Cp.1 The Science of Nutrition PDF

**Cp.1 The Science of Nutrition** **Nutrition** - study of food and how food nourishes our bodies and influence our health   **Healthy People 2030** - Developed by experts under the direction of the US department of HHS - Primary goals - Attain healthy, thriving lives and well-being f...

**Cp.1 The Science of Nutrition** **Nutrition** - study of food and how food nourishes our bodies and influence our health   **Healthy People 2030** - Developed by experts under the direction of the US department of HHS - Primary goals - Attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death - Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all - Promote healthy development, healthy behaviors, and well-being across all life stages - Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all    **Nutrients** - chemicals found in food and are critical for human growth and function - Organic nutrients contain carbon and hydrogen, essential components of all living organisms - - Carbohydrates - Proteins - Lipids (fats and oils) - Vitamins - - Inorganic nutrients are those not containing carbon and hydrogen - - Minerals - Water - - Energy density - amount of calories compared to weight or volume - Nutrient density - amount of nutrients compared to calorie - Main form of stored energy is glycogen - complex carbohydrate that is stored primarily in the liver and muscles **Macronutrients** - required in relatively large amounts to support normal function and health - Provide energy/fuel to our bodies - Carbohydrates, lipids, and proteins **Nutrient necessity** - Essential (indispensable): the body cannot make the nutrient or cannot make it in sufficient amounts. You must obtain the nutrient from foods - Nonessential: the body can make it in sufficient quantities to meet physiological needs **How is energy in food measured?** - Kilocalories (kcal) (1kcal=1000cal) - amount of heat needed to raise the temperature of 1kg water by 1°C - Energy Yielding Nutrients: - 1g carbohydrates (CHO) = 4 kcal - 1g protein = 4 kcal - 1g lipids = 9 kcal - 1g alcohol = 7 kilocalories **Think metric** - - Volume: Liters (L) - 240 mL = 1 cup - Weight: Grams (g) - 28.35 g or \~30 = 1 oz - 1 kg = 2.2 lbs - 2.54 cm = 1 in **Determining nutrient needs** - - Dietary Reference Intakes (DRIs): - Estimated Average Requirement (EAR) - 50% - Recommended Dietary Allowance (RDA) - 97-98% - Adequate Intake (AI) - Tolerable Upper Intake Level (UL) - AMDR (Acceptable Macronutrient Distribution Range) - CHO - 45-65% - Pro - 10-35% - Lipids - 20-35%   **Assessing nutritional status** 1. 2. Nutritional-status assessment a. Food/nutrition-related history i. Diet history ii. Twenty-four-hour dietary recall iii. Food frequency questionnaire iv. Diet records b. Anthropometric measurements v. Height vi. Body weight vii. Head circumference in infants viii. Limb and waist circumferences in adults c. Biochemical data, medical tests, and procedures d. Nutrition-focused physical findings e. Client health history 3. Nutrition diagnosis 4. Nutrition intervention 5. Nutrition monitoring and evaluation      **Research** - - Research drives nutrition recommendations and guidelines - Replication needed - Peer review - research evaluated by panel of scientists. - Control group and experimental group - Placebo - Randomization - Sample size - Control for other variables - Have one variable at a time - Double-blind experiment: BEST - Subjects and researchers do not know who belongs to which study group   **Ch.2 Designing a Healthful Diet** **A healthful Diet** - Adequate - Sufficient in energy and nutrients (iron & fiber) - Moderate - Don't eliminate any foods. No \"good\" & \"bad\" foods - Nutrient-dense - Amount of nutrients relative to energy - More nutrients, fewer kcal = high nutrient density - Low nutrient dense foods \~ "empty kcalories" - Balanced - Energy (kcal) in = energy out - Varied - Choose a variety of foods from each food group   **Food Labels** The FDA requires food labels on most food products. These labels must include these five components: 1. A statement of identity 2. Net contents of the package 3. Ingredient list 4. Manufacturer's name and address 5. Nutrition information (Nutrition Facts Panel) Terminology for grains 1. Refined: uses only the endosperm 2. Enriched: addition of nutrients back into a food that were lost during