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Nutrition 251 Final Exam
Terms in this set (225)
Which is one of the major electrolytes in the intracellular fluid compartment?
What is the recommendation (low end of range) for fluid intake (water from food and beverages) for Bob who is consuming about 2500 kcal / day?
The major function of the tubules in the nephron of healthy adults is to ...
reabsorb water back into the blood compartment.
A drop in blood sodium concentrations would result in which of the following responses?
A stimulation of aldosterone release.
You have had an evening of modest yet responsible drinking of alcoholic beverages with friends. This caused inhibition of your antidiuretic hormone (ADH)and thus
inhibition of water reabsorption by your kidneys.
What is the role of sugar in ORT?
Glucose uses sodium as a cotransporter so sodium and water enters the body this way.
Two slices of turkey salami contains 610 mg of sodium. The Nutrition Facts label reads that the % DV for sodium is ...
To increase the potassium in your diet, you should increase your intake of ...
milk, fruits, and vegetables.
In bone, parathyroid hormone (PTH) and active vitamin D ...
stimulates bone breakdown and works to increase blood calcium.
The risk for osteoporosis ...
is higher in women, increases in women who are postmenopausal and is higher in underweight individuals.
For a general estimate, how many milligrams of calcium are in 1.5 ounces of cheese(a few slices)?
Which statement is FALSE about these major minerals?
When you eat inorganic sulfur, enzymes in your body incorporate it into methionine.
Spinach is rich in _____ iron and this form of iron has _____ bioavailability than the iron in a hot dog.
Heme iron is
the part of hemoglobin that carries oxygen in the blood.
Ferroportin (also known as mucosal transferrin)
takes iron from the intestinal cell and transfers it across the membrane into blood.
Hemochromatosis is a disease characterized by over absorption of iron and Iron deficiency without anemia can result in behavioral and learning problems in children.
A classic sign of zinc deficiency is
Which statement in TRUE about zinc?
Zinc is stored in the intestinal cell as part of metallothionein.
Fluorosis occurs when fluoride
is in excess in water.
Which is the correct enzyme/mineral pair?
From 2 weeks to 8 weeks post fertilization, the _______ initiates the development of the placenta and amniotic sac.
Vitamins designed for pregnant women do not contain preformed vitamin A because
retinoids are toxic to the developing embryo and/or fetus.
Which is TRUE about neural tube defects?
Higher intakes of folic acid in early pregnancy have resulted in decreased incidence of spina bifida in populations at risk.
Tanya has a BMI of 23 and just heard she was pregnant. The nurse practitioner tells her that a good weight range to gain in her pregnancy is
25 to 35 pounds.
Women who are underweight when starting their pregnancy
are at increased risk for low birth weight newborns and should gain more weight during the 9 months of pregnancy than healthy weight women.
A low birth weight infant is defined as a baby
of less than 5.5 pounds at birth.
Which statement(s) is(are) TRUE about low birth weight infants?
Lower weight gain in nine months of pregnancy below recommendations is a risk factor for low birth weight, pregnant women older than 40 have higher frequency of low birth weight infants, and smokers have higher frequency of low birth weight infants
In terms of iron nutrition during pregnancy
low iron status increases risk for low birth weight newborns, iron recommendations are increased by 50% over pre-pregnancy RDA, and iron absorption increases.
In terms of calcium nutrition during pregnancy
calcium absorption increases.
TRUE/FALSE: Caffeine crosses the placenta.
TRUE/FALSE: To avoid listeriosis during pregnancy, women should avoid unpasteurized milk and undercooked eggs and meats.
TRUE/FALSE: Fish to be avoided during pregnancy because of mercury content include trout, salmon, and light tuna.
TRUE/FALSE: No safe amounts of alcohol consumption during all 9 months of pregnancy have been identified.
Which statement is TRUE concerning lactation in women?
Slow weight loss by lactating women neither compromises quantity of breast milk nor quality of breast milk and prevalence of breastfeeding has increased since the 1970's.
Emily is 8 months old and has been consistently tracking at the 75th percentile for weight, this means that
25% of U.S. children are heavier than she is.
the first milk secreted by lactating women and is high in immune factors.
Which statement(s) is(are) TRUE regarding breast milk?
Bifidus factor in breast milk favors healthy growth of non-pathogenic bacteria in the GI tract of infants, breast-fed infants grow at a slightly slower rate than formula fed infants, and for infants prone to allergies, there is a reduced risk for some of them with breast feeding over formula feeding.
What nutrient is of most concern in the first semi-solid food offered to breast-fed infants?
It is recommended that young children limit their milk consumption to 2-3 cups per day. The reason for this limitation is because...
milk displaces other nutrient-dense foods and can lead to "milk anemia."
