Topic 1 week 3 - The elusive healthy diet Flashcards

1
Q

Across the world what does the type of food people eat depend on?

A

Across the world, the foods people choose to eat not only depend on availability and affordability, but also on cultural and societal norms

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2
Q

How does the range and quality of food vary from low income and high income countries?

A

In many low-income countries, the range and quality of foods available to most of the population are inadequate, leading many to malnutrition and even starvation. In high-income countries, there is a huge diversity of foods available and the relative affordability of different foods drives nutritional behaviours that have different but significant impacts on long-term health. Furthermore, countries in transition from low income to middle income face both problems at the same time from different sectors of their society.

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3
Q

To stay healthy, the body needs a diet that provides the right balance of six categories of nutrients.

List the six categories of nutrients required in the diet.

A

The six nutrient categories are:

proteins
fats
carbohydrates (e.g. sugars, and starch in foods like flour and potatoes)
vitamins
minerals (e.g. iron and calcium)
water.
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4
Q

What is a macronutrient and what do they consist of?

A

Dietary carbohydrates, fats and proteins are collectively termed macronutrients because the body requires them in relatively large amounts.

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5
Q

What in the diet provides the building blocks needed to construct cells?

A

Proteins also provide energy, but more importantly they are required to provide the building blocks needed to construct the cells that form most of the body’s structures.

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6
Q

What provides the body with the majority of energy?

A

Dietary carbohydrates and fats typically provide the body with most of its energy.

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7
Q

What are vitamins and minerals essential for in the body?

A

Vitamins and minerals are essential for regulating chemical reactions and some of them are required for building and maintaining structures in the body. Minerals like calcium are incorporated into the teeth and bones to make them dense and hard.

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8
Q

You met vitamin A in Week 2 of this topic. What body systems is this vitamin essential for?

A

Vitamin A is essential for the immune system which is responsible for fighting infectious disease and also for maintaining the health of the retina in the eye.

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9
Q

What are micronutrients and what do they consist of?

A

Dietary vitamins and minerals are collectively referred to as micronutrients because they are required by the body in very small amounts. But even these very small daily amounts can be very hard to come by for many people. You have seen evidence of the effect of vitamin A deficiency in South-East Asia and Africa; it is the leading world cause of preventable blindness in children. Deficiencies in the minerals iron and iodine can be as debilitating and cause, respectively, anaemia (a deficiency of red blood cells) and poor mental development.

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10
Q

How can macronutrients affect health?

A

On the other end of the scale, macronutrients are required in significant quantities in our daily diets and insufficient supplies can have just as catastrophic effects on human health, leading to stunting (insufficient growth in children) and wasting (severe loss of muscles and tissues leading to very low body weight). However, in terms of our macronutrient nutritional status there is an additional issue. It is not just the case that insufficient macronutrients cause ill health: an excess of these nutrients can also be damaging. Diets that contain more macronutrients than the body needs, or inappropriate proportions of the various macronutrients, are also at risk of causing poor health, and it seems that diets commonly consumed by people in middle- and high-income countries fall squarely into this category.

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11
Q

What is the eatwell plate and what does it represent?

A

The ‘eatwell plate’ represents a pie chart, where each ‘slice’ of the pie indicates the proportion of total food intake that should consist of a particular class of food. It visually summarises several current recommendations for a healthy diet, including:

plenty of starchy foods such as rice, bread, pasta and potatoes (choosing wholegrain varieties when possible)
plenty of fruit and vegetables; at least five portions of a variety of fruit and vegetables a day
some protein-rich foods such as meat, fish, eggs, beans and non-dairy sources of protein, such as nuts and pulses
some milk and dairy produce, choosing reduced-fat versions or eating smaller amounts of full-fat versions or eating them less often
just a little saturated fat, salt and sugar.

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12
Q
What are the Dietary Reference Values (DRVs) for selected nutrients (per day) for adults (age 19–50) in the UK. (Department of Health, 1991)?
protein
fibre
salt
iron
zinc
vitamin A
folate
vitamin C
A
Nutrient	Dietary reference value (DRV)
protein	53 g
fibre	18 g
salt	6 g
iron	9 mg
zinc	9.5 mg
vitamin A	0.7 mg
folate	0.2 mg
vitamin C	40 mg
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13
Q

What is the percentage of Food energy (as a percentage of total food energy) for adults (age 19–50) in the UK. (Department of Health, 1991)?

