Nutrition exam prep

Question 1

What are the two predominant bacteria species in the gut?

Answer 1

1. Firmicutes

2. Bacteroidetes

Question 2

How does an imbalanced gut bacteria associate with the development of obesity?

Answer 2

An increase in Firmicutes bacteria causes metabolic disturbances within substrates protein synthesis and enzyme activity, this can lead to a decrease in FIAF which causes the suppressive effect to be lost, causing weight gain. This causes a decrease in CPT1(Less fat entry into the mitochondria), PGC1-A(Less mitochondrial biosynthesis), MCAD(Less beta-oxidation of medium fatty acid chain), and Lipoprotein lipase to decrease. The decrease in these causes less fat to be broke down and used. Furthermore, due to the effect of an imbalance of gut bacteria causes an increase in lipopolysaccharides which increase toxins in the blood, commonly known as endotoxemia.This can cause inflammation, insulin resistance, an increase in liver fat and adipose tissue which can lead to type two and obesity.

Question 3

How may gut imbalances be altered through dietary manipulation?

Answer 3

Plant-based, fibre rich diet and probiotic supplementation

Question 4

How are the two types of ways you are able to store fat?

Answer 4

Hyperplasia and hypertrophy

Question 5

Which type of fat storage causes dysfunctional adipose tissue and why?

Answer 5

Hypertrophy because it is highly metabolic.

Question 6

Dysfunctional adipose tissue can lead to what?

Answer 6

Dysfunctional adipose tissue can lead to altered cytokines and adipokine, fibrosis, lipolysis, an increase in glycolytic metabolism and a decrease in oxidative metabolism.

Question 7

an alteration in cytokines and adipokines can lead to what?

Answer 7

an increase in hunger and decrease in satiety and also local and systemic insulin resistance

Question 8

fibrosis can lead to what?

Answer 8

an increase in cardiovascular disease

Question 9

what does lipolysis lead to?

Answer 9

an increase in circulating FA/ which causes an increase in ectopic and visceral adipose tissue/ causing local and systemic insulin resistance which means a decrease in insulin secretion which means there is a decrease in glucose uptake leading to increased blood glucose levels

Question 10

an increased glycolytic metabolism due to dysfunctional adipose tissue leads to what?

Answer 10

increased glycaemic activity

Question 11

an increased oxidative metabolism from dysfunctional adipose tissue can lead to what?

Answer 11

oxidative stress, due to oxygen breakdown not being efficient, highly reactive oxygen molecules are left over that can only react with important tissues, such as p-enzymes, proteins, and borders of cells. A build-up of these molecules causes oxidative stress which can increase inflammation

Question 12

Describe RED-S?

Answer 12

RED-S is an energy deficiency that refers to a impaired physilogical function. it is catergoried by three risks, low, moderate and high

Question 13

What are the treatment strategies of RED-S

Answer 13

Increased energy intake by 300-600kcal/day and address suboptimal practices related to energy spread over the day and around exercise sessions

Another treatment plan is to increase energy intake, a reduction in exercise or a combination of both.

Question 14

What are the health implications of RED-S

Answer 14

Cardiovascular 
Metabolic 
Psychological 
Growth
Development

Question 15

What are the performance implications of RED-S

Answer 15

Decreased endurance performance
Decreased muscle strength 
Decreased glycogen stores
Increased injury risk
Depression

Question 16

Outline the key recommendations for female athletes

Answer 16

Female athletes should consume adequate amounts of PRO and CHO to maintain liver glycogen.

Question 17

What are the tips for traveling athletes?

Answer 17

Plan ahead of your journey, research the destination Food patterns should be investigated as thoroughly as possible before leaving home.

Question 18

What are nutritional challenges expected for traveling athletes?

Answer 18

Achieving CHO and PRO requirements 
Meeting daily vitamin and mineral requirements 
Balancing energy intake
Maintaining adequate hydration 
Food safety

Question 19

What are the recommendations for winter sports and altitude?

Answer 19

Increase energy intake by 200-300kcal/day
CHO intake 6-12kg/per kg/BW a day on high intensity on high volume days.
PRO 1.4-1.7/per kg/BW/day
FAT 1-1.9/per kg/BW/day
Ingestion sports drinks with electrolytes at intervals
Micronutrients, iron, Vit D, antioxidants,
supplements, creatine caffeine, blood bluffers

Question 20

What is the definition of energy deficiency?

Answer 20

Failure to increase energy intake when energy expenditure increases.

Question 21

What are the ACSM guidelines for weight loss

Answer 21

1-2 pounds per week.