In terms of juice for infants and young children, experts agree that
Juice should be avoided until a child can drink from a cup.
Recommended Dietary Allowance:
the average daily amount of a nutrient considered adequate to meet the known nutrient needs of practically all healthy people.
the average daily amount of a nutrient that appears sufficient to maintain a specified criterion.
Tolerable Upper Intake Level (UL):
the maximum daily amount of a nutrient that appears safe for most healthy people and beyond which there is an increased risk of adverse health effects.
What are the DV's?
reference values developed by the FDA specifically for use on food labels.
Which nutrient DV's are based on RDA's (or AI's)?
Fat, saturated fat, cholesterol, carbohydrates (total), fiber, sodium, protein, Vitamin A, Vitamin C, iron and calcium.
What is the DV for total fat for a person eating 2000 kcal/day (ie. 100% DV = __ g fat, find it on the label)?
How many cups of fruit and how many cups of vegetables are recommended by the USDA for a healthy person who consumes 2000 kcal/day?
4 1/2 cups.
What types of molecules (nutrients) get absorbed into the portal blood vessels and which types are absorbed into lymph vessels?
Portal blood vessels are water-soluble vitamins and lymph vessels are fat-soluble vitamins.
tiny spherical complexes of emulsified fat that arise during digestion
the class of lipoproteins that transport lipids from the intestinal cells to the rest of the body.
What is bile, where is it made, and what does it do? What is the role of the gall bladder?
an emulsifier that prepares fats and oils for digestion. It is made in the liver and stored in the gallbladder. The gallbladder squirts bile into the small intestine when fat arrives there.
single sugars; Glucose (blood sugar), Fructose (sweetest sugar), Galactose (naturally occurring sugar).
sugars composed of pairs of monosaccharides; Condensation, Hydrolysis, Maltose (two glucose), Sucrose (glucose and fructose), Lactose (glucose and galactose)
large molecules composed of chains of monosaccharides; Glycogen, Starches, Fiber.
Soluble Dietary Fiber:
dissolve in water, form gels, and are easily digested by bacteria in the colon. Commonly found in oats, barley, legumes, and citrus fruits. Associated with protecting against heart disease and diabetes by lowering blood cholesterol and glucose levels.
Insoluble Dietary Fiber:
do not dissolve in water, do not form gels, and are less readily fermented. Commonly found in whole grains (bran) and vegetables. Associated with promoting bowel movements, alleviating constipation, and preventing diverticular disease.
The hormone that lowers blood glucose after a meal is ____.
The hormone, ______, causes the liver to break down ______ to raise blood glucose when you are hungry or fasting.
Type 1 Diabetes:
the pancreas loses its ability to synthesize insulin. People must receive insulin through injections or external pumps.
Type 2 Diabetes:
insulin resistance, a reduced sensitivity to insulin. Moderate weight loss and regular physical activity can help this.
Hydrogenation vegetable oil vs tub margarine:
hydrogenation vegetable oil - Decreasing double bonds and increasing trans fatty acids serve to solidify vegetable oils creating products like margarine and shortening; tub margarine - low levels of saturated and trans fatty acids, thus they are a heart healthy choice than stick margarine.
Saturated vs Monounsaturated vs Polyunsaturated:
Saturated - fatty acids with ONLY single bonds in their structure; Monounsaturated - fatty acids with one double bond in their structure; Polyunsaturated - fatty acids with 2 or more double bonds in their structure
Cis Fatty Acids vs. Trans Fatty Acids:
Cis fatty acid - c=c double bond where the position of hydrogen is on the same side; Trans fatty acid - c=c double bond where the position of hydrogen is on opposite sides.
large composition of cholesterol and it increases risk for plaque development because it carries cholesterol (BAD).
brings cholesterol back to liver, some is recycled, some is secreted (GOOD).
What dietary modifications can be made in an attempt to lower LDL's?
reduce saturated fat intake and increase dietary fiber especially soluble fiber in the diet.
When HDL is high, it ....
reduces heart disease risk.
EPA/DHA Fatty Acids:
are made from linolenic acid but are called long chain omega 3 fatty acids because their carbon chain lengths are 20-22. They are rich in fish, shellfish, sea algae and human breast milk. Enhancing EPA/DHA status may decrease risk of heart disease by improving blood lipids, lower high blood pressure, and reduce inflammation.
List the 7 dietary strategies in Lesson 5 to reduce cardiovascular disease risk.
Maintain a healthy body weight. Total fat in moderation. Aim for healthy fats. Minimize saturated and trans fats. Try a variety of complex carbohydrates rich in dietary fiber. Aim for modest dietary cholesterol. Eat like MyPlate. Eating fish adds EPA and DHA.
