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The diet-planning principle that provides all the nutrients, fiber, and energy in amounts sufficient to maintain health is called
a. variety.
b. adequacy.
c. moderation.
d. kcalorie control.

b

What are the principles of diet planning?
a. Abundance, B vitamins, kcalories, diet control, minerals, and variety
b. Abundance, balance, conservative, diversity, moderation, and vitamins
c. Adequacy, bone development, correction, vitamin density, master, and variety
d. Adequacy, balance, kcalorie control, nutrient density, moderation, and variety

d

Which of the following is the most calcium-dense food?
a. Whole milk
b. Nonfat milk
c. Low-fat milk
d. Cheddar cheese

b

Nutrient dense refers to foods that
a. carry the USDA nutrition labeling.
b. are higher in weight relative to volume.
c. provide more nutrients relative to kcalories.
d. contain a mixture of carbohydrate, fat, and protein.

c

The concept of nutrient density is most helpful in achieving what principle of diet planning?
a. Variety
b. Balance
c. Moderation
d. kCalorie control

d

Which of the following is an expression of the nutrient density of a food?
a. 0.01 mg iron per kcalorie
b. 110 kcalories per cup
c. 0.5 mg iron per serving
d. 110 kcalories per serving

a

An empty-kcalorie food is one that contains
a. no kcalories.
b. an abundance of vitamins but little or no minerals.
c. an abundance of minerals but little or no vitamins.
d. energy and little or no protein, vitamins or minerals.

d

Providing enough, but not an excess, of a food is a diet-planning principle known as
a. safety.
b. variety.
c. moderation.
d. undernutrition.

c

Applying the principle of variety in food planning ensures the benefits of
a. moderation.
b. vegetarianism.
c. nutrient density.
d. dilution of harmful substances.

d

Which of the following practices is not consistent with achieving a healthy diet?
a. Intake of eggs
b. Intake of nuts
c. Emphasis on trans-fat
d. Emphasis on low-fat milk products

c

Which of the following is among the recommendations of the Dietary Guidelines for Americans?
a. Practice good foot hygiene
b. Reduce television viewing time
c. Reduce computer Internet time
d. Engage in regular physical activities

d

The consumption of 2000 kcalories per day is sufficient to meet the energy needs of most
a. teenage girls.
b. most children.
c. sedentary men.
d. sedentary women.

d

Which of the following is not a feature of a food group plan?
a. Defines serving equivalents
b. Considered a tool for diet planning
c. Sorts foods of similar water content
d. Specifies the number of servings from each group

c

Consider the following menu from the point of view of the USDA Food Guide.

Which of the following describes the nutritional value of the fruits and vegetables in this menu?
a. A source of vitamin A is missing
b. A source of vitamin C is marginal
c. The daily amounts recommended for a 2000-kcalorie diet are met
d. The daily amounts recommended for a 2000-kcalorie diet are exceeded

b

Jamie is a vegetarian who is trying to plan a healthy diet according to the USDA Food Guide. Which of the following meat alternatives would be the best nutrient choices for one day?
a. 2 pieces bacon, ½ can tuna, 2 pieces bread
b. 3 oz. cheese, ½ sweet potato, 2 tbsp peanut butter
c. ½ cup black beans, 2 tbsp peanut butter, 1 c spinach
d. 1 skinless chicken breast, 2 egg whites, meal replacement bar

c

Of the daily recommended intake of fruit servings, what maximum percentage may be supplied by fruit juice?
a. 10
b. 20
c. 33
d. 50

d

What two major nutrients are supplied by the fruit and vegetable groups?
a. Vitamins D and E
b. Vitamins A and C
c. Protein and calcium
d. B vitamins and iron

b

Which of the following is not characteristic of the USDA Food Guide?
a. It places most foods into one of five groups
b. Its nutrients of greatest concern include iron, chromium, and vitamin B12
c. It can be used with great flexibility once its intent is understood
d. It specifies that a certain quantity of food be consumed from each group, based upon energy intake

b

All of the following are examples of legumes except
a. peas.
b. beans.
c. peanuts.
d. potatoes.