A

Energy source Percentage of total food energy*
Total fats not more than 35%
of which saturated fats not more than 11%
Total carbohydrate 50%
of which intrinsic sugars, milk sugars and starch 39%
of which non-milk extrinsic sugars
not more than 11%

Average total food energy for women is 8400 kJ per day (2000 kcal per day), and for men, 10 500 kJ per day (2500 kcal per day).
** Intrinsic sugars are those present naturally within the structure of food such as fruits and vegetables. Extrinsic sugars are generally those that are added to food.

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14
Q

What is coronary heart disease?

A

Coronary heart disease (CHD) is a disease in which a substance called plaque builds up inside the coronary arteries leading to a condition called atherosclerosis . These arteries supply oxygen-rich blood to the heart muscle. Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart leading to heart attack.

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15
Q

Which nutrient is said to be responsible for coronary heart disease?

A

The low-fat era began in the 1940s with a range of studies suggesting that low-fat diets were healthier. One very famous protagonist, Ancel Keys (Figure 1.2), a physiologist at the University of Minnesota, concluded there was a correlation between the amount of fat consumed and the incidence of coronary heart disease (CHD). Keys postulated that CHD was less common amongst populations where people traditionally ate a diet lower in fat. Keys was convincing enough to persuade the American Heart Association to publish guidelines in 1961 calling for Americans to cut back on saturated fat as the best way to reduce their risk of CHD.

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16
Q

What are fats? are they insoluble to water and what are they referred to as?

A

Fats are a group of chemicals that are insoluble in water and are also referred to as lipids. The term lipids also includes oils.

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17
Q

What is an important distinction between fats and oils?

A

The main difference between fats and oils relates to their state at room temperature; oils are liquid while fats are solid, but this is a very loose and unscientific definition that doesn’t tell us much about their individual properties. It is, however, an important distinction for the food industry, since liquid oils and solid fats have different functions in the manufacture and processing of foods

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18
Q

What function do lipids have within the body?

A

All diets must include some lipid and these important molecules have a range of functions in the body. Lipids:

provide energy, with 1 g of fat releasing 37 kJ of energy when oxidised within cells
are stored in adipose tissue for times of energy need
transport and store fat-soluble vitamins
provide a source of precursors (starting materials) for a number of cellular structures most notably cell membranes.

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19
Q

What is the most important steroid in the body?`

A

The term lipid also applies to a subclass of molecules known as steroids. The most common steroid in the human body is cholesterol; this molecule is an important component of cell membranes and is used to synthesise some hormones.

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20
Q

What is a glycerol?

A

An alcohol which condenses with three fatty acid molecules to give a triacylglycerol.

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21
Q

What is a fatty acid?

A

An organic molecule consisting of two distinct parts: a long hydrocarbon chain and a carboxylic acid group.

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22
Q

What molecules does fat contain?

A

Fats contain the elements carbon (C), hydrogen (H) and oxygen (O). Each molecule of fat is a combination of one molecule of glycerol and three molecules of substances called fatty acids.

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23
Q

What is the chemical composition of glycerol? what can glycerol also be termed as?

A

Glycerol is a liquid and is also known as glycerine. A molecule of glycerol has three carbon atoms attached together in a row, an OH group (one oxygen atom with one hydrogen atom) attached to each carbon atom, and the rest of the bonds of the carbon atoms are taken up with single hydrogen atoms.

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24
Q

What is the name of the COOH group?

A

COOH is the carboxylic acid group.

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25
Q

How many CH2 groups does the palmitic acid molecule have in its long tail?

A

There are 14 of them.

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26
Q

What information does the word ‘triacylglycerol’ convey to you about the chemical make-up of a fat molecule?

A

You should recognise ‘tri-’ as meaning that the molecule contains three of something – in this case, three fatty acids; that’s the ‘-acyl-’ part, which is similar to the word acid. Then ‘glycerol’ is the name of the component that makes up the rest of the molecule.

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27
Q

Do all fatty acids have a similar structure? what are fatty acids also called?