Can amino acids be converted to fatty acids for fat storage?
Can amino acids be converted to glucose when blood glucose is low?
Yes, the carbon part of amino acids into glucose (gluconeogenesis).
High Protein Quality Foods:
Milk, egg, meat, fish and poultry.
Low Protein Quality Foods:
Plants, beans and legumes.
Bob eats 80 grams of protein per day. Bob is a typical college student who weighs 175 pounds (80 kg) and has a BMI of 24. Compare his intake to his RDA.
80 x .08 = RDA = 64 grams of protein per day compared to his RDA is 80.
List the three processes of energy metabolism and indicate as to which are aerobic and which anaerobic.
1. Conversion to Acetyl CoA - Anaerobic; doesn't require oxygen. 2. Acetyl CoAs enter the TCA Cycle -
Aerobic; requires oxygen 3. Energized H+ carried by NAD and FAD enters the Electron Transport Chain
- Aerobic; requires oxygen.
List the physiological fuel values for carbohydrate, protein, fat and alcohol.
Carbohydrates - 4kcal/g; Proteins - 4kcal/g; Fat 9kcal/g; Alcohol - 7 kcal/g.
What are the two other criteria listed in Lesson 7A (besides BMI) which are used to determine healthy body status?
Be "metabolically fit" - lack biochemical risk factors for chronic illness and have a body fat distribution that minimizes risk for disease.
List the BMI cut-offs for healthy weight and overweight as established by the CDC.
Underweight - below 18.5; Healthy Weight - 18.5 to 24.9; Overweight - 25 to 29.9; Obese - greater than or equal to 30.
List the components of behavior modification strategies that can be used to assist in sustained behavior change in order to lose weight or maintain a healthy body weight.
Become aware of behaviors; Change behaviors; Cognitive skills; Personal attitudes; Support groups.
organic molecule made of carbon, works with enzyme to perform its catalytic job.
B12 Deficiency caused by trouble with absorption.
symptom of Pernicious Anemia due to folate depletion.
What vitamins are rich sources of the two essential nutrients involved in these anemias?
Vitamin B12 and Folate.
Elders, in particular, are at risk for ________ anemia. Why?
Pernicious anemia because atrophic gastritis is common in adults over 50 and impairs the functions of the tissues lining the stomach. As well as HCl and IF tend to be lower in elders which leads to poor Vitamin B12 absorption.
How many carrots would it take for you to fulfill your RDA for vitamin A?
A cup of shredded raw carrots.
Compare plant and animal sources of vitamin A.
Animal sources are rich sources of retinoids that come from liver, fish liver oils, milk, butter, and eggs. Plants are rich sources of carotenoids that come from cantaloupe, carrots, sweet potatoes, broccoli, and spinach.
Beta carotene has two roles:
1) is as a precursor to retinal and 2) as an antioxidant.
What happens if you have a deficiency of Vitamin A? Of beta-carotene?
It can lead to infectious diseases, night blindness, xerophthalmia (total blindness), and keratinization of the hair, nails and skin.
Why is vitamin D referred to as the sunshine vitamin?
because it is made in the body from exposure to the sun.
To fulfill your RDA for vitamin D, how much exposure to the sun is needed by Caucasians?
Exposing hands, face, and arms to sun for 5-10 minutes, 2-3 times a week should be plenty for good vitamin D status.
Describe the role of vitamin E as an antioxidant.
Vitamin E has been shown to reduce oxidation of LDL-cholesterol, known to damage arteries and contribute to development of atherosclerosis and heart disease. It also has a possible role in preventing or delaying cardiovascular disease and cancer.
List all the other antioxidants in the antioxidant defense system in your diet that are mentioned in Lesson 9, including the phytochemicals. Include the two enzymes and their cofactors.
glutathione peroxidase, superoxide dismustase, selenium, copper, manganese, zinc, Vitamin C, Vitamin E, Carotenoids and Flavonoids.
In liters/day and in ml/kcal, what is the typical water recommendation for college students (who are not in sports)?
2 to 3 liters or 8 to 12 cups.
Approximately what percent of this water typically comes from foods eaten each day?
700 to 1000 ml comes from food
What is the consequence of a loss of about 3-4% of your body weight by water loss (sweating, breathing, etc.)?
impaired physical performance, apathy, and flushed skin.
For a typical adult who consumed no food or water for a day, what is the estimated obligatory water loss?
List the components of water lost by a typical adult who is eating and drinking.
Sweat, Urine, Feces, and Breath.
What are the 2 largest components of water loss?
2 largest components - Sweat 450-900 and Urine 500-1400
Why are some elders at risk for dehydration?
As we age, total body water decreases; may no longer have the sensitivity to thirst; may be voluntarily reducing fluid intake due to problems with frequent urination; mild fever or during a hot, humid summer heat, elders can critically lose body water.
