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Questions taken from the review sheet that Dr. Nightengale gave us for her first exam.

What does AMDR stand for?

1. Acceptable Macronutrient Distribution Range

What is the AMDR for carbohydrates?

1. 45-65% of daily kcal

What is the AMDR for lipids?

1. 20-35% of daily kcal (shoot for ~30%)

What is the AMDR for proteins?

1. 10-35% of daily kcal

What does RDA stand for?

1. Recommended Daily Allowance

What is the RDA for protein?

1. 0.8 g/kg of body weight
2. ~ 0.37 g/lb

What is the RDA for carbohydrates?

1. 130 g/day

What is the RDA for lipids?

1. There is no recommended amount. Each person is different

How much energy do we obtain from carbohydrates?

1. 4kcal/g

How much energy do we obtain from lipids?

1. 9 kcal/g

What 7 functions do proteins play in the body?

1. Cell signaling compounds & receptors
2. Structure (collagen & muscle)
3. Fluid balance (plasma proteins)
4. Transport & storage proteins
5. Immunoglobulins
6. Buffering compounds (plasma proteins)
7. Enzymes

What functions do carbohydrates have in the body?

1. Fuel activity
2. Spare protein

What 7 functions do lipids have in the body?

1. Energy during rest (30-70% of energy)
2. Energy during low intensity exercise
3. Energy storage
4. Cell integrity
5. Food texture & flavor
6. Satiety
7. Nutrient transport for fat soluble vitamins A,D,E, & K

What are the normal values for fasting blood glucose?

1. 70-99 mg/dL

What are the abnormal values for fasting blood glucose?

1. Hypoglycemic - <70 mg/dL
2. Prediabetic - 100-125 mg/dL
3. Diabetic - >125 mg/dL

What does the body do when it detects high levels of blood glucose?

1. Releases insulin from Beta cells of pancreas.
2. Insulin helps shuttle glucose into muscles & adipose via production of Glut4
3. This restores the normal level of blood glucose

What does the body do when it detects low levels of blood glucose?

1. Alpha cells of pancreas release glucagon.
2. Glucagon causes breakdown of glycogen to glucose, stimulates glucocorticoids which inhabit cell uptake of glucose, & stimulates gluconeogenesis
3. Blood glucose is returned to normal

What is the difference between type 1 & type 2 diabetes?

1. Type 1 is an autoimmune disorder with insulin dependence, & requires insulin injections
2. Type 2 is the result of a poor diet & sedentary lifestyle. It is insulin independent & can be treated with weight loss & eating healthy

What are the complications of uncontrolled diabetes?

1. Cardio Vascular Disease
2. Kidney failure
3. Blindness
4. Nerve damage

Based upon chain length, how are lipids classified?

1. Short chain - 4-6 carbons long
2. Medium chain - 8-12 carbons long
3. Long chain - 14-24 carbons long

Based upon saturation, how are lipids classified?

1. Saturated (SFA) - no double bonds (fats)
2. Monounsaturated (MUFA) - 1 double bond (oils)
3. Polyunsaturated (PUFA) - >1 double bond (oils)

What do you look on an ingredient list at to signify trans fat?

1. Anything that says partially hydrogenated

What are the bioactive essential fatty acids?

1. Omega-6 which include Linoleic acid, Gamma-Linolenic acid, Eicosatrienoic acid, & Arachidonic acid
2. Omega-3 which include Alpha-Linolenic acid, Eicosapentanoic acid (EPA), & Docosahexaenoic acid (DHA)

What does PDCAAS stand for & what is it used for?

1. Protein Digestibility Corrected Amino Acid Score
2. Used to evaluate protein quality

What constitutes an incomplete protein?

1. Foods that do not contain all essential amino acids
2. Ex: Corn, Wheat, Rice, Legumes

What constitutes a complete protein?

1. Foods that contain all essential amino acids.
2. Ex: animal proteins

What is Marasmus & what are some of its symptoms?

1. Protein energy malnutrition
2. Skin & bone appearance, depressed metabolism, stunted brain development, anemia, weakened immune system, & fluid electrolyte imbalance

What is Kwashiorkor & what are some of its symptoms?

1. Protein malnutrition
2. Stomach distension, retarded growth & development, fatty liver, loss of appetite, skin pigmentation changes, & dry brittle hair

What are the big 8 food allergens?

1. Nuts, Eggs, Wheat, Milk, Peanuts, Soy, Shellfish, & Fish

When should kids be introduced to the Big 8 food allergens?

1. Eggs, Wheat, Soy, Shellfish, & Fish - after 6 months
2. Milk - after 12 months
3. Nuts & Peanuts - after they have teeth

How would you properly diagnose a food allergy?

1. Double-blind, placebo-controlled food challenge
- Possible food allergen in beverage or pill form
- Placebo in beverage of pill form
- Wait for reaction in clinic
- DO NOT used for foods that may cause anaphylactic shock

What foods comprise a semivegetarian diet?