A

There are many different types of fatty acids, but they all have a similar basic structure, with the long tail of carbon atoms, and a COOH group at one end. Fats are often called triacylglycerols (pronounced ‘try-ay-sile-gliss-er-rols’), sometimes abbreviated to TAGs. You may also see them referred to by the older term triglycerides (pronounced ‘try- gliss-er-ides’).

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28
Q

what is the chemical reaction called that links fatty acid a glycerol together?

A

In order to make a molecule of fat it is necessary to link the three fatty acids and the glycerol together.

A type of chemical reaction called condensation is needed to link each fatty acid to glycerol via an ester bond. Figure 2.3a shows the reaction whereby one molecule of water is synthesised for every ester bond that forms. Three fatty acids need to be added to make a complete triacylglycerol molecule

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29
Q

How many water molecules are produced when a complete triacylglycerol (fat) molecule is made?

A

Since each time a fatty acid is linked to glycerol, one water molecule is produced, a total of three water molecules are produced when a complete triacylglycerol molecule is synthesised from glycerol and three fatty acids.

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30
Q

What two groups can fatty acids be classified according to their certain characteristics?

A

Fatty acids are classified according to certain specific characteristics, including:

the number of carbon atoms in their tails,
whether they are saturated or unsaturated.

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31
Q

How many carbon atoms are there in short chain, medium chain and long chain fatty acids?

A

Fatty acids with six or fewer carbon atoms are classed as ‘short-chain’ fatty acids; those with between eight and 12 carbon atoms are ‘medium-chain’ fatty acids. From 14 carbon atoms onwards, the fatty acids are called ‘long-chain’ and about 95% of the fats we eat contain long-chain fatty acids.

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32
Q

What does the term saturated mean with reference to organic compounds?

A

Saturated organic compounds contain no carbon-to-carbon double bonds (C=C).

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33
Q

Where is palmatic acid found?

A

Palmitic acid, shown in Figure 2.3a and b and reproduced below, is found in the seeds of the oil palm and coconut palm and is the most common fatty acid found in living organisms. It is a saturated fat as it does not contain any carbon-to-carbon double bonds.

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34
Q

What is this the structural formula of?

CH3–CH2–CH2–CH2–CH2–CH2–CH2–CH2–CH2–CH2–CH2–CH2–CH2–CH2–CH2–COOH

A

This is the full structural formula of palmitic acid but it can be abbreviated to this representation, which omits the carbon atoms and their associated hydrogen atoms along the carbon chain

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35
Q

What is this the structural formula of? CH3–CH2–CH2–CH2–CH2–CH2–CH2–CH2–CH=CH–CH2–CH2–CH2–CH2–CH2–CH2–CH2–COOH

A

In contrast, the fatty acid shown in Figure 2.5 is called oleic acid, and forms nearly three-quarters of the fatty acids in olive oil

36
Q

How many carbon atoms does oleic acid have in comparison with palmatic acid?

A

Oleic acid has 18 carbon atoms compared to 16 in palmitic acid.

37
Q

What other differences are there between oleic acid structure and the structure of the saturated fatty acid palmitic acid?

A

Palmitic acid has single bonds between all its carbon atoms, while oleic acid has a double bond (C=C) between the ninth and tenth carbon atoms, counting from the CH3 end (so it also has two fewer hydrogen atoms).

38
Q

What type of fatty acid is oleic acid and why? What type of omega is it?

A

Oleic acid is therefore an example of an unsaturated fatty acid, and as there is just one double bond in the carbon chain it is said to be monounsaturated. Since the double bond is attached to the ninth carbon, oleic acid, which is the most common monounsaturated fatty acid, belongs to the n-9 family of fatty acids, also known as omega-9. (Omega is a Greek letter written in lower case as ω.)

39
Q

What is a fatty acid called if it has more than one double bond of carbon?

A

If a fatty acid has more than one double bond (even if there are only two) it is called polyunsaturated. The term polyunsaturated fatty acid can be abbreviated to PUFA.

40
Q

What is a fatty acid called if it only has one carbon double bond?