At what level would water be toxic to humans?
10 or more liters of water in a few hours.
What are the consequences of consuming too much water?
Confusion, convulsion, and even death due to hyponatremia.
fluid outside the cells; sodium cations and chloride anions.
fluid inside the cells; potassium cations and phosphate anions.
fluid between the cells.
the movement of water across a membrane toward the side where the solutes are more concentrated.
Describe the basic regulation of body water at the level of the nephron.
Filtration: Electrolytes, water, and urea are filtered into the tubules of the nephron. For adults, about 180 liters of water are filtered each day; Reabsorption: As needed, water and electrolytes are reabsorbed back into the blood by actions of osmosis and membrane pumps. Usually 99% of water is reabsorbed. Hormones regulate membrane pumps capable of electrolyte reabsorption and water reabsorption; Excretion: Excess water, urea, and electrolytes travel through the nephron tubules to the bladder and are excreted via urine.
How much is excreted as urine by the average adult?
The consumption of alcohol inhibits ADH. What is the consequence in the kidney of inhibiting ADH?
ADH is a water-conserving hormone that stimulates the kidneys to reabsorb water. The more water you need, the less your kidneys excrete.
Therefore, would you recommend that you drink water or not drink water before going to bed after a night of responsible drinking of alcoholic beverages, i.e. to prevent a hangover the next day?
Alcohol depresses ADH activity, thus promoting fluid losses and dehydration, so you should drink a glass of water before bed.
If you are very thirsty, what hormone is elevated that regulates water balance?
Explain the hormonal regulatory process when blood sodium level is low (ie, could also result in low blood pressure). What happens to sodium and water in the kidney tubules during this process?
ADH stimulates the kidneys to reabsorb more water from the nephron tubules back into the blood to dilute blood sodium concentration. Dehydration can also reduce blood flow, that is, lower blood pressure. The kidney responds by releasing the enzyme renin into the blood, which activates the blood protein angiotensinogen converting it to angiotensin. Angiotensin signals the adrenal glands to release the hormone, aldosterone. Aldosterone causes the kidney to reabsorb sodium (Na+). Na+ and other electrolytes attract water. When Na+ is retained or reabsorbed into blood, water follows via osmosis and blood volume and thus blood pressure is increased. Angiotensin is also a powerful vasoconstrictor causing blood vessels to narrow which also increases blood pressure. Water is reabsorbed.
Explain why ORT has saved the lives of millions of children in third world nations.
Dehydration is common in third world nations but a simple solution of 1 cup of boiled water, a pinch of salt, and 2 tsp. of sugar can restore electrolytes and reduce dehydration at home.
Besides its role in water balance, what are other essential functions of sodium?
nerve impulse transmission and muscle contraction.
List the sodium AI, UL, and DV.
AI - 1500 mg. UL - 2300 mg. DV - based on 1500 mg/day
Tony is a typical American and consumes about 7 grams of sodium each day. Even though you do not know his dietary practices, make some suggestions as to how he may lower his intake to closer to the UL?
Add little or no salt to foods at the table; Try other sodium-free spices; Select fresh or frozen vegetables or low-sodium canned varieties; Cook with less salt; Read food labels for high sodium DV's and look for lower sodium products; Use less often or find alternate lower sodium varieties of high sodium foods and condiments.
If Tony were to sprinkle ½ teaspoon of salt on his corn on the cob, how much sodium would he be adding to his meal?
3000 mg of sodium.
Explain "sodium sensitive."
kidneys are less efficient at removing excess sodium, and therefore, they may experience hypertension with high sodium intake.
About a third of adults in the U.S. have hypertension. What percentage of these is probably sodium sensitive?
Besides sodium, what other minerals may affect blood pressure regulation? Describe the DASH Diet and how it is designed to provide these minerals.
Magnesium, potassium, and calcium rich diets help lower blood pressure. Along with lots of fruits, vegetables and low-fat dairy foods, the DASH diet includes whole grains, poultry, fish, legumes, and nuts.
List the major functions of potassium in the body.
electrolyte balance, nerve transmission, muscle contraction, and maintaining blood pressure.
travels to the kidney and stimulates the activation of vitamin D. PTH and active vitamin D together increases re-absorption of Ca, drawing Ca back into the body instead of being excreted in urine.
induces intestinal Ca-binding proteins causing an increase in the absorption of dietary Ca into the body.
PTH and Vitamin D:
stimulate osteoclasts to break down bone for the release of Ca into blood.
Calcitonin (if CA is too high):
inhibits the activation of vitamin D to its hormone form, and therefore, intestinal absorption decreases, kidney reabsorption decreases, and osteoclasts are not stimulated.