processing - Iron, Thiamin, Riboflavin, Niacin, Folate 3. Whole Grain: entire grain (not husk) - Is wheat bread a whole grain? Not unless the label states: whole wheat bread Claims - Nutrient and health claims - Must meet FDA-approved definitions - Example: "low in sodium" = contains 140 milligrams or less of sodium per serving - Structure--function claims - Made without FDA approval, proof, or guarantees that any benefits are true How to Understand and Use the Nutrition Facts Label \| FDA **Nutrition Facts Panel** 1. Serving size and servings per container 2. Calories - Total number of calories per serving in large, bold print 3. Percent Daily Values (%DVs) - How much a serving of food contributes to an average individual's recommended intake of the listed nutrients (sugars, vitamin D, calcium, iron, and potassium) - Compare %DV between foods for nutrients - More than 5%, less than 20% 4. Footnote - Provides a simple definition of %DV - \%DV is based on a 2,000-calorie diet  **2020-2025 Dietary Guidelines for Americans - USD of HHS** - Healthy Diet Pattern Includes: - - Vegetables of all types - Fruit - Grains (make ½ whole grains) - Fat-free or low-fat dairy - Variety of proteins - Oils - USDA MyPlate What Is MyPlate? - Healthy Diet Pattern Limits: - - Saturated fat (\>10% kcal) - Trans fat (as little as possible) - Added sugars (\> 10% kcal) - Sodium (\> 2,300 mg) - Alcohol (in moderation -- 1 drink for women, 2 drinks for men - DASH (Dietary Approaches to Stop Hypertension) - nutritionally based eating plan that helps lower blood pressure. It\'s rich in fruits, vegetables, whole grains, low-fat dairy, and lean protein, while limiting foods high in salt, saturated fat, and added sugar   **Eating Out** Section 4205 of the Patient Protection and Affordable Care Act - Restaurants/retail food establishments or vending machine operators with 20 or more locations - Must post caloric content of foods typically served on menus/menu boards  - Must also include a statement about recs for daily calorie intake **Ch.3 The Human Body: Are We Really What We Eat?** **Hunger** - physiologic sensation that prompts us to eat - Brain - major organ affecting hunger - Hypothalamus - triggers hunger & thirst - Nerve cells - Hormones - Stimulate food intake - Low levels of blood glucose, glucagon (hormone) is an important signal for hunger - Feeling of fullness (satiety) - High levels of blood glucose; insulin (hormone) is an important signal for satiety - Satiety value - highest - protein - second - fat - lowest - CHO - Fiber foods **Appetite** - psychological desire to consume specific foods **Food undergoes three processes:** 1. Digestion - large food molecules are broken down to smaller molecules, mechanically and chemically 2. Absorption - process of taking these products through the intestinal wall 3. Elimination - undigested portions of food and waste products are removed from the body **Organs involved** 1. The GI tract a. Mouth - where digestion begins i. Chewing - mastication ii. Food moves through upper esophageal sphincter to esophagus b. Esophagus iii. Peristalsis - rhythmic contraction and relaxation of both circular and longitudinal muscles iv. Food moves through gastroesophageal sphincter (lower esophageal sphincter) to stomach c. Stomach v. "Holding place" for food vi. Gastric Juice 1. Water, enzymes, hydrochloric acid 2. Mucous neck cells and mucous surface cells secrete mucus protecting the stomach wall from digestion vii. Mixes all together and forms chyme viii. Churns food - physical breakdown ix. Digestion of protein begins x. Stomach chyme moves through pyloric sphincter:slowly released into duodenum d. Small Intestine xi. Where most digestion & absorption of nutrients occur xii. Food travels from duodenum to jejunum to ileum xiii. Fluid & enzymes are added by the pancreas and gallbladder e. Large Intestine xiv. Main function is to store undigested food material and absorb water, short-chain fatty acids, and electrolytes xv. Ileocecal valve: sphincter located at start of colon xvi. Appendix: also located near start of colon f. Rectum 2. Accessory (helper) organs g. Salivary Glands h. Pancreas xvii. Digestive enzymes xviii. Bicarbonate xix. Metabolic hormones 3. Insulin and glucagon i. Liver xx. Synthesize metabolic chemicals xxi. Makes bile xxii. Receives the products of digestion xxiii. Processes digestive