d

Which of the following is an alternative choice for meats in the USDA Food Guide?
a. Nuts
b. Bacon
c. Baked potatoes
d. Sweet potatoes

a

In which of the following food groups are legumes found?
a. Meats
b. Dairy
c. Fruits
d. Grains

a

Which of the following foods could help meet the iron needs of vegetarians who consume dairy?
a. Coconut
b. Legumes
c. Skim milk
d. Potato salad

b

How many subgroups comprise the vegetable food group?
a. 1
b. 3
c. 5
d. 7

c

Legumes are used as meat alternatives for all of the following reasons except
a. they are economical.
b. they can be graded as prime, choice, and select.
c. they can be processed to look and taste like meat.
d. they contribute the same key nutrients, including zinc and protein.

b

Approximately how many kcalories more per day are needed by an average college-age student who is active compared with her inactive counterpart?
a. 400-500
b. 600-800
c. 1000-1200
d. 1500-2000

a

General features of legumes include all of the following except
a. they are high in fat.
b. they are low in cost.
c. they are rich in fiber.
d. they include peanuts.

a

According to the principles of the USDA Food Guide, the foundation of a healthful diet should consist of
a. dairy.
b. fruits.
c. nutrient-dense foods.
d. meats and alternatives.

c

Which of the following foods provides discretionary kcalories for the person on a weight reduction diet?
a. Watermelon
b. Canned pears in syrup
c. Milk with all fat removed
c. Chicken with the skin removed

b

Which of the following foods' kcalories would be considered as part of one's discretionary kcalorie allowance?
a. Jam
b. Watermelon
c. Raw carrots
d. Brussels sprouts

a

A cup of fresh blueberries is about the size of a
a. golf ball.
b. baseball.
c. grapefruit.
d. marshmallow.

b

Which of the following is not descriptive of MyPyramid?
a. An education tool that illustrates the concepts of the Dietary Guidelines and USDA Food Guide
b. A graphic image designed to encourage consumers to make healthy food and physical activity choices every day
c. A multi-colored pyramid that illustrates variety, with each color representative of the five food groups, plus one for oils
d. A broad-based figure that conveys the message that grains should be abundant and form the foundation of a healthy diet

d

What is the assessment tool designed to measure how well a diet meets the recommendations of the Dietary Guidelines and MyPyramid?
a. Healthy Eating Index
b. Supplemental Nutrition Assistance Program
c. Dietitian's Comparative Effectiveness Plan
d. U.S. Public Health Nutrient Assessment Barometer

a

Which of the following is a main criticism of the use of the MyPyramid?
a. It lacks a personalized approach
b. The five food groups are not clearly identified
c. There is no encouragement of physical activity
d. Not enough information is readily available because there is no text

d

Food exchange systems were originally developed for people with
a. diabetes.
b. terminal diseases.
c. cardiovascular disease.
d. life-threatening obesity.

a

Which of the following is a feature of the exchange list system?
a. Foods are grouped according to their source
b. Adequate intakes of minerals and vitamins are virtually guaranteed
c. A fat portion provides about twice the energy as a carbohydrate portion
d. All foods are grouped according to their content of carbohydrate, protein, and fats

d

In food exchange lists, to what group are olives assigned?
a. Fat
b. Meat
c. Carbohydrate
d. Meat substitute

a

Whole-grain flour contains all parts of the grain with the exception of the
a. bran.
b. husk.
c. germ.
d. endosperm.

b

Refined grain products contain only the
a. bran.
b. husk.
c. germ.
d. endosperm.

d

The addition of calcium to some orange juice products by food manufacturers is most properly termed nutrient
a. enrichment.
b. restoration.
c. fortification.
d. mineralization.

c

What nutrient makes up most of the endosperm section of grains such as wheat and rice?
a. Fat
b. Fiber
c. Starch
d. Protein

c

The part of the grain that remains after being refined is the
a. bran.
b. germ.
c. husk.
d. endosperm.

d

Which of the following breads has the highest fiber content?
a. White
b. Refined
c. Enriched
d. Whole-grain

d

Which of the following is a characteristic of enriched grain products?
a. They have all of the added nutrients listed on the label
b. They have the fiber restored from the refining procedure
c. They have virtually all the nutrients restored from refining procedure
d. They have only 4 vitamins and 4 minerals added by the food manufacturer

a

All of the following are features of the process of nutrient enrichment of flours except
a. it includes products such as pastas.
b. fiber levels are similar to those in the whole grains.
c. it is required of all refined grain products that cross state lines.
d. thiamin and riboflavin are added in amounts exceeding their levels in the whole grain.