What percent of adults over 75 years of age have osteoporosis and about what percent are women?
One in three adults over 75 years of age have osteoporosis and about 80% of those are women.
Why are women more at risk for osteoporosis than men?
Men generally achieve a higher peak bone density than women, so can lose more bone before displaying symptoms. Women on average have lower stores and can lose up to 20% of their bone mass during the onset of menopause when estrogen levels drop.
Briefly describe the roles of peak bone mass and aging on the risk for fractures in older adults.
By the age of 20, 95% of people reach their peak bone mass, and by age 30, all people have reached their peak bone mass. Studies show that adequate nutritional status in adults reduces the incidence of falls as well as provides a cushion of soft tissue to protect bones from fall-related fractures.
Discuss why nutrition and physical activity during childhood is important in the prevention of osteoporosis in the elder years.
weight-bearing activity is hugely important for developing strong, dense bones.
Why is underweight a risk factor for osteoporosis?
Without adequate fat stores, estrogen production decreases, monthly menstruation ceases, and young women lose bone density at a similar rate as older women during menopause.
What is the adult RDA for calcium (adults from 19-50 years of age)?
Describe a "300 milligram rule" for an easy way to estimate your calcium intake.
One cup (8 ounces) of milk, 1.5 ounces of cheese, or 1 cup of yogurt contain roughly 300 mg of calcium. Putting all other non-dairy foods together in most daily diets equals about 300 mg.
Is there a UL for calcium; if so, what is it?
Yes, 2500 mg/day.
List the functions of magnesium. What does it mean that magnesium plays a role with metalloenzymes?
It is important in the formation of ATP in energy metabolism and also is part of hundreds of metalloenzymes. It acts with Ca in muscle contraction: Ca stimulates, while Mg relaxes. The balance between Ca and Mg helps maintain normal blood pressure.
List 3 foods rich in magnesium.
Green plants, dairy products, meats.
Name some organic molecules in the body which contain sulfur. Do humans have to eat inorganic sulfur to stay alive?
Amino acids, methionine, cystine, and cysteine. They do not have to eat it.
Describe the heme molecule.
made from hemoglobin and myoglobin.
What is the function of hemoglobin?
picks up O2 in the lungs and transports it via red blood cells to all parts of the body.
One possible consequence of iron deficiency in infancy and young children is a disruption of cognitive development. What function of iron may explain this outcome?
important in brain and nervous tissue function.
What is the cofactor for the collagen metalloenzyme called hydroxylase? What does the enzyme do?
Iron. It helps to mature collagen to protect from the symptoms of scurvy.
What is the role of vitamin C in this process?
Vitamin C keeps iron in its reduced form so that it's able to combine with an inactive enzyme protein to form an active enzyme complex to mature the collagen.
is only found in foods of animal origin.
is found in both foods of animal origin and plant origin.
Which is more bioavailable, heme or non-heme iron?
What percent of heme iron is absorbed?
What are the roles of vitamin C and the MFP factor in the absorption of non-heme iron?
They enhance nonheme iron absorption by keeping the form of iron in the reduced state.
What does MFP stand for?
Meat, fish, poultry.
High amounts of phytates and fiber in a plant based-diet may lower bioavailability of non-heme iron to _____ % as compared to iron in a mixed food diet being ____%.
Name foods that contain phytates.
legumes, whole grains, and rice.
has the capacity to temporarily store thousands of iron atoms and is also the storage protein for iron in the liver.
delivers iron to the body tissues.
blocks ferroportin from transferring iron into the blood.
Why is there only a tiny amount of iron in urine?
Extremely little iron can be excreted in urine since it is protein bound and proteins are not filtered out by the kidney.
So how does the body attempt to keep high levels of iron out of the body? What is the major excretory route of iron for men? ... for women?
For men and postmenopausal women, iron is excreted through feces or the small intestine and for women, it is excreted during menstruation.
Iron Deficiency Anemia:
a microcytic hypochromic anemia that results from not only depleted iron stores, but also depleted iron transport and reduced production of hemoglobin. It results in fatigue, weakness, or headaches when physically stressed as well as apathy and poor resistance to cold. It is more common in adults.
refers to depleted iron stores in the liver, but not severe enough to cause anemia. It may cause behavioral and motivational changes often mistaken for laziness; symptoms may include fatigue, decreased ability to concentration, and sluggish reactivity. More common in children.
What do you measure in blood to assess iron deficiency anemia (name two tests)?
Blood hemoglobin and hematocrit.
Since you are taking Nutr 251 and reviewing iron nutrition, what might you recommend to your father when he goes to his next physical exam?
He should stop self medicating with iron supplements without a medical diagnosis of iron deficiency anemia is unwise.