1. Vegetables, grains, nuts, fruits, legumes, sometimes seafood, poultry, eggs, & dairy

What foods comprise a pescovegetarian diet?

1. Semivegetarian but excludes poultry

What foods comprise a Lacto-ovo-vegetarian?

1. Vegetables, grains, nuts, fruits, legumes, dairy, & eggs

What foods comprise a Ovovegetarian diet?

1. Vegetables, grains, nuts, fruits, legumes, & eggs

What foods comprise a Lactovegetarian diet?

1. Vegetables, grains, nuts, fruits, legumes, & dairy

What foods comprise a vegan diet?

1. Vegetables, grains, nuts, fruits, & legumes

What foods comprise a fruititarian diet?

1. Raw or dried fruits, seeds, nuts, honey, & vegetable oil

In the fed state, what happens to carbs upon consumption?

1. 50% of glucose is taken up by the liver & turned into glut-6-phosphate for glycogen storage.
2. Insulin is released from the pancreas & stimulates glycolysis & glycogenesis in the liver & muscles.
3. With excess glucose, lipogenesis is elevated in the liver & adipose tissue

How are dietary lipids transported in the fed state?

1. Transported by chylomicrons

What are chylomicrons?

1. Contains mostly triglycerides
2. Travel through the lymphatic system to thoracic duct
3. Eventually transported to adipocytes

What is the copper dependent enzyme used to pick up free cholesterol?

1. Lecithin Cholesterol Acyltransferase (LCAT)

How does free cholesterol regulate cellular cholesterol concentrations?

1. Inhibition of the rate limiting enzyme in cholesterol synthesis (HMG CoA reductase)
2. Decreases LDL receptor synthesis
3. Promotes cholesterol storage as cholesterol ester

Where does the liver get lipids from?

1. Chylomicron remnants
2. Uptake of other lipoproteins (HDL & LDL)
3. Circulating fatty acids
4. Endogenous lipid synthesis in the liver

What is happening to macronutrient use in the post absorptive state?

1. Liver glycogen is depleted during an overnight fast by glucagon & epinephrine
2. Muscle glycogen can provide glucose for muscle it is stored in
3. Glucose is made from lactate (from RBC) & alanine (from muscle) in the liver through gluconeogenesis

What is happening to macronutrient use in the fasted state?

1. Liver glycogen is depleted within 24 hours by glucagon & epinephrin
2. Glucose is made from glycogenic amino acids from muscles (mostly alanine & glutamine) in the liver & kidneys through gluconeogenesis

What does E.A.R. stand for in dietary planning?

1. Estimated Average Requirement

What does R.D.A. stand for in dietary planning?

1. Recommended Dietary Allowances

What does A.I. stand for in dietary planning?

1. Adequate Intake

What does U.L. stand for in dietary planning?

1. Tolerable Upper Intake Level

What should your plate look like proportionally when you sit down to eat?

1. Half fruits & vegetables
2. One fourth protein
3. One fourth starches

How would you calculate the calories from grams of macronutrients listed on a nutritional label?

Total fat X 9 cal/g
Total carbs X 4 cal/g
Total protein X 4 cal/g
+_______________________
Total Calories

How would you calculate the % calories from fat?

Total fat X 9 cal/g
---------------- X 100%
Total Calories

How would you calculate the % calories from carbohydrates?

Total carbs X 4 cal/g
------------------ X 100%
Total Calories

How would you calculate the % calories from proteins?

Total proteins X 4 cal/g
-------------------- X 100%
Total Calories

What does the nutrient content claim of "Free" mean when found on a nutrient label?

1. <0.5g/serving = total fat, saturated fat, trans fat, or sugar
2. <2mg/serving = cholesterol
3. <5mg/serving = sodium

What does the nutrient content claim of "Low" mean when found on a nutrient label?

1. <3g/serving & 30% calories from = total fat
2. <1g/serving & <15% calories from = saturated fat & trans fat
3. <20mg/serving = cholesterol
4. <140mg/serving = sodium

What does the nutrient content claim of "Reduced" mean when found on a nutrient label?

1. 25% less of Calories, Fat, Saturated Fat, Cholesterol, Sodium, & Sugars than reference product

What are the 3 structural forms of vitamin A discussed in class & what is each best for functionally?

1. Retinol - Reproduction & growth
2. Retinal - Vision
3. Retinoic Acid - Cell differentiation

What are examples of preformed vitamin A?

1. Animal products - dairy, liver, fish

What are examples of proformed vitamin A?

1. Plant products (orange, yellow & red color foods) - Carotenoids = antioxidants

How is the protein removed from a retinol ester in vitamin A digestion?

1. Pepsin in the stomach
2. Proteases in the small intestine

How are fatty acids removed from retinol in vitamin A digestion?

1. Esterase in the small intestine

What happened to free retinol once it has had the protein and fatty acid removed?