b

Approximately what minimum percentage of all grains consumed by a person should be whole grains?
a. 20
b. 35
c. 50
d. 100

c

What mineral is added to refined flours in the enrichment process?
a. Iron
b. Iodine
c. Calcium
d. Magnesium

a

Which of the following product labels always denotes a whole-grain product?
a. Multi-grain
b. 100% wheat
c. Whole-wheat
d. Stone-ground

c

The enrichment of grain products in the United States was initiated in the
a. 1840s.
b. 1890s.
c. 1940s.
d. 1990s.

c

Approximately how many years have grain products been subject to nutrient enrichment legislation?
a. 70
b. 100
c. 175
d. 225

a

Which of the following is an enrichment nutrient for grains?
a. Zinc
b. Folate
c. Protein
d. Calcium

b

The "More Matters" food campaign promotes increased consumption of
a. fruits and vegetables.
b. fish and skinless poultry.
c. five to nine kcalories less per day.
d. nonfat dairy products.

a

The most highly fortified foods on the market are
a. frozen dinners.
b. imitation foods.
c. enriched breads.
d. breakfast cereals.

d

Which of the following nutrients would be supplied in much greater amounts from whole-grain bread versus enriched bread?
a. Zinc
b. Folate
c. Riboflavin
d. Thiamine

a

Which of the following nutrients is not supplied in about the same amount by a slice of enriched bread compared with one from whole-grain bread?
a. Iron
b. Niacin
c. Thiamine
d. Magnesium

d

Cooking an 8-ounce raw steak will reduce the weight (ounces) to approximately
a. 3 ½.
b. 5.
c. 6.
d. 7.

c

Textured vegetable protein is usually made from
a. soybeans.
b. corn stalks.
c. a mixture of legumes.
d. cruciferous vegetables.

a

Which of the following terms is used to describe a cut of meat having a low fat content?
a. End
b. Round
c. Prime
d. Choice

b

A meat described as "prime cut" means that it
a. has an extended shelf life.
b. usually carries a high price.
c. is served only in restaurants.
d. is higher in fat than other cuts of meat.

d

Which of the following is not the same as fat-free milk?
a. Skim milk
b. No-fat milk
c. 1% milk
d. Non-fat milk

c

What term describes a food that resembles and substitutes for another food but is nutritionally inferior to it?
a. Faux food
b. Pseudo food
c. Imitation food
d. Food substitute

c

According to food labeling laws, acceptable synonyms for nonfat milk include all of the following except
a. skim milk.
b. no-fat milk.
c. zero-fat milk.
d. reduced-fat milk.

d

Which of the following is a feature of U.S. laws governing information on food labels?
a. The term "fresh" can be used only for raw and moderately processed food
b. Nutrition labeling must appear on virtually all processed as well as fresh foods
c. Restaurant foods must provide nutrient content information on the menu
d. Nutrition labeling is not required on foods produced by small businesses or products produced and sold in the same establishment

d

A food scientist is developing a new and improved cereal bar. She consults with you to ask in what order the ingredients should be listed on the food label. The ingredients are: Sugar: 30 g, Puffed wheat: 28 g, Dry milk powder: 5 g, Red food coloring: 35 mg, Salt: 2 g. What is the appropriate order in which to list these ingredients on the food label?
a. Sugar, puffed wheat, dry milk powder, salt, red food coloring
b. Red food coloring, salt, dry milk powder, puffed wheat, sugar
c. Dry milk powder, puffed wheat, red food coloring, salt, sugar
d. Puffed wheat, sugar, dry milk powder, salt, red food coloring

a

According to nutrition labeling laws, what two minerals must be listed on the package label as percent Daily Value?
a. Calcium and Iron
b. Zinc and Phosphorus
c. Fluoride and Chloride
d. Chromium and Magnesium

a

A food label ingredient list reads in the following order: Wheat flour, vegetable shortening, sugar, salt, and cornstarch. What item would be found in the smallest amount in the food?
a. Salt
b. Sugar
c. Cornstarch
d. Wheat flour

c

By law, a serving size on beverage food labels is
a. 4-6 fluid ounces.
b. 8 fluid ounces.
c. 10-12 fluid ounces.
d. 16 fluid ounces.