Define hemachromatosis. What causes it and what are the consequences?
Hereditary iron overload. It is the most common genetic disease in the United States. Because too much iron gets into the body, iron overload disorder can cause liver damage, apathy, lethargy, and fatigue.
Why is iron toxicity a concern in young children in the US?
Iron poisoning cases are reported every year due to young children accidentally overdosing on their mother's iron supplements, mistaking them for children's vitamins. As little as 200 mg, which could be just 5 pills, can cause death in a young child.
Why did the Egyptian youth in the 1960's become zinc deficient, i.e. explain the dietary and environmental conditions which precipitated deficiency? What were the symptoms?
Their diet was plant-based, high in fiber and phytates causing binding of zinc in the intestine. Unleavened breads which were a staple in their diet, does contain zinc, but it is unavailable for absorption since it is in a bound form. Contributes to enhanced infection rates or poor growth and development in children.
Describe the similarities and differences of the regulation of iron and zinc absorption in the small intestine. What is the role of metallothionein?
Like iron, less than 40% of dietary zinc is absorbed into blood and metallothionein, a mucosal cell protein temporarily stores zinc before further transport into blood. Only when the body needs zinc will metallothionein release zinc for transport into blood through albumin or blood transferrin.
Many throat lozenges contain ~10 mg of zinc and packages suggest taking 2 lozenges every 2 hours when you have cold symptoms. What precautionary words might you mention to someone following these package suggestions? How does this dosage compare to the UL for zinc?
There is no evidence that zinc prevents common cold symptoms. It can have side effects of nausea and bad taste. Zinc should only be used in short duration - 1 to 2 weeks. The UL for zinc is 1100.
List 4 good sources of zinc in the US food supply.
Beef, poultry, legumes and nuts.
Describe the role of iodide in the body.
Helps to control basal metabolic rate, body temperature, growth, reproduction, muscle function, and energy metabolism.
What are the effects of iodine deficiency during pregnancy on the outcome in the infant?
Will cause severe mental and physical retardation of the developing fetus, known as cretinism.
What is the effect of iodine deficiency on the thyroid gland?
It causes the thyroid gland to enlarge to trap more iodine. If left untreated in adults, it can cause weight gain and sluggishness and in kids, poor cognitive functioning.
Where and when in the US were goiters prevalent and how was it resolved?
Prior to the 1930's, soils in many areas of the central United States especially in the Midwest and Rocky Mountain states are poor in iodide, thus goiter was fairly common in these regions during the settling of our country. Iodized salt eliminated iodine deficiency.
What is the optimal level of fluoride intake (in ppm in water) shown to reduce tooth decay, yet not produce adverse effects?
What might be the outcome of a long term intake of fluoride in water at 8 ppm?
8 ppm could increase chances of fluorosis.
Outline 3 mechanisms by which fluoride reduces tooth decay.
Replaces the hydroxyl group in hydroxyapatite and forms an even stronger and harder, fluorapatite; also increases rates of re-mineralization; acts as an antibacterial agent in saliva.
In what capacities are selenium and copper associated with the antioxidant defense system? Name the enzymes.
Selenium associated with glutathione peroxidase; Copper associated with superoxide dismutase.
True or false? Chromium is an effective supplement to build muscle and lose body fat.
False because there is no evidence of this.
List functions of chromium.
assists carbohydrate and lipid metabolism and helps maintain glucose levels by enhancing insulin activity.
The initial product of the union of ovum and sperm; a fertilized ovum.
The developing infant from 2 to 8 weeks after conception.
The developing infant from 8 weeks after conception until term.
births occurring before 37 weeks of gestation.
Full Term Infant:
births occurring at 39 through 40 weeks of gestation.
Describe the role of the placenta in providing nutrients to the fetus and in the regulation of fetal growth.
The placenta is a metabolically active organ producing hormones that regulate fetal growth and maternal support tissue. It has finger like projections allowing the fetus's arteries and veins to access a pool of the mother's blood. Nutrients, oxygen, and fetal waste products cross between the mother and fetus via this shared pool of blood. The normal development and maintained integrity of the placenta is key for the healthy growth of the child.
Explain the concept "critical period" of embryonic development.
an organ or organ system can be irreversibly affected by an adverse event such as exposure to a toxic substance or too little or too much supply of an essential nutrient in the first 10 weeks after conception.
Why do formulations of vitamin/mineral supplements omit preformed vitamin A (retinol)?
Retinoids have long been known to be potent teratogens, causing severe birth defects especially if toxic exposure is during the first trimester.
Is Rita (see above) at risk for too much vitamin A intake if she ate carrots everyday?
No because carrots are associated with beta-carotenes not retinoids which are not associated with toxicity. It may just turn her skin yellow.