A

monounsaturated fatty acid

41
Q

What is this a structural formula of? CH3–CH2–CH2–CH2–CH2–CH=CH–CH2–CH=CH–CH2–CH2–CH2–CH2–CH2–CH2–CH2–COOH

A

formula of linoleic acid, which is found very widely, including in some meats, eggs, nuts and many oils.

42
Q

What does the term polyunsaturated mean?

A

Describing a compound containing several C=C double bonds.

43
Q

Compare the structures of oleic acid and linoleic acid.

A

Oleic acid and linoleic acid are two fatty acids with the same number of carbon atoms but linoleic acid has an additional double bond, so it is polyunsaturated. The family to which a polyunsaturated fatty acid belongs depends on the position of the first double bond, counting from the CH3 end. So this one belongs to the n-6 or omega-6 family.

44
Q

How many carbon atoms and double carbon bonds does linoleic acid have?

A

Linoleic acid has 18 carbon atoms, with the first double bond on the sixth carbon atom and the second on the ninth carbon atom. Note that there are two carbon atom-numbering conventions shown on the representation above. The numbers in blue start numbering the carbon atoms from the carboxyl end of the molecule, this is called the carboxyl reference. The red numbering starts from the opposite end of the molecule and is called the omega reference system. When discussing dietary fatty acids, it is usually the omega convention which is used.

45
Q

Apart from the very subtle difference in name, what other differences are there between linolenic and linoleic acid?

A

Linolenic acid has a third double bond. This double bond is attached to the third carbon, making it a member of the very important family of n-3 or omega-3 fatty acids. Note that the ‘3’ in n-3 refers to the position of the first double bond and not to the number of double bonds present. The rest of the molecule is the same in both acids.

46
Q

What is omega is linoleic acid?

A

Linolenic acid has a third double bond. This double bond is attached to the third carbon, making it a member of the very important family of n-3 or omega-3 fatty acids. Note that the ‘3’ in n-3 refers to the position of the first double bond and not to the number of double bonds present. The rest of the molecule is the same in both acids.

47
Q

What is docosahexaenoic acid (DHA) and where is it found?

A

This is an omega-3 polyunstaurated fatty acid which is an important structural component of cells. It plays a particularly important role in brain, retina and skin cells and can only be made in the human body in small amounts. DHA is found in oily fish and to a lesser extent in meat and eggs.

48
Q

Where is linoleic acid found?

A

Linolenic acid is also found in a wide range of foods, including dark-green leafy vegetables, as well as nuts and the oils derived from them, and in smaller quantities in poultry meat.

49
Q

How many carbon atoms does docosahexaenoic acid have and which omega is it?

A

you may have also heard about other types of omega-3 fatty acids such as the 22-carbon-containing docosahexaenoic acid (DHA) in the context of oily fish such as sardines, salmon, trout, mackerel and tuna, and in many plants and seeds.

50
Q

What is the processing of fat in the body highly dependent on?

A

You may be wondering why it is important to study the chemical structures of the many different types of fats. Fats are indeed a very diverse group of biological molecules and the processing of fat in the body is highly complex and is dependent on the fine distinctions between apparently similar compounds. The key issue is that different types of food contain fats with different fatty acid compositions and it is this that seems to vary their effect on the body.

51
Q

What do you notice about the most widely occurring fatty acid in each of the three groups – saturates, monounsaturates and polyunsaturates?

A

The most common fatty acid in each group has 18 carbon atoms. This is stearic acid in the saturates, oleic acid in the monounsaturates and linoleic and linolenic acids in the polyunsaturates.

52
Q

Which two food items each contain about 30% of an 18-carbon polyunsaturated fatty acid?

A

The two tallest blue columns (measuring approximately to the 30% mark) correspond to corn oil and soft margarine. It is not possible to identify whether this fatty acid is linoleic or linolenic acid, or a mixture.

53
Q

What do you notice about the range of fatty acids found in hard fats compared to those found in oils?

A

Hard fats contain more saturated fatty acids (SFAs) and oils contain more polyunsaturated fatty acids (PUFAs). Both groups contain significant quantities of monounsaturated fatty acids.

54
Q

What do you notice about the range of fatty acids found in olive oil compared to other fats and oils?