b

Approximately how many milliliters constitute a fluid ounce?
a. 10
b. 20
c. 30
d. 40

c

Approximately how many grams are in an ounce?
a. 10
b. 20
c. 30
d. 40

c

All of the following are features of serving size information on food labels except
a. serving sizes for solid foods are expressed in both ounces and grams.
b. small bags of individually wrapped food items must contain only one serving.
c. serving sizes on food labels are not necessarily the same as those of MyPyramid.
d. for a given product, the serving size is the same, no matter how large the package

b

Which of the following is a characteristic of food serving sizes?
a. Serving sizes for most foods have not yet been established by the FDA
b. The serving size for ice cream is 2 cups and the serving size for all beverages is 12 fluid ounces
c. Serving sizes on food labels are not always the same as those of the USDA Food Guide
d. Serving sizes must be listed in common household measures, such as cups, or metric measures, such as milliliters, but not both

c

Information that must be lawfully provided on food labels includes all of the following except
a. the amount recommended for ingestion each day.
b. the amounts of specified nutrients and food components.
c. the net contents expressed by weight, measure, or count.
d. the name and address of the manufacturer, packer, or distributor.

a

According to nutrition labeling laws, the amounts of what two vitamins must be listed on the package label as percent Daily Value?
a. Vitamins D and E
b. Vitamins A and C
c. Thiamin and riboflavin
d. Vitamin B6 and niacin

b

Food labels express the nutrient content in relation to a set of standard values known as the
a. Daily Values.
b. FDA Standards.
c. Reference Dietary Intakes.
d. Recommended Dietary Intakes.

a

Population groups such as sedentary older men, sedentary younger women, and active older women have a daily energy need (kcalories) of approximately
a. 1200.
b. 1500.
c. 2000.
d. 2700.

c

On a food label, the "% Daily Value" table compares key nutrients per serving for a person consuming how many kcalories daily?
a. 1500
b. 2000
c. 2500
d. 3000

b

Which of the following foods qualifies as a "good source" of calcium?
a. Cheese with 50 g of calcium
b. Yogurt with 150 mg of calcium
c. Ice cream with 90 mg calcium
d. Whole milk with 300 mg of calcium

b

Which of the following is a feature of the Daily Values found on food labels?
a. They are updated every two years as mandated by the USDA
b. They are expressed on a "per 1000-kcalorie intake" basis
c. They assist people in determining whether a food contains a little or a lot of a nutrient
d. They define a food as an excellent source of a nutrient if it contributes at least 50% of the dietary recommended intake

c

A food label that advertises the product as a "rich source of fiber" is an example of a
a. nutrient claim.
b. lite-food claim.
c. weight reduction claim.
d. structure-function claim.

a

Greg is trying to decide which brand of cereal to buy, but he is a somewhat confused by the health claims. Which of the following represents the highest level of significant scientific agreement?
a. "Promotes a healthy heart"
b. "This cereal supports heart health"
c. "This product contains whole grains which have been proven to reduce the risk of heart disease and certain cancers"
d. "Very limited and preliminary scientific research suggests this product can reduce risk for cancers, FDA concludes that there is little scientific evidence supporting this claim"

c

Which of the following is descriptive of the FDA's "A" list?
a. A series of unqualified health claims on food labels
b. A list of foods conforming to the USDA Food Guide
c. The most nutrient-dense foods found within MyPyramid
d. A list of foods that should be avoided to maintain a healthy diet

a

Which of the following is a feature of the FDA's regulations of food label health claims?
a. The claims cannot be reviewed in a court of law
b. There are four grades of health claim quality: A, B, C, and D
c. There are three grades of health claim quality: prime, choice, and select
d. All health claims must undergo careful and scientifically thorough evaluation to ensure accuracy

b

According to U.S. food labeling regulations, clear and convincing evidence has been found for all of the following health claims regarding nutrition and disease except
a. sugar and diabetes.
b. sodium and hypertensioxn.
c. calcium and osteoporosis.
d. lipids and cancer and cardiovascular disease.