Question 22

What are the ACSM guidelines for weight gain

Answer 22

500-1000kcal increase per day as well as strength training.

Question 23

What is fatigue?

Answer 23

The accumulation of lactate acid

Question 24

what are the protective elements in a cancer prevention diet?

Answer 24

Selenium, folic acid, vitamin d, Vit B-12, Chlorophyll

Question 25

What are the antioxidants in a cancer prevention diet?

Answer 25

Carotenoids (a-carotene/b-carotene) lycopene, lutein, crytoxantin

Question 26

What other supplementations can be included in a cancer prevention diet?

Answer 26

Ascorbic acid taken orally and supplementary use of digestive enzymes and probiotics.

Question 27

Does the cancer prevention diet reduce cancer by a percentage (Donaldson)

Answer 27

yes, 60-70% decrease in breast colorectal & prostate cancers. 40-50% decrease in lung cancer can prevent cancer and can enhance recovery

Question 28

Donaldson recommended diet to prevent cancer

Answer 28

``` Green leafy veg (folic acid 4 or more servings of fruit/day vegetables (garlic, onion and leak) Low fat foods, but still consuming essential fatty acids adequate vit d no red meat no refined flour no refined sugar supplementation of selenium 200mg/day ```

Question 29

Outline the key pathological mechanisms responsible for exercise-induced hypoglycemia.

Answer 29

Type 1 diabetes occurs when the pancreas is unable to produce insulin, to regulate blood sugar levels due to beta cells being destroyed.

Question 30

Provide evidence-based recommendations for maintaining blood glucose levels for patients with type 1 diabetes.

Answer 30

1. 60 minutes prior to exercise, consume 1g.kg of CHO and reduce bolus insulin intake by 75%. 2. 60 minutes post-exercise consume 1g.kg of low GI CHO, and reduce bolus insulin intake by 50%. 3. Before sleeping consume 0.3g.kg of CHO and omit any insulin injection. 4. The following day reduce total basal insulin dose by 20% and continue bolus adjustments.

Question 31

What are the fuels source locations and what fuels come from those locations

Answer 31

1. Liver - Glycogen - Triglycerides - GNG 2. Muscle - Glucogen - Triglycerides

Question 32

Using your knowledge of type 2 diabetes, provide a summary which outlines the key pathophysiology of the disease

Answer 32

Type 2 diabetes is a metabolic disorder caused by increased levels of fatty acids being stored and synthesised in b-cells, this leads to dysfunction of b-cells and causes impairment of glucose-stimulated insulin secretion. When the body has high blood glucose the pancreas excretes insulin, insulin acts as a key which would usually enable glucose to enter cells in the muscles and adipose tissue. However, in patients with type 2, insulin receptors do not work or aren’t as effective. Meaning insulin doesn’t work properly on the liver adipose tissue and skeletal muscle. As a result of this there will be higher blood glucose for a longer period of time. Due to there being high blood glucose the pancreas is told to excrete more insulin despite insulin sensitivity being present. This leads hyperglycaemia and the increase of hunger, thirst, urination and weight loss. Due to the persistent high blood glucose, glucose travels to the kidneys and is secreted out.

Question 33

What is the role of a VLCD as a curative intervention make specific reference to the twin cycle hypothesis.

Answer 33

A very low-calorie diet (VLCD) is commonly used as a way to reverse type 2 diabetes. (Taylor, 2012) previous research has stated that the twin cycle hypothesis is a way of reversing type 2 diabetes. The twin cycle hypothesis involves, a positive calorie balance causing an increase of fat stored in the liver and pancreas. Fat build up in the liver and pancreas leads to impaired fasting glucose metabolism and increases exportation of VLDL triglyceride causing an increase in islet triglyceride. After days of a VLCD taylor, 2012 stated that hepetic insulin becomes more sensitive along with a decrease in liver fat and normalisation of fasting glucose levels and after weeks a return of normal b-cell cell insulin secretion due to a fall in pancreas fat. However, individuals that have had type 2 for >8years a VLCL has a 50% less chance at achieving non-diabetic fasting glucose levels. Observations of the reversal of type 2 diabetes confirm that that if the primary influence of positive calorie balance is removed then the processes are reversible.

Question 34

Outline the mechanistic role of fat, obesity and the associated t cell response to autoimmunity

Answer 34

A high-fat diet has been shown to promote obesity. Obesity leads to excessive accumulation of white adipose tissue. White adipose tissue releases pro-inflammatory mediators, such as TNF-a, IL-6, Leptin and C-reactive proteins. The resultant systemic inflammation can high impact T cell responses and thus potentially have a direct influence on autoimmune diseases