A

Olive oil has a very high proportion (70%) of one type of fatty acid, the 18-C monounsaturated, oleic acid. No other fat or oil has a composition so dominated by one type of fatty acid.

55
Q

What is the difference between cis and trans fatty acid?

A

two chemically identical fatty acid chains; they contain the same atoms and bonds arranged in nearly exactly the same way except for one significant difference. Most naturally occurring fats contain fatty acids that are cis; this means that the hydrogen atoms attached to the carbon atoms in the double bond are arranged on the same side of the molecule. Figure 2.9a shows the cis arrangement.
the two hydrogen atoms attached to the carbon-to-carbon double bond are on opposite sides of the molecule; this is the trans configuration. Notice how in both cases the presence of a double bond introduces a ‘kink’ in the straight chain of carbon atoms. The degree of bending of the chain is much more noticeable in the cis fatty acid chain than the trans fatty acid chain. This change in configuration results in a change in the physical properties of the molecule, in particular the melting temperature.

56
Q

why are trans fats more likely to be solid at room temperature?

A

Trans fats are more likely to be solid at room temperature. This is because their straighter fatty acid tails allow adjacent molecules to be packed more tightly. This tighter packing of the fat molecules results in a higher melting temperature, as it takes more energy to separate the adjacent molecules in the solid form into the liquid form.

57
Q

Comparing the shape of the two types of fatty acid chain, can you suggest a reason why cis fats are more likely to be liquid at room temperature?

A

The orientation of the hydrogen atoms on the carbon atoms in the carbon-to-carbon double bond results in a bend in the fatty acid chains (Figure 2.9b). These fatty acids molecules cannot line up so closely with each other and so pack together less easily into a solid. They therefore are liquids or semi-solids at room temperature.The orientation of the hydrogen atoms on the carbon atoms in the carbon-to-carbon double bond results in a bend in the fatty acid chains (Figure 2.9b). These fatty acids molecules cannot line up so closely with each other and so pack together less easily into a solid. They therefore are liquids or semi-solids at room temperature.

58
Q

There are relatively few naturally occurring trans fats and most of these are monounsaturated fats. However in the last 30 years, food manufacturers have been using chemical methods to partially hydrogenate polyunsaturated fats, usually vegetable oils.

What does hydrogenation mean in this context?

A

Hydrogenation is the addition of hydrogen across a carbon-to-carbon double bond (C=C).

59
Q

What does hydrogenation do? why would food manufacturers want to do this?

A

Hydrogenation reduces the number of C=C bonds in the polyunsaturated fat molecules and consequently confers some of the properties of saturated fats, i.e. solid or semi-solid at room temperature. However, the process of hydrogenation used may result in the formation of trans rather than cis fats. Production of hydrogenated fats resulted in a rapid increase in the proportion of trans fats available in foods worldwide from the 1960s to recent times, particularly in processed foods like biscuits, cakes and pastries. There is evidence to suggest that the increasing proportion of trans fat in the diet is harmful, but for food manufacturers hydrogenation results in a cheap source of fat with similar properties to animal fats like butter.

60
Q

What is cholesterol and what type of organism synthesises it?

A

Cholesterol is a specific type of lipid synthesised by all animal cells

61
Q

What type of fat contain cholesterol?

A

In dietary terms, any food that contains animal fat will also contain cholesterol.

62
Q

Why is cholesterol important?

A

It is a vital component of cell membranes and the precursor molecule from which steroid hormones, vitamin D and other biologically important molecules are synthesised.

63
Q

Why is cholesterol classed as a lipid despite its rather different structure from triacylglycerols?

A

Typically fats have at least one long chain of carbon atoms, with hydrogen atoms attached. Triacylglycerols have three such chains (derived from the three fatty acids). A long chain of carbon atoms (with hydrogen atoms, or other carbon atoms attached) can be identified in the cholesterol molecule too. This is at least 15 carbon atoms long (depending on which way you count around the rings), and so is similar to the length of many fatty acids. It is this structure that gives cholesterol the properties of a lipid.

64
Q

How is cholesterol synthesised in the human body?