a

Which of the following is a characteristic of structure-function claims on food labels?
a. They are allowed only for unprocessed food
b. They can be made without any FDA approval
c. They must conform to guidelines of the "A" list of health claims
d. They must state the name of the disease or symptom for which a benefit is claimed

b

According to the FDA, which of the following diet-health messages on food labels represents a qualified health claim?
a. Fiber and cancer
b. Lipids and obesity
c. Calcium and osteoporosis
d. Sodium and high blood pressure

b

Which of the following are allowed in the diet of a lactovegetarian?
a. Plant foods only
b. Eggs and plant foods only
c. Meat, eggs, and plant foods only
d. Milk products and plant foods only

d

Tempeh is made from
a. soybeans.
b. any legume.
c. fermented leafy vegetables.
d. fermented yellow vegetables.

a

Which of the following would not be permitted on a macrobiotic diet?
a. Small amounts of dairy
b. Small amounts of seeds
c. Abundant amounts of legumes
d. Abundant amounts of whole grains

a

Which of the following ingredients found on a food label is a source of protein?
a. BHT
b. Tofu
c. Corn starch
d. Diglycerides

b

Which of the following is a feature of people regularly eating meals based on tofu?
a. They show less heart disease but more colon cancer than omnivores
b. They show evidence of marginal protein intake compared with omnivores
c. They have lower blood cholesterol and triglyceride levels than those eating meat
d. They have lower sodium intakes but blood pressure is similar to those eating red meat

c

All of the following are documented benefits for people following a vegetarian diet except
a. lower body weights.
b. lower rates of anemia.
c. lower blood cholesterol levels.
d. lower rates of certain types of cancer

b

In vegetarians, the RDA is higher for
a. iron.
b. folate.
c. calcium.
d. vitamin A.

a

Which of the following is a feature of iron nutrition in vegetarians?
a. Vegetarians absorb iron more efficiently
b. Iron utilization is inhibited by the high zinc content in grains
c. The absorption of iron is low due to the high vitamin C intake
d. More iron deficiency is found in vegetarians than in people eating a mixed diet

a

Textured vegetable protein is usually made of
a. soy protein.
b. fish protein.
c. bean plus rice proteins.
d. bean plus cheese proteins.

a

For the most part, all of the following are advantages of vegetarian diets except
a. fat intake is lower.
b. fiber intake is higher.
c. vitamin B12 intake is higher.
d. intakes of vitamins A and C are higher.

c

Which of the following is a feature of vitamin B12 nutrition in vegetarians?
a. Vitamin B12 in fortified cereals has low bioavailability
b. Vegan mothers need only infrequent intake of vitamin B12-fortified cereals
c. The vitamin B12 in fermented soy products may be present in inactive form
d. Infants born to vegan mothers are resistant to the development of vitamin B12 deficiency

c

All of the following are typical characteristics of vegetarians except
a. they are no more iron deficient than are omnivores.
b. their zinc absorption is efficient due to their high soy intake.
c. they are at risk for iodine toxicity when consuming high amounts of seaweeds.
d. their need for calcium can be met, in large part, from enriched soy milk, breakfast cereals, and fortified juices.

b

protein

large, complex molecules found in the cells of all living things; critical components of all tissues including bones and blood

DNA

genetic material in our cells, dictates the structure only of protein molecules

our bodies are able to manufacture (synthesize)

all of the macronutrients

chemicals in proteins

C, H, O, N; we digest protein- containing plant and animal foods, N is released for use in many important body processes

amino acids

nitrogen-containing molecules that combine to form proteins

peptide bonds

link that bind the amino acid "beads" to each other

proteins in our body are made from combo of

20 amino acids; our cells manufacture an estimated 10,000-50,000 unique proteins

at the core of every amino acid molecule

is a central carbon atom; 4 attachment sites

4 attachment sites of carbon atom

hydrogen atom; acid group (all acid groups in AA are identical); amine group (all amine groups in AA are identical); side chain (portion of AA that makes it unique)

amine

nitrogen-containing; nitrogen is essential component of the amine portion of the molecule

essential amino acid

our bodies cannot produce at all OR cannot be produced in sufficient quantites; insufficient amounts we lose our ability to make the proteins and other N containing compounds we need

nonessential amino acid

our body can make in sufficient amounts; don't need them in our diet; we make by combining parts of differnt AA and the breakdown products of carbs and fats

genes

segments of DNA that carry the instructions for assembling available AA into our body's unique proteins

difference in proteins result in the

unique physical and physiological characteristics you possess

dipeptide

2 AA joined

tripeptide

3 AA joined

oligopeptide

string of 4-9 AA

polypeptide

10 or more AA; as it grows, it begins to fold into any of the variety of complex shapes