products (regulates blood nutrients) j. Gallbladder - stores bile (helps digestion by emulsifying lipids) **Organs that Produce Secretions** 1. Mouth - Salivary glands a. Enzymes (salivary amylase) b. Water c. Bicarbonate (neutralizes acid) d. Mucus, antibodies 2. Stomach - Gastric juice e. Hydrochloric acid f. Enzymes (Gastric lipase & Pepsin) g. Intrinsic Factor h. Mucus protects stomach lining 3. Pancreas i. Enzymes (protease, lipase, amylase - acts on all energy nutrients) j. Bicarbonate i. Neutralizes acidic chyme coming from stomach to small intestine 4. Liver k. Bile 5. Small intestine l. Enzymes (aminopeptidase, lipase, sucrase, maltase, lactase) **Absorption** - The passage of molecules of food from the GI tract into circulation - 2 routes - Vascular System (Circulatory) - Accepts nutrients into blood - Water soluble nutrients - Lymphatic - Lipids and other fat-soluble nutrients - Types 1. Passive Diffusion: a. b. 2. Facilitated Diffusion: c. d. 3. Active Transport: e. f. g. 4. Endocytosis (pinocytosis) h. i. **Blood Lymph Transport** - Blood travels through the cardiovascular system - Water soluble nutrients enter the blood stream; some require protein carriers - Lymph travels through the lymphatic system - Lacteals pick up most lipids and fat-soluble vitamins - Lymph nodes are clusters of immune cells that filter microbes and other harmful agents - Enters blood near the heart (Thoracic duct) **Digestive Disorders** - Heartburn & Gastroesophageal Reflux Disease (GERD) - Acidic gastric juice seeps back up into the esophagus - Peptic Ulcer - H. Pylori bacteria - Prolonged use of certain medications **Functional Disorders of the GI Tract** - Diarrhea - Often caused by GI tract infection, stress, food intolerance, medication, or an underlying bowel disorder - Constipation - Diet - increase insoluble fiber & water - Irritable Bowel Syndrome - interferes with normal colon function - Crohn's Disease - inappropriate immune reaction - Ulcerative Colitis - inflammation and ulceration of mucosa (inner lining) in the colon - Food Allergies & Intolerance - Allergy -- immune system - Intolerance -- GI response - Celiac Disease (Celiac Sprue) - immune response to gluten **FODMAPs** - FODMAPs = fermentable oligo-di-monosaccharides and polyols - Small, highly fermentable, short-chain, poorly absorbed carbohydrates - Recent attention as contributing factors to IBS - Claim: limiting FODMAPs reduces colon fermentation, gas production, and fluid in the small intestine - Restricts: - Fructose in excess of glucose (apples, pears, honey) - Fructans (artichokes, garlic, onion, wheat, rye) - Polyols or sugar alcohols (stone fruits, some vegetables such as mushrooms, sugar substitutes) - Lactose - Galectins (lentils, broccoli, chickpeas) **Simple** **Complex** ------------ ------------- ---------- **Mono** **Di** **Poly** Glucose Maltose Glycogen Fructose Sucrose Starch Galactose Lactose Fiber - Simple CHO (C~6~H~12~O~6~) - Monosaccharides - single sugar - Glucose - essential energy - Fructose - sweetest - Galactose - does not occur alone in foods - Disaccharides - two - Maltose: glucose + glucose - starch breaks down - Sucrose: glucose + fructose - in nature - Lactose: glucose + galactose - Complex CHO - many glucoses - Oligosaccharide - 3-10 - Raffinose and Stachyose - causes intestinal gas - Polysaccharides - many - Starch - storage of glucose in plants - Amylopectin - long, branched chains - Amylose - long, unbranched chains - Grains - richest food source - Glycogen - storage of glucose in animals/humans - Fiber - provide structure to plants - Dietary fiber - nondigestible parts of plants - Functional fiber - nondigestible, plants or lab - Total fiber - dietary fiber & functional fiber - Dextrins - short glucose chains - Digestion - begins in mouth, halts in stomach, resumes in small intestine - Fiber - slows gastric emptying - Hydrolysis -- breaking chemical bond with water - Condensation -- making chemical bond with water as a by-product - In the small intestine - Pancreatic amylase -- major CHO-digesting enzyme - Breaks starch into short glucose chains and disaccharides - Final step occurs on outer membrane of the intestinal cells (microvilli) where specific enzymes work to break varying disaccharides into monosaccharides - Maltase: maltose -\> glucose + glucose - Sucrase: sucrose -\> glucose + fructose - Lactase: lactose -\> glucose + galactose - Resistant starch - Escapes digestion - Classified as type of fiber Absorption - Glucose and galactose are absorbed into enterocyte by active transport - Requires ATP and carrier protein saturated with sodium - Fructose absorbed by facilitated diffusion - No ATP - Stays in the intestine longer - Lower rise in blood sugar levels - Large amounts may cause diarrhea - Converted to glucose in the liver to be metabolized Transport - In liver fructose and galactose converted to glucose - All carbs turn to glucose - Liver is body processing center - Decides where glucose goes - Stored in the liver -- glycogen - Goes to cells or muscle - Storage as fat - Glucose not needed by liver, is transported via bloodstream to body cells and tissues - Rise in body's blood glucose levels results - Pancreatic hormones released to manage glucose homeostasis Impact on Blood Glucose Levels Can be measured using the glycemic index - Used to identify effect a food will have on increasing blood glucose levels - To classify foods - Depends if food is eaten alone - Only provides measure of how much food will increase blood glucose and how quickly - May be beneficial in fueling athletes Storage -- Glycogen - Glucose can be stored as glycogen if not needed for immediate use - Liver (\~1/3 stored) - Can be broken down to glucose for other parts in the body - Storage is limited - Muscle (\~2/3 stored) - Can be broken down to glucose and used only by the muscle - Holds water so storage is bulky Mobilizing Glycogen - Glucose - Chief energy nutrient - Red blood cells only use glucose for energy, brain, other nervous tissues rely on glucose - Provides 4kcal/gram - Extra glucose converted to fat - Unlimited ability to store fat - Uses more energy to convert CHO to fat (cannot be converted back) Depleted - Absence of glycogen stores and dietary glucose - Energy from protein or fat - Can convert protein to glucose through gluconeogenesis - Cannot convert fatty acids to glucose Ketone Bodies - Result: ketones build-up in the blood causing ketosis - Disturbs normal blood pH - Dehydration - Need a minimal level of carbohydrate to protect from ketosis - DRI for carbohydrate is 130 gm/day - Ideal - CHO = 45-65% of total kcal/day - Emphasis: complex CHO, fruits - \ - Average was 17 teaspoons - Milk -- less sugar calories and many vitamins and minerals Artificial Sweeteners -- non-nutritive sweeteners - Approved by the FDA - Saccharin -- 200-700x sweeter - Aspartame -- 200x sweeter than sugar (4kcal/gm) - Acesulfame K -- 200x sweeter, no kcal - Neotame -- 7,000-13,000x sweeter, no kcal - Sucralose -- 600x sweeter, no kcal - Advantame -- 20,000x sweeter - Cyclamates -- banned in US in 1969 Dietary Fiber - Include 25g fiber/day (Females) 38g fiber/day (Males) - 14g/1,000 kcal per day - Average American = 15-18g/day **Lipids** Large and diverse group of molecules, insoluble in water Triglycerides - Main form of fat in diet (95%) and major storage form of fat in the body (adipose tissue) - One glycerol and fatty acids - Composed of C, H, O - C & H \ O - More energy/gram, 9 kcal/g of fat  - Fatty acids can vary by: - Chain length -- number of C - Short -- \ - Hydrogenation: H are added to unsaturated fatty acids - Make oils more solid and saturated - Create trans fatty acids - Help food reduce oxidation and resist rancidity - Increase risk of cardiovascular disease - Partially hydrogenated oils contain trans fats - No longer generally recognized as safe (GRAS) (phased out y by 2018) - Essential fatty acids: obtained from food - Linoleic acid -- omega-6 fatty acid (vegetable and nut oils) - Alpha-linolenic acid -- omega-3 fatty acid - In dark green leafy vegetables, soy, flaxseeds, walnuts - Precursor - Eicosatetraenoic acid (EPA) - Docosahexaenoic acid (DHA) - In fish, shellfish, and fish oils - Sterols - Multiple ring structure -- C, H, O - Both plant and animal sterols exist Cholesterol - Only found in animals, mostly in cells - Starting substrate for bile acids, sex hormones, adrenal hormones, vitamin D - Lipid Transport - Cluster of lipids: triglycerides, cholesterol, phospholipids - Proteins - Allow for movement of lipids I blood and lymph - Chylomicrons -- largest, least dense - Very Low Density Lipoproteins (VLDL) -- primarily made from liver (triglyceride, cholesterol, chylomicron remnants) - Low Density Lipoproteins (LDL) -- Cholesterol