of soluble fibre?

oats, legumes, barley, and citrus fruits

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Health benefits of soluble fibre?

dec blood cholesterol, stabilize blood sugars

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Insoluble fibre?

Does not dissolve in water, does not form gelS, and is not fermentable

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Examples of insoluble fibres?

Cellulose and hemicellulose...whole grains and veggies

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Health benefits of insoluble fibres?

Prevent diverticular disease, promotoes healthy bowel movements and decreases constipation

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What are resistant starches?

Starches that escape digestion and absoprtion in the SI

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Examples of resistant starches?

Whole or partially milled grains, legumes, just ripened bananas

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DRIs for fibre?

Total Fibre AI for females is 25g/d and males 38g/d. WHO adives less than 40 g per day

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What happens with too much fibre?

GI distress, filling before nutrient needs are fulfilled, and may interfere with mineral absorption

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What are the cardiovascular health benefits of soluble fibre?

Soluble fibre (oats) binds bile (made from cholesterol) in the intestine for removal from the body. Because bile is lost, the liver uses body cholesterol to synthesize more bile which helps to decrease blood cholesterol levels. Also, bacterial by-products from fibre fermentation in the large intestine are also thought to decrease hepatic cholesterol synthesis

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Diabetes health benefits of soluble fibre?

Soluble fibre decreases the rate of glucose absorption which helps to control blood glucose levels

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How does fibre improve gastrointestinal health?

Increases fecal bulk, which speeds up fecal passage through the GI tract and decreases constipation, hemorrhoids and diverticulitis

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How does fibre decrease risk of colon cancer?

Binds and removes potential cancer causing agents. Bacterial fermentation of fibre in colon produces short chain fatty acids which decrease pH in the large intestine and may provide anti-cancer benefits

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How are glucose and galactose absorbed?

Active transport

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How is fructose absorbed?

facilitiated diffusion

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What are the 3 hormones that regulate blood glucose?

Insulin, glucagon, and epinephrine

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What does insulin do?

Helps facilitate transfer of glucose from the blood into body cells

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What does glucagon do?

Brings glucose out of storage

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What does epinephrine do in terms of blod glucose levels?

"Fight or flight" ensures glucose availability during times of stress

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What is the glycemic response?

how much a food causes blood glucose concentrations to rise and to bring about an insulin response

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WHat is the glycemic index?

An index (0-100) to classify foods based on the ability to raise blood glucose levels compared to a standard food (glucose or white bread)

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Gylcemic index is influenced by?

Type of carb, ripeness of food, cooking/processing/storage of food, other constituents in the food and other foods eaten with the food

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Low GI foods are characterized by?

Slow absorption, a small rise in blood glucose, a gradual return to baseline

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Examples of low GI foods?

legumes and milk products

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High GI foods are characterized by?

Quick absorption, a rapid increase in blood glucose, a quick insulin response--often resulting in an over compensatory drop in blood glucose

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Examples of high GI foods?

White bread and corn flakes

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Standards for low, medium, and high GI?

Low = less than or equal to 55. Medium = 56-69, high = greater than or equal to 70

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What is the glycemic load?

Takes into account both the GI and the quantity of available carbohydrate a good contains

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Low, medium, and high glycemic loads?

Low <10, medium 11-19, high is greater than or equal to 20

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Total carbohydrates = ?

fibre + sugars (added and naturally occurring) + starch

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Recommended servings of fruit/veggies, grain products, milk and alternatives, and meat and alternatives for a female age 19-50?

7-8, 6-7, 2, 2

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Recommended servings of fruit/veggies, grain products, milk and alternatives, and meat and alternatives for a male age 19-50?

8-10, 8, 2, 3

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What age groups need 3-4 milk and alternative servings per day?

9-13, 14-18, 51+

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Overall recommendations regarding fruits and veggies for Canada's food guide?

1. eat at least 1 dark green and 1 orange veggie per day 2. Choose veggies and fruit with little added salt, sugar, and fat 3.have veggies and fruit more often than juice

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Overall recommendations regarding grains for Canada's food guide?

make at least 1/2 whole grain and choose ones that are low in fat, salt, and added sugar

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Overall recommendations regarding fmilk and alternatives for Canada's food guide?

Drink milk errryday and select lower fat milk alternatives

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Overall recommendations regarding meat and alternatives for Canada's food guide?

Have alternatives such as tofu and beans and lentils frequently, eat at least 2 food guider servings of fish each week, select lean meat and alternatives prepared with little or no added fat or salt

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3 types of alternate sweeteners?

Artificial sweetners, herbal products, sugar alcohols

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What are artificial sweeteners?

Non-nutritive sweeteners. Sweetness without adding calories. Very sweet, so only very small amounts are needed

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What is saccharin?

Artificial sweetner, 450X sweeter than sucrose, only used as a tabletop sweetener in Canada, ADI: 5 mg/kg (10 packets)

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What is sucralose?

Splenda. 600X sweeter than sucrose. Available as a tabletop sweetener and permitted to be added to many different foods in Canada. Similar in structure to sucrose (Cl- replaces OH groups). ADI: 8,8 mg/kg (6 cans diet pop)

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What is aspartame?

NutraSweet, Equal. 200X sweeter than sucrose, 4kcal/g. Approved fro use in many different food products and as a tabletop sweetener. 2 amino acids (phenylalanine and asprtic acid with a methyl group)

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Is aspartame bad for you?

Health Canada does NOT support allegations that aspartame may be linked to cancer, tumours, etc. No evidence of adverse health effects. Safe during pregnancy--in moderation. Not suitable for people with PKU. ADI: 40mg/kg (18 cans diet pop)

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What is stevia?

South American plant leaf that contains compounds that are very sweet. 0 kcals, 300X sweeter than sugar. Available in products and as a tabletop sweetener.

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What are sugar alcohols?

Sorbitol, Mannitol, Xylitol, Maltitol, Lactitol. Used to increase sweetness and bulk in food products. Less sweet or a similar sweetness compared to sugar. Nutritive "sugar free" but not "kcal free" NO DENTAL CARIES. Can cause diarrhea, bloating, cramps if eaten in large amounts because of it is absorbed, but others go into colon and get fermented.

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Fasting plasma glucose for a diabetes diagnosis?

greater than equal to 7 mmol/L

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2 hr plasma glucose levels from a 75 g oral glucose tolerance test for a diabetes diagnosis?

greater than or equal to 11.1 mmol/L

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Random plasma glucose levels for a diabetes diagnosis?

greater than or equal to 11.1 mmol/L

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What is pre-diabetes?

When blood glucose values are higher than normal, but are not high enough to be diagnosed with Type 2 diabetes. A risk factor for diabetes.

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Percentage of Canadians with diabetes? Worldwide?

2008-2009 there were 6.8% of Canadians. 8.3% worldwide

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Complications of diabetes?

Acute or chronic. Chronic and long term complications include atherosclerosis, blindness, amputations, renal failure, erectile dysnfunction

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Dietary guidelines for diabetes management?

Regular balanced meals (spread CHO over day), Saturated fat <7% total energy, limit trans fat and cholesterol intake. Quench thirst with water indtead of soft drinks or juice. Regular physical activity.Limit intake of refined/added sugars to less than 10%. Increase fibre intake, including soluble fibre sources. Emphasize slow glycemic foods. Small amounts of protein at each meal to stabilize blood sugar. Alcohol can be consumed in moderation. Weight management.