proteins that form tendons are

much longer than they are wide; tendons are connective tissues that attach bone to muscle and their long rod-like structure provides strong, fibrous connection

proteins that form red blood cells are

globular in shape; allows them to change shape and return to regular shape

denaturation

change in shape; exposed to heat, acids, bases, heavy metals, alcohol

limiting amino acid

essential Aa that is missing or in the smallest supply in the AA pool and is thus responsible for slowing or halting protein synthesis

incomplete amino acid (low quality)

protein that doesn't contain all of the essential AA in sufficient quantities to support growth and health; ex- lentils

complete amino acid

proteins that have all 9 essential AA; ex- animal products such as egg whites, beef, poultry, fish, and dairy products (milk/cheese), soybeans

mutual supplementation

combining two or more incomplete protein sources to make a complete protein

complementary proteins

foods that when combined provide all 9 essential AA; don't need to be eaten at the same meal but should be eaten the same day

we maintain a free pool of AA in

the blood; they combine to synthesize complete proteins

proteins functions best when

we eat adequate amounts of energy as carbs and fat

proteins in the body are

constantly being broken down, repaired and replaced; AA are recycled into new proteins; turnover of proteins from our diet is essential for such cell growth, repair and maintenance

enzymes

proteins that speed up chemical reactions w/o being changes by the reactant; bind substances together or break them apart and can transform one substance into another

hormones

act as chemical messengers in the body; many made from lipids some made from AA; insulin and glucagon, thyroid hormone (helps control resting metabolic rate)

electrolytes

minerals such as sodium and potassium that are able to carry an electrical charge

fluids and electrolytes

must be maintained inside/outside cells and within blood vessels for our bodies to function properly

when protein intake is deficient

the concentration of proteins in bloodstream is insufficient to draw fluid from the tissues causing adema; potentially fatal changes in the rhythm of the heart; muscle weakness and spasms, kidney failure, death

adema

fluid collection in tissues; can lead to serious problems

conduction of nerve signals and contraction of muscles also depends on

a proper balance of electrolytes

buffers

proteins that help maintian pH; either attract H and neutralize it or release H when blood becomes to basic

when proteins are needed for energy they are

taken from the blood and body tissues such as the liver and skeletal muscle; AA are broken down into glucose to provide energy for the brain;

functions of proteins

1- enabling growth, repair and maintenance of body tissues; 2- acting as enzymes and hormones; 3- maintaining fluid and electrolyte balance; 4- maintain pH balance; 5- make antibodies; 6- providing energy when carbs and fat intake are inadequate

dietary proteins are first

digested and broken into smaller particles such as AA, dipeptides, tripeptides; absorbed and transported to cells

HCL

denatures protein in the stomach and converts pepsinogen (inactive) into pepsin (active enzyme); pepsin not denatured by HCL; pepsin breaks down protein into smaller for travel to sm intestine

in small intestine polypeptides are

digested into single amino acids, dipeptides and tripeptides by protease; these are absorbed by the cells in the wall of the sm intestine; enzymes in theses cells break down the di/tri peptides into AA; AA transported into the bloodstream to the liver and cells in the body

digestibility of proteins

how efficiently our bodies can digest and abosorb a protein

high digestability foods

animal foods, legumes, soy products

low digestability foods

grains and vegetable proteins

kwashiorkor

common develops when a toddler is weaned from breastmilk and fed a diet high in diluted starches; protein deficiency

marasmus

disease resulting from severe deficits of all of the energy nutrients during times of famine

calculating protein intakes

body weight from lb to kg (divide weight by 2.2); weight in kg X protein recommendation (.8 g/kg body weight/day) = protein intake (g/day)

regular exercise

increases transport of oxygen to body tissues, requiring changes in teh oxygne-carrying capacity of the blood; stimulates tissue growth and causes tissue damage, which must be repaired by additional proteins

most americans already consume

more than twice the RDA for protein

protein needs are higher

in children, adolescents and pregnant/lactating women because more protein is needed during times of growth and development

recommeded percentage of energy from protein

12-20% of total daily energy intake

high protein intake

may increase risk of heart disease, bone loss, and kidney disease (no true evidence of bone loss and kidney disease)

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