Nutrition

Question 1

EAR / AR def
(USDA)

Answer 1

EAR = Estimated Avg Requirement
AR = Avg Req

-amt to meet requirements for 50% healthy ppl in a pop

Question 2

RDA / RNI
(USDA)

Answer 2

= Rec’d Daily Allowance
= Rec’d Nutrient Intake (?derived from AR)

-avg daily amt to meet reqs of 97-98% of pop

Question 3

AI
(USDA)

Answer 3

= adequate intake
*used when insufficient data for AR

-rec’d avg intake based on observed or experimentally-determined estimates in healthy pop

Question 4

UL
(USDA)

Answer 4

= upper level of intake

highest daily amt likely to post no adverse effects to most ppl

Question 5

Order of increasing intake

Answer 5

EAR / AR
RDA / RNI
RDA <– AI –> UL

Question 6

AMDR and %’s

Answer 6

= Acceptable Macronutrient Distribution Range (% total cals)

P: 10-35%
C: 45-65
F: 20-35

Question 7

Fat #’s

Answer 7

RDA / AI: (?infants only)
31 g/d in 0-6 mo
30 g/d in 7-12

AMDR:
30-40% in 1-3 yo
20-35% in 4+ yo (adults)

UL:
not defined (low sat fat)

Question 8

EFA types (2)

Answer 8

-o6 (linoleic)
-o3 (a-linoleic –> EPA & DHA)

Question 9

o6
-roles
-health benefits
-AHA

Answer 9

-roles:
clotting, CM in brain

-benefits:
↓ LDL
↓ infl
cardioprotective
possibly ↓ stroke
?benefits in CA, IBD, AI dz like RA

*AHA: 5-10% of E to ↓ risk CHD

Question 10

o3
-eg
-roles
-health benefits
-AHA

Answer 10

-oils & some veg: ALA
-fish: EPA, DHA
(ALA can be partially converted to EPA or DHA)

Question 11

o-6 to o-3 ratio

Answer 11

typical american diet 20:1
ideal may be 4:1

achieve by ↑ o-3 intake

Question 12

Omega-3 PUFA #’s

Answer 12

(a-linoleic, fish oil, some veg, etc)

RDA / AI:
0.5-1.6 g/d
(men- 1.6, women 1.5)

AMDR:
0.6-1.2% (>1 yo)
… but AHA recs 5-10% to ↓ risk of CVD

UL:
not determined

Question 13

Saturated fat, Trans fat, and Cholesterol #’s

Answer 13

RDA / AI:
Not defined!

AMDR:
Not defined!

UL:
“minimized”

*no required role
*AHA rec’s sub polys for sat fat ↓ risk of CVD 30%!

Question 14

Carb #’s

Answer 14

EAR:
-100 g/d

RDA / AI: (?1o source of energy for brain)
-130 g/d

AMDR: (to maint wt)
45-65%

UL:
Not established
(sugars <25% E intake)

?
Preg: 175 g
Lact: 210 g

Question 15

Are carbs essential

Answer 15

-Generally not essential!
…Except w some genetic defects in glucose metab

*No know carbohydrate deficiencies

Question 16

Sugar limits

Answer 16

<25% total E intake (source?)

<50 g/d (12t)

Question 17

Protein #’s

Answer 17

EAR:
.66 g/kg/d

RDA / AI:
56 g/d men
46 g/d women

AMDR:
10-35%

UL:
not defined!

Question 18

Protein deficiencies

Answer 18

Kwashioror- protein only
Marasmus- pro & carbs

Question 19

Protein and weight loss & maint

Answer 19

Loss:
1.2-1.5 g/kg daily
(about 90-120 lbs)

Maint:
0.7-1 g/kg daily

Question 20

Fiber

Answer 20

38 g men (14-50y)
25 g women (19-50y)

(28 preg)
(29 lact)

Question 21

Water AI

Answer 21

-includes all sources (food too)
-no RDA or UL

AI (L/d):
3.7 men ~1 gal
2.7 women

Question 22

Vit D def & xs

Answer 22

def: osteomalacia (Rickets in kids)

xs: hyperCa+ complications

Question 23

Vit D supp in babies

Answer 23

400 IU/d if breastfed only

Question 24

Vit D def in obesity

Answer 24

-very common
-obesity causes vit D def bc diluted throughout body

Question 25

Ca & obesity, effects on adipocytes

Answer 25

↑ Ca --> ↓ obesity Adipocytes: ↓ PTH, vitD, intracellular Ca, lipogenesis, fat stores ↑ lipolysis *opposite effects above with low Ca intake

Question 26

Fe def

Answer 26

-common after bariatric surg, all need MVI to prevent -ucytic anemia (MCV<80) ** serum ferritin most sensitive