Explain the story of folic acid fortification of the food supply and what this has to do with critical periods during embryonic development.
The critical period for embryonic folate exposure is at 17-30 days. In 1998, the FDA mandated all processed grain products be fortified with folic acid to help reduce incidence of neural tube defects. The U.S. folic acid fortification program has been successful at significantly decreasing the incidence of neural tube defects by about 25%
Describe the development of Spina bifida.
where the neural tube fails to close and the spinal cord is not completely protected by normal development of bones in the spine. Unprotected, the spinal cord can be irreparably damaged leading to paralysis below the point of exposure and multiple health problems.
Are obese women more or less at risk for a birth with neural tube defect?
Discuss why all pregnant women are not at risk for neural tube defect?
more common amongst whites and Hispanics; a previous pregnancy resulting in a child born with a neural tube defect increases risk of a second neural tube defect baby; maternal diabetes; maternal obesity; maternal anti-seizure medication; exposure to hot temperatures early in pregnancy;
In the 1950's, recommended weight gain for women was 15-18 pounds over 9 months because smaller babies were easier for mothers to deliver. Now the recommended weight gain in 25-35 pounds. Why?
Women who do not gain a healthy amount of weight are at risk for a smaller placenta, low birth weight infants, and premature birth.
Should women who are underweight before getting pregnancy gain more or less than women who are normal weight before pregnancy?
Should obese women lose weight during pregnancy?
Know the weight gain recommendations for full-term pregnancies.
Underweight - 28-40 lb; Healthy Weight - 25-35 lb; Overweight - 15-25 lb; Obese - 11-20 lb;
List the estimated energy needs (kcal/day) of pregnancy in additional kcals above their non-pregnant energy needs during the second, and third trimesters.
Second Trimester - 340 kcal/day; Third Trimester - 450 kcal/day.
List the risk factors for the mother and the infant for overweight women during pregnancy.
maternal medical complications: hypertension, diabetes, postpartum infection; labor and delivery complications: large infant, birth trauma, or cesarean section; poor development, infant death; neural tube defect.
Define a low birth weight infant (LBW).
less than 5.5 lb.
Describe the prevalence of low birth weight infants across population groups in terms of race, age of mother, and smoking.
Inappropriately low maternal weight gain; Both younger and older mothers have increased risk; African Americans have highest risk; Iron deficiency increases risk; Smoking; Genetics; Prior health conditions; Low socioeconomic status; No or infrequent prenatal care; Alcohol or drug use.
True or false and explain why? The RDA for calcium is the same for pregnant and non-pregnant women.
TRUE because the physiological changes during pregnancy adapt to the fetus's needs for calcium by increasing absorption and retention. Calcium RDA = 1000 mg/day.
True or false and explain why? The RDA for iron is the same for pregnant and non-pregnant women.
FALSE because iron is needed for an enlarged maternal blood volume and to provide for the needs of the placenta and infant. Iron RDA for regular women = 18 mg/day and for pregnant women = 27 mg/day.
List the cautionary advice you would give a pregnant women in terms of herbal supplement and alcohol use; fish consumption; and avoidance of listeriosis.
Herbal supplements shouldn't be taken without consulting a doctor. Women should drink no alcohol during pregnancy. Avoid the following fish: shark, swordfish, king mackerel, and tilefish. Limit average weekly consumption to 12 ounces (cooked or canned) of seafood (including light tuna) or to 6 ounces (cooked or canned) of white, albacore tuna. Supplements of fish oil are not recommended due to risk of contaminants. To avoid listeriosis, pregnant women should not eat or drink unpasteurized milk, milk products, or juices; raw or undercooked eggs, meat, or poultry; or raw sprouts.
Compare Rita's intake of caffeine with recommended limits of consumption for pregnant women.
Limit caffeine beverages to one cup of coffee per day or two colas.
Health professionals recommend an extra 330 kcals per day for a lactating woman. However, 550 kcal per day are actually needed. Why this difference?
So that women slowly utilize the extra body fat accumulated during pregnancy.
List advantages of breastfeeding over formula feeding for Ben.
Breast milk provides the appropriate composition of nutrients and at high bioavailability for infants; contains immune factors and thus reduces risk for GI infections; reduced risk for allergies; contains long chain fatty acids (DHA and EPA) for brain and vision development; exposes infants to different flavors through breast milk and thus may try a greater variety of foods as toddlers; breast-fed infants grow at a slightly, but significantly slower rate than formula fed infants; there is some limited evidence that breast-fed infants may be at lower risk for adult obesity; some evidence that breast-fed infants have reduced risk for some chronic diseases as adults, such as heart disease.