A

In humans, all cells can synthesise cholesterol; but, in general, the amount they produce is insufficient for their needs, and additional cholesterol is synthesised by the liver and transported to the rest of the body in the blood. When blood cholesterol levels are high, for example if the dietary intake is high, cholesterol synthesis by the liver is reduced. Thus under ‘normal’ circumstances, cholesterol levels appear to be kept within an appropriate range and, contrary to popular belief, variations in dietary intake of cholesterol do not, for most individuals, have much effect on blood cholesterol levels.

65
Q

Lipids, including cholesterol and triacylglycerol, are transported around the body in the blood; however, the specific properties of these lipid molecules mean that they cannot be transported simply as molecules.

Why can’t lipids be transported as free molecules in the blood?

A

Since triacylglycerol molecules are hydrophobic (water-hating), they do not dissolve in the water-based blood and could separate out into droplets.

66
Q

What is a lipoprotein?

A

A group of soluble proteins that combine with and transport fat or other lipids in the blood plasma.

67
Q

What is an Apolipoprotein?

A

Apolipoproteins are proteins that bind to lipids to form lipoproteins.

68
Q

what specific protein molecules are lipids associated with?

A

So for transport around the body in the blood, lipids are associated with specific protein molecules (called apolipoproteins) and packaged into complex molecules called lipoproteins

69
Q

What variety of functions does apolipoproteins have?

A

There are different types of apolipoproteins (Apo) and these molecules have a variety of functions; for example, conferring stability (ApoE) on the lipoprotein or acting as receptors (ApoB) so the lipoprotein ultimately reaches and targets the correct cell type.

70
Q

What is a phospholipid?

A

These are the phospholipids, a class of lipids containing glycerol, two fatty acid chains and a phosphate group

71
Q

How can lipoproteins disperse in to a watery environment despite them being hydrophobic?

A

The phosphate group is a polar molecule and therefore hydrophilic. It is the presence of phospholipids on the surface of lipoproteins that enables the lipoprotein to disperse in the watery environment of the blood.

72
Q

What is a very low density lipoproteins?

A

Lipoproteins originating in the liver which contain a greater proportion of fat compared to protein.

73
Q

What type of lipoproteins are formed continuosly from the liver?

A

Lipoproteins are formed continuously in the liver from the products of digested fats and then secreted into the bloodstream for transport. Since these lipoproteins originating in the liver contain much more fat than protein and fat has a low density, they are called very low-density lipoproteins (VLDLs)

74
Q

What sizes do low density lipo proteins and high density lipoproteins come in?

A

It is worth noting that both low-density lipoproteins (LDLs) and high-density lipoproteins (HDLs) particles are a heterogeneous group of particles, found in a variety of sizes. There are two broad categories of each. Both exist as larger, buoyant, cholesterol-richer forms as well as smaller, denser forms and there seems to be a genetic component as proportions of these two types of LDL and HDL in the blood differ between individuals

75
Q

What is cardio vascular disease?

A

This is a general term which describes disease in the heart or the blood vessels, it includes coronary heart disease, stroke and diseases of other arteries including the aorta (the largest artery carrying blood from the heart).
The term cardiovascular disease is a broad description for the group of conditions that involve the heart and blood vessels; these include the coronary artery diseases such as heart attack and angina

76
Q

What is atherosclerosis?

A

These coronary artery diseases have the same underlying cause, atherosclerosis, a thickening of the walls of arteries resulting in restricted blood flow.

77
Q

What is the ;leading cause of death in the UK?

A

Coronary heart disease (CHD), one type of CVD, is the leading cause of death in the UK, (NHS choices, 2016), causing more than one-in-six male deaths and one-in-ten female deaths every year, an average of 73 000 deaths per year or 200 every day.

78
Q

What is the seven countries study and what is a large scale epidemiological longitudinal study?

A

Epidemiology is the study and analysis of the patterns, causes and effects of disease conditions in defined populations.

Longitudinal studies (sometimes called observational studies) are those that make observations and repeat measurements over a long period of time with the same participants.

Keys’ interest in CVD began in the late 1940s when he realised that the restricted diets available during and immediately after the war in some countries of northern Europe appeared to correlate with a drop in the incidence of CVD amongst those populations. After several small-scale studies including the so-called Six Countries study (Andrade et al., 2009) which involved examining available data on diet, serum cholesterol levels and incidence of heart disease of a small range of countries, Keys launched the much more ambitious Seven Countries Study, which studied the amount of dietary fat consumed by matched sample populations of middle-aged men.