Question 27

GI sites of nutrient absorption

Answer 27

Stom: H2o, EtOH Duod: Fe, Ca (FA, AA, other vits & mins) Jeju: Fe, Ca proximally; also K, vits & min, carbs, AA, ?fats Ileum: K, min, salts **WATER **FATS & vits ADEK B12 & remain nutrients bile salts & acids Colon: **WATER Vit K Biotin B12 Thiamine Riboflavin NaCl --> secretes K, HCO3

Question 28

Most important parts of diet for wt loss

Answer 28

-LOW ENERGY -ADHERENCE

Question 29

LCD -cals -types

Answer 29

800-1500 cal/d many types: -exchange system/points -portion controlled +/- MR -low F -low carb -paleo, SB, Medit, etc

Question 30

Low fat diet def (%)

Answer 30

<20% fat ??20-30% fat (AMDR 20-35) 55-65 carb 15 pro <10% sat fat ↓ LDL & total chol

Question 31

AHA recs & sat fat

Answer 31

?low fat diets only -replace w polyuns veg oil ↓ CVD risk 30% (~statins!) -if replaced w whole grain carbs ↓ CVD risk 9% XXX do not replace with refined carbs (↑ CVD risk 1%)

Question 32

Low carb diet def (%)

Answer 32

<45% (AMDR 45-65%) Carbs: 50-150 g/d -eliminate refined carbs e.g. Zone, South beach, diabetic diet, VLCD >=25% protein considered "high"

Question 33

Ketogenic def

Answer 33

<50 g/d

Question 34

Joslin new guidelines for T2DM

Answer 34

Low carb: 40% carbs (AMDR 45-65%) -low GI, high fiber 20-30% protein 30% fat -no trans -7-10% sat -20% mono & poly

Question 35

VLCD

Answer 35

<800 cal/d -MR plans typically: -75-105 g protein (1.5 g/kg IDEAL bw men) (1.2 " women) -50-100g carbs -10-20g fats (incl. EFA's) *can also be done w store-bought foods (PSMF)

Question 36

VLCD's more effective than LCD's?

Answer 36

-VLCD's did not produce greater weight losses than LCD's -MR plus LCD may be effective and less $ alternative

Question 37

VLCD complications

Answer 37

GI: n/v/change in BMs Cold intol Dizziness Fatigue Derm: skin, hair, nail changes Amenorrhea Psych Electrolytes: K, Na, cramps, arrhythmias EFA def Gout (pre-tx w allo) Gallstones

Question 38

Keto

Answer 38

Induction 20 g/d carbs Maint 60-90 g/d -20% protein -75% fat ↓ HbA1c -rapid weight loss -may ↑ LDL, if ↑↑ possibly familial

Question 39

Medit

Answer 39

35-40% fat = Moderate fat (AMDR 20-35%) -high o-3, olive oil -whole grains, fruits, veg, legumes -fish, seafood -limited poultry, rare red meat -moderate EtOH PREDIMED: 30% ↓ 1st CV event 40% ↓ onset of T2DM 50% ↓ recurrent CHD (Lyon)

Question 40

Vegetarian diets -protein sources -vegan risks -health benefits

Answer 40

-proteins: low-fat dairy, soy, legumes, whole grains, nuts, seeds -vegans ↑ risk of deficiencies: ...B12*, Fe, Zn, Ca, Vit D*, o-3* *may need to supp ...often in Lys as well -health benefits of vegetarian diets: ...may ↓ CA risk (colon) ...cardioprotective ...↓ LDL ...↓ DM risk, ↑ glycemic control

Question 41

MR

Answer 41

** best evidence for wt loss & MAINT -loss: 2 MR/d better wt loss than diets w food -maint: 1 MR/d -can be used with any dietary approach ** partial MR plans produce ↑ wt loss vs. equivalent calorie diets

Question 42

DASH diet

Answer 42

-↓ HTN, 8-14 pts in 2 wks -not intended for wt loss <1500 Na mg/d whole grains fruit & veg dairy lean meats, fish, poultry nuts, seeds, legumes

Question 43

E density

Answer 43

Dietary tx can also focus on low-E density foods like fruits & veg -allows for ↑ volume & satiety

Question 44

Diet effects on lipids

Answer 44

Wt loss in general: ↓ LDL and total chol Low C (vs. low fat): ↓ TG & VLDL ↑ HDL dz: ↓ DM2 Low fat: ↓ total chol may ↓ LDL more than low carb

Question 45

Health benefits of other diets

Answer 45

Med: ↓ CV mortality ↓ DM2 Veg: ↓ CV mortality ↓ DM2 also ↓ LDL DASH: ↓ BP VLCD: ↓ DM2 Low GI, High protein: Weight maintenance

Question 46

IF

Answer 46

-many different types Study: -IF w 70% calc EE ↓ wt, fat mass, LDL ... as compared to 70% red without fast -if no E deficit, IF lost some weight but not improve health compared to other groups

Question 47

Dietary effects on metabolism?