Then list advantages of breastfeeding for Rita.
contracts uterus to pre-pregnancy size more quickly; delays ovulation; delays menstruation, thus iron is conserved; may protect against breast and ovarian cancer; cheaper than purchasing formula; environmental savings in the manufacturing, packaging, and shipping of formula.
Your list of benefits swayed her and she is now nursing Ben. How would Rita's dietary needs change from being pregnant to being a lactating mother?
Mothers will sacrifice their own calcium to supply the needs for milk production, thus mothers need to consume calcium adequate diets for their own bone health. Consume a nutrient rich diet, possibly with vitamin supplement if poor eating habits. Lactating women to drink about 3 liters of fluids per day.
True or false? Alcohol can transfer into human breast milk.
True or false? Caffeine can transfer into human breast milk.
So what are the recommendations for lactating women in terms of these substances.
Breastfeeding should be delayed two hours after an alcoholic beverage. Caffeine consumption should be moderate, 1 to 2 cups of coffee per day.
What are the Healthy People 2010 goals for breastfeeding prevalence in the U.S.? How are American women doing?
The Healthy People 2010 goal in the U.S. is that 75% of women leaving the hospital should be breastfeeding and 50% still breastfeeding at 6 months. We have met the first goal, however, only about 33% of mothers are still breastfeeding at 6 months.
What does it mean if an infant over the course of 6 months is tracking at the 25th percentile for weight and 50th percentile for height?
It means that 25% are lighter and 75% are higher in weight and 50% are taller and 50% are shorter for height.
Why do health professionals track growth by the CDC charts?
Important for nutritional assessment is not the absolute percentile but rather whether the infant rapidly changes his pattern of growth. A change in growth pattern alerts a physician to examine health and nutritional status for causation.
True or false? Formula-fed infants grow at a slightly slower rate compared to breast-fed infants. What is the implication of this information?
TRUE. Breast-fed infants are less likely to become obese during childhood.
What is colostrum and why is it important for the newborn?
A watery milk substance produced by the mother during the first few days after delivery, is especially rich in antibodies and white blood cells.
What are the advantages of breast milk as the first food for infants?
It provides immunological benefits protecting the infant from disease causing bacteria for many months after birth. It also has the following: Bifidus factors - favor the growth of "friendly" bacteria in the GI tract; Lactoferrin - binds iron in breast milk, preventing growth of iron-dependent harmful bacteria in the GI tract and increasing bioavailability of iron for absorption; Growth factors - stimulates development of a healthy GI tract; Lipase enzymes - helps protect against additional infections.
Why should an infant in the first 12 months of life not be fed cow's milk?
An infant's kidneys are not fully matured and can only handle the protein level in breast milk or formula. Higher protein milk will stress the infant's kidneys because of the excess urea production. Additionally, the balance of minerals such as calcium and phosphorus in breast milk is just right for the human infant, whereas cow's milk has very high levels of major minerals which would again stress the infant's kidneys.
Why is infant cereal or pureed meat important as second foods (first food is breast milk or formula) for 6 month old infants?
It provides additional energy and nutrients (especially iron and vitamin C) and has an important role in proper growth and development.
What are nutritional recommendations to infants in terms of fluoride and vitamin K?
At six months, infants should be given water supplemented with fluoride or fluoride supplements; Newborns are injected with Vitamin K at the hospital to prevent hemorrhagic disease of the newborn (bleeding to death).
Why are some breast-fed infants at risk for rickets in the United States?
Rickets has recently appeared as an issue in some breast-fed infants who are from ethnic groups with darker skin and have little exposure to sunshine. They just require a Vitamin D supplement.
Compare and contrast the diet of a 6 month old infant with that of a 9 month old infant with that of a one-year old toddler.
6 months - mashed veggies, fruits and meats. 9 months - finger food. 1 year - reduced-fat or low-fat cow's milk plus normal foods.
What could be the consequences of a young child drinking too much milk or too much juice? How much is too much?
Milk consumption should be 2-3 cups per day. Too much milk will displace other nutrient-dense food, possibly resulting in "milk anemia" which displaces good sources of iron; Juice should be limited to ½ cup per day. Too much juice may lead to diarrhea, intestinal upset or suppressed appetite.
One prominent nutritionist promotes the "Division of Responsibility." She says that parents are responsible for what and when to serve children healthy meals and snacks. What are children responsible for?
It falls to the children to letting parents know if they are hungry or not.
True or false and explain? There is a separate MyPlate for kids, which is distinctly different from the adult Myplate.
TRUE because it helps parents to meet their child's needs.
If a young child is a fussy eater, parents should instill the "clean your plate" rule. Why or why not?
You shouldn't instill the rule because children should listen to their hunger and fullness cues. Do not force or bribe a child to eat because it will result in them disliking the food and just wanting the reward.