79
Q

What is the relationship between saturate fat and cholesterol?

A

the larger the average % intake of saturated fat in the diet (x-axis) the higher the average serum cholesterol (y-axis). There is therefore, on average, a linear relationship between the amount of saturated fat in the diet and the amount of cholesterol in the blood serum. This is called a positive correlation.

80
Q

Does this mean that high serum cholesterol is caused by a high % of saturated fatty acids in the diet?

A

No, although the two factors show correlation this does not necessarily imply causation - one does not necessarily cause the other.

81
Q

What is the relationship between Coronary Heart Disease cholesterol and saturated fatty acids?

A

There is a positive correlation between the incidence of CHD and the average % intake of saturated fat in the diet (x-axis). Once again this does not prove that a high % intake of saturated fat causes CHD but that there is an association between them in these cohort populations.
There is a positive correlation between the incidence of CHD and the average serum cholesterol in the blood in these cohort populations.

82
Q

What was the outcome of the seven countries study?

A

When this data was considered alongside what the researchers knew about the types of traditional diets consumed in each cohort it seemed to suggest that where saturated fat (including foods high in dietary cholesterol) was a major component of every meal (e.g. the US and Finland), both the serum cholesterol levels and the incidence of coronary heart disease were highest. Conversely, in cultures where diets were based on fresh fruit and vegetables, bread, pasta, and plenty of olive oil (e.g. the Mediterranean region) blood cholesterol was low and heart attacks were rare.

Keys called this a diet–heart hypothesis and he implied in his 1970s report that there was sufficient evidence from the Seven Countries Study and other studies to suggest that high intake of dietary fat caused high serum cholesterol, which in turn caused CHD.

83
Q

What are good fats and bad fats?

A

These reported differences between types of fats and their effect on serum cholesterol have led to the commonly used labels – healthy fats and unhealthy fats. The former includes monounsaturated fats and polyunsaturated fats and the latter includes the saturated fats and the trans fats. By the same token, clinicians now describe two types of serum cholesterol: the good type and the bad type. The terms good and bad cholesterol require some explanation; there is only one specific chemical formula for cholesterol (Figure 2.10), so how can there be different types with different properties? What clinicians are referring to as ‘bad cholesterol’ here are the low-density lipoproteins (Section 2.5) where cholesterol makes up about 45% of the molecule. This is the type of lipoprotein that delivers cholesterol to the tissues. ‘Good cholesterol’ describes the high-density lipoproteins, the type that returns cholesterol to the liver, which contain proportionally less cholesterol, around 30% (Figure 2.11). The unhealthy fats are viewed as being responsible for increasing the amount of the bad type of cholesterol (LDL) in the serum, whilst healthy fats are said to increase the quantity of good cholesterol (HDL).

84
Q

How do atherosclerotic plaques form?

A

Throughout this period of epidemiological study, clinicians have sought to correlate the lipid hypothesis with observable changes in the heart and blood vessels of patients with CHD. In fact, it had been long known that the type of atherosclerotic plaques found in patients with CHD contain cholesterol. Arteries carry blood under pressure and are constantly subject to wear and tear, which damages the artery walls. Blood vessels constantly repair themselves using various components such as blood platelets, collagen and smooth muscle fibres, which over time gradually thicken the surface of the artery. Once the wall of the artery has become compromised in this way, LDL cholesterol can become deposited in the artery wall at these sites. It is this process that starts the formation of the atherosclerotic plaques typical of CHD

85
Q

Many common foods actually contain cholesterol (e.g. eggs, meat and dairy produce) and initially dieticians suggested reducing the amount of cholesterol consumed on a daily basis to combat this. But lowering intake actually has little effect on the serum cholesterol levels. Why not?

A

There is little correlation between the amount of cholesterol consumed in food and the level in the serum, because the body can manufacture cholesterol itself. Only about half of the body’s total cholesterol is ingested from the gut; the body synthesises the remainder of its requirements. If the diet is deficient in cholesterol, the body will synthesise more to ensure levels are kept within a personalised acceptable range.