Answer 47

Resting EE decreases: low fat > low GI > low carb i.e. lower carb diets result in less metabolic slowing *But POUNDS lost shows similar slowing across diets

Question 48

Metabolic adaptation

Answer 48

>10% wt loss leads to ↓ TDEE greater than expected from wt loss alone ...300-400 less calories to maintain body weight as someone who hasn't lost 10% bw -may last 6 mo - 7 yrs (↑ muscle efficiency as well)

Question 49

What is a calorie

Answer 49

1 _c_al = amt of heat to raise temp of 1 g of h2o by 1C 1 Cal = 1 kcal = 1000 calories

Question 50

Essential AA

Answer 50

9(11): HILLMPTTV His Isoleu Leu Lys *Meth & Cys *Phenylala & Tyr Threo Trypto Val

Question 51

Conditonally essential AA's

Answer 51

can convert to the other: *Meth & Cys *Phenylala & Tyr

Question 52

RQ def & macros

Answer 52

-ratio Co2 produced : O2 burned ("C:Otient"), 20 min breath into tube -unique to individ. -used to calc BMR Which macros metabolized: 0.7 fats 0.81 proteins / mixed diet 1.0 carbs* *stupid mnemonic, high carbs = high co2

Question 53

Micronutrient deficiencies after bariatric surgery (4)

Answer 53

Thiamine (B1) Cyanocobalamin (B12) Fe Vit D

Question 54

Thiamine (B1) def, sx & tx

Answer 54

-can become acutely deficient post-op, esp if lots of vomiting Sx: diplopia nystagmus facial weakness polyneuropathy ataxia confusion Wernicke's encephalopathy (confusion, ophthalmoplegia, gait ataxia) _B_eriber_1_: wet- high output CHF dry- symm polyneuropathy Tx: 100 mg IV/IM QD x1-2wks ...then, 10 mg/d until recovered

Question 55

Fe def

Answer 55

-p-bariatric surgery, all pts need MVI! -routine monitoring to catch early (MCV <80) -ferritin most sens test Tx: -oral replacement -20-30% may need parenteral

Question 56

B12 def causes (5)

Answer 56

1. Pernicious anemia: AI dz, gastric atrophy w ↓ IF 2. Gastric bypass: -loss of parietal cells, ↓ IF -30% @ 1 yr, 50% @ 5y if not suppl 3. Metformin: --| ileum abs of B12 Tx: w Ca supp 4. Kids w obesity have 4x risk B12 def 5. Vegans: inadequate B12 intake from animal products Others: -low intake of meat and dairy -poor digestion of meats ↓ B12 release -low acid e.g PPI -low IF (as above)

Question 57

B12 def sx

Answer 57

weakness / tired palps smooth tongue angular cheilitis change BM nerves (numbness, gait, vision) depression memory loss

Question 58

B12 dx

Answer 58

-B12 levels detect def but dont tell cause -85% pern an have parietal cell abs, but IF abs less sens & more spec -↑ MMA (bc B12 converts to succCoA) -↑ homocysteine

Question 59

Vit D def -role -def -xs -obesity

Answer 59

role: -fight infxn, support healthy immune system -bone formation, abs Ca def: -osteomalacia (Rickets in kids) -post-bariatric bc ↓ Ca, vit D intake in food and ↓ absorption ...leads to 2o hyperPTH & osteoporosis -exclusively breastfed babies need 400 IU/d xs: -rare, hyperCa & assoc complications common in obesity: -diluted -↓ skin:volume ratio -obesity causes vit D def, but NOT other way around -30-40% prior to bariatric surg --> replace pre-op (50K u/wk x 2 mo) -need to supp post-op & monitor q3mo, ?DEXA

Question 60

Folic acid (B9) def -causes (5 + 5 meds) -sx -dx -tx

Answer 60

-aka pteroylglutamate / -ic acid -suppl in preg to prevent neural tube defects causes: -unhealthy diets without fruit & veg -abs probs: Crohn's, celiac -genetic do -EtOH smoking -MEDS: phenytoin, sulfasal, TMP-SMX, triamterene, OCP) Sx: -loss of app -wt loss -weakness -sore tongue -HA -palps -irrit -macro, megalo anemia Dx: CBC, B12, folate (RBC folate leves better) MMA nL w folate def (↑ w B12 def)

Question 61

Biggest loser study @ 6 yrs

Answer 61

Metabolic adaptation: -after 6 yrs, TEE increased but but remained below baseline -those w ↑ persistent wt loss has ↑ metabolic slowing -BUT those who regained also still had metabolic slowing ~500 cal -physical activity maintained since competition ↓ leptin, T4, TG ↑ HDL, adiponectin no change in ins sens

Question 62

Estimating energy needs

Answer 62

1. Need BMR: -direct or indirect calorimetry -calcuated 2. Maint cals = BMR x activity factor (1.2 sed - 1.9)