Question 35

Sarcopenia

Answer 35

Sarcopenia is loss of skeletal muscle mass and strength with age. Combining exercise with appropriate nutritional support is likely to be an important strategy to maintain muscle mass and strength in older age. Recommended older age groups should increase dietary protein to 1.0-1.2.g/kg body weight per day. However, this may be difficult due to appetite supressing effect of protein. There is also significant amount of evidence that suggest supplementation of vitamin D to preserve muscle mass, strength and physical function in older ages to prevent and treat sarcopenia and potentially omega-3 fatty acids and anti-oxidants. Sarcopenia has two categories. Category one is age related and when no other cause is evident but aging. Whereas category two is when one or more other causes are evident.

Question 36

What are the effects of lactobacillus NCFM on insulin sensitivity and systemic inflammatory response.

Answer 36

Oral supplement intake of lacidophillus NCFM for 4 weeks on normal or impaired insulin sensitivity subjects preserved insulin sensitivity compared with placebo but did not affect the systemic inflammatory response.

Question 37

Outline the key consideration for female athletes.

Answer 37

Females should have a specific nutritional plan designed for them and there sport, specifically this would include maintain energy balance with adequate CHO, PRO and essential fats. Adequate calcium 1500mg.

Question 38

Outline the mechanistic role of fat, obesity and the associated t cell response to autoimmunity

Answer 38

Fat is an essential part of the diet, it is used for energy protection of vital organs and obsorbs certain nutritents, however, high fat diets has been shown to promote obesity. Obesity leads to excessive accumulation of white adipose tissue (WAT). Wat releases pro imflammatory makers such as IL-6, TMF-a, leptin and C-reactive proteins. These imflammatory markers can have a profound affect on CD4 T cell populations and has been shown in murine studies that obesity can impact regularatory T cells (TREG) and promote TH17 biased immunity dependent on IL-6.

Question 39

Outline the benefits of Omega-3 Supplementation for off-setting the risk of Alzheimer’s disease

Answer 39

The benefits of omega-3 supplementation in reducing the risk of AD, are indirect effects on vascular function by protecting against vascular diseases, lowering plasma triglycerides, decreasing heart rate and blood pressure. ¬¬Remodelling of membranes, by reducing total cholesterol fraction and strongly influencing neutral membrane properties and reducing inflammation and oxidative stress, by reducing serum pro-inflammatory cytokine levels. Omega-3 has also shown to reduce beta—amyloid generations in the brain by reducing beta and gamma-secretase activity. Which have been associated with AD.

Question 40

Outline the mechanics of the Amyloid Hypothesis and Lott & Head (2005) physiological evidence behind this.

Answer 40

The hypothesis suggests that accumulation of beta-amyloid protein is the primary cause of Alzheimer's disease. These peptides are obtained from Amyloid precursor proteins (APP). Which is split by beta and gamma-secretase to form Beta-Amyloid. This is possibly related to the disrupted calcium homeostasis and consequent cell adiposis. Lott & Head Evidence behind this is, the location of the APP is on chromosome 21, this is the chromosome that individuals with Down syndrome have an extra copy of this, thus producing more APP. People with down syndrome show symptoms of Alzheimer's by age 40.

Question 41

What are the rapid weight loss techniques?

Answer 41

Dieting Increased exercise Dehydration methods such as reducing fluid intake or a sweat suit. or a combination of all of these.

Question 42

name the three weight loss categories.

Answer 42

Rapid - 24-72 hours Moderate - 72 hours - several weeks Gradual - several weeks to months

Question 43

Potential advantages of weight loss

Answer 43

Increased power to weight ratio | Decreased energy expenditure

Question 44

Body fat percentages of what is not recommended for men and women and what are the long-term effects of rapid weight loss

Answer 44

``` Men = <5% Women = <12% ``` Long-term effects are chronic energy restriction

Question 45

What are Slater et al (2007) & ACSM guidelines

Answer 45

Slater et al,.2007 Fluid intake has a greater influence on performance CHO and sodium are important for recovery ACSM (2009) Restore fluid balance by replacing with 150% of fluid deficit Replenish glycogen 1g/KG/BW

Question 46

Mangement strategies for weight loss

Answer 46

``` Maintain sufficient CHO intakes Decrease fat intakes Maintain micronutrients Ensure adequate PRO intakes maintain high fluid intake increase aerobic exercise ```