core -- high in "Bad" cholesterol - Everyone 20 yrs or older should have a lipid profile done once/5 years - \< 100 mg/dL is optimal - Total cholesterol \< 200 mg/dL - HDL cholesterol ≥ 50 mg/dL females, ≥ 40 mg/dL males - High Density Lipoproteins (HDL) -- carry cholesterol away from cells to liver - Triglycerides in chylomicrons must be disassembled by lipoprotein lipase before they can enter body cells - Used immediately for energy - Used to make lipid-containing compounds - Stored in muscle and adipose tissue - Lipid Metabolism - Mobilize fat from tissues for energy - Glycogen, muscles, or glycerol will be a source of glucose - Person can lose 1-2lbs of fat/week (more than that is water and muscle breakdown) - Ketone bodies - Form when glycogen stores are depleted - Can be used by nerve tissue, brain, eye - Ketone body formation increases during starvation (also seen diabetes) - Acetoacetate changes to acetone- \"sweet breath\" - Ketonemia - increase in blood ketones - Can spill into urine -- ketonuria - Can induce an excess of hydrogen produced -- ketoacidosis - Fat Storage - Adipose cell is primary storage site for triglycerides - Extra fat stored in muscle tissue - Can be used when the body need energy - Absorption of Fats - Mostly in small intestine - Micelles -- capture lipid digestion products and transport to enterocytes for absorption - Lipoproteins -- transport lipids into bloodstream - Chylomicrons -- lipoproteins produced in enterocyte to transport lipids from a meal - How Much Fat - Acceptable Macronutrient Distribution Range (AMDR) for fat: 20-35% of calories - Very low-fat diets (\ - Ketone bodies - Form when glycogen stores are depleted - Can be used by nerve tissue, brain, eye - Ketone body formation increases during starvation (also seen diabetes) - Acetoacetate changes to acetone- "sweet breath" - Ketonemia -- increase in blood ketones - Can spill into urine -- ketonuria - Can induce an excess of hydrogen produced -- ketoacidosis - Ketosis is a process that happens when your body doesn\'t have enough carbohydrates to burn for energy - Ketogenic diet -- a metabolic state where the body uses fat for energy instead of carbohydrates Cardiovascular Disease - Dysfunction of the heart or blood vessels - CVD is the leading cause of death in the United States - Coronary heart disease -- blood vessels supplying the heart are blocked or constricted - Stroke -- blockage or rupture of blood vessels supplying the brain - Hypertension -- increases chances for heart attack or stroke - Risk factors: - Obesity - Physical inactivity - Smoking - Type 2 diabetes - Inflammation - Abnormal blood lipids - Highly saturated and trans fat intakes increase blood cholesterol - Omega-3 fatty acids reduce inflammation and blood triglycerides - Lifestyle changes can prevent or reduce cardiovascular disease - Follow DRIs for total fat, saturated fat, and trans fat - Increase omega-3 fatty acids - Increase intake of whole grains, fruits, and vegetables; dietary fiber: 20-30 g/day - Consume RDA of vitamins B6, B12, and folate - Select and prepare foods with less salt - Eat smaller meals and snacks - Add plants sterols to your diet - Maintain normal blood glucose level - Maintain an active lifestyle - No more than 2 alcoholic beverages per day for men and 1 drink per day for women High-Fat Diets and Cancer - Until more is known about links with diet and cancer, the American Cancer Society recommends: - Maintain a healthy body weight - Engage in moderate physical activity at least 150 minutes per week - Limit intake of sugar-sweetened beverages - Eat a variety of whole fruits, legumes, and other vegetables - Additional recommendations: - Eat whole grains instead of refined grains, limit refines carbohydrate intake and highly processed foods - Limit red and processed meat intake - Limit alcohol intake **CHAPTER 6** **Protein** Large, complex molecules found in tissues of all living things - Dictated by genetic material (DNA) - Most body proteins are made from 20 different amino acids Roles 1. Growth & repair a. Cell replacement i. Skin cells - every 30 days ii. GI tract cells - every 3 days b. Tendons c. Muscles d. Bones 2. Enzymes a. Speeds up chemical reaction  1. Hormones - some are proteins a. Example: insulin, glucagon 2. Fluid & electrolyte balance a. Help maintain volume and composition of body fluids b. Proteins