1. It is incorporated into micelles

Where is vitamin A absorbed & by what process?

1. Passive diffusion in the duodenum & jejunum

What are the 3 steps to vitamin A transport?

1. Retinol is bound by cellular-retinol binding protein (CRBP) in the enterocyte
2. Fatty acids are reesterified by lecithin: retinol acyltransferase (LRAT) reforming a retinol ester
3. Retinol esters & carotinoids are packaged into chylomicrons & sent throughout the lymph system

If retinol intake is low, what happens?

1. Carotenoids are metabolized to 2 retinals.
2. Retinal is either bound by CRBP, reduced to retinol, esterified via LRAT & incorporated into chylomicrons OR oxidized to retinoic acid & travels to the liver bound to albumin

If retinol intake is adequate, what happens?

1. Carotenoids are incorporated into chylomicrons

What are the functions of vitamin A?

1. Important for rhodopsin production & vision in dim light
2. Cellular differentiation
3. Gene expression
4. Growth
5. Reproduction
6. Bone growth & breakdown
7. Immune system
8. Antioxidant

What are the symptoms of vitamin A deficiency?

1. Vision problems - night blindness
2. Xerophthalmia - dry eyes from inadequate mucus production & bigot's spots
3. Depressed immune system

What are the symptoms of vitamin A toxicity?

1. Nausea, vomiting, headache, double vision, dizziness, dry & itchy skin (hyperkeratosis), alopecia, bone & muscle pain, bone fractures, & liver damage

What are the forms of vitamin D discussed in class?

1. Cholecalciferol - Vitamin D3, animal form
2. Ergocalciferol - Vitamin D2, plant form

How is vitamin D digested & absorbed?

1. Vitamin D consumed with food
2. Bile released into small intestine
3. 50% absorbed by passive diffusion in SI (mostly ileum)
4. 40% bound to vitamin D-binding protein (DBP)
5. 60% packed into chylomicrons

How is vitamin D transported?

1. Vitamin D3, Calcidiol, & Calcitriol are all transported by vitamin D-binding protein (DBP) in blood to tissues

What are the 6 functions of vitamin D?

1. Calcium homeostasis
2. Cell differentiation & growth
3. Lower blood pressure
4. Prevent autoimmune diseases
5. Immune activity
6. Insulin secretion

What are some symptoms of vitamin D deficiency?

1. Osteoporosis, osteomalasia, Rickets, Stress Fractures, & Low Back Pain
2. Rheumatoid arthritis, Multiple sclerosis, & Inflammatory bowel disease
3. Myopathy
4. Diabetes
5. Depression, Alzheimer's, Schizophrenia, & Anxiety
6. Solid cancers (prostate, colon, stomach, breast, liver, kidney, etc)
7. Hypertension, Atherosclerosis, Metabolic syndrome
8. Respiratory tract infections
9. Loss f balance

What are the symptoms of vitamin D toxicity?

1. Bone demineralization
2. Hypercalcemia
3. Nephrocalcinosis (renal failure)

What are the 2 forms of vitamin E discussed in class?

1. Tocopherol
2. Tocotrienol

How are vitamin E natural tocopherols digested, absorbed, & transported?

1. Bile released in SI
2. ~50% absorbed by passive diffusion in the SI (mostly jejunum)
3. 100% packed into chylomicrons
4. Sent to liver
5. Alpha tocopherol transport protein
6. incorporated in VLDL

How are vitamin E synthetic tocopherols & natural tocotrienols digested, absorbed, & transported?

1. ~50% absorbed by passive diffusion in the SI (mostly jejunum)
2. 100% packed into chylomicrons
3. Sent to liver
4. Alpha tocopherol transport protein
5. incorporated in VLDL

What are the functions of vitamin E?

1. Antioxidant
2. Blood thinner
3. Anti-inflammatory
4. Decreases cancer risk
5. Lowers cholesterol
6. Prevents neurodegeneration

What are symptoms of vitamin E deficiency?

1. Myopathy
2. Neurdegeneration
3. Peripheral neurpathy
4. Loss of coordination

What are symptoms of vitamin E toxicity?

1. Bleeding
2. Nausea
3. Diarrhea
4. Respiratory infections
5. Double vision

What are the types of vitamin K discussed in class?

1. Phylloquinone - majority, found in plants
2. Menaquinone - made by bacteria

How is vitamin K digested, absorbed, & transported?

Phylloquinone & menaquinone:
1. Consumed in diet
2. Bile released into SI
3. ~80% absorbed by passive diffusion in SI (mostly jejunum)
4. 100% packed into chylomicrons
5. Sent to liver
6. Incorporated into VLDL

What are the functions of vitamin K?

1. Blood clotting
2. Bone formation
3. Sphingolipid synthesis

What are the symptoms of vitamin K deficiency?

1. Increased bleeding
2. Osteoporosis
3. Can be fatal

What are the symptoms of vitamin K toxicity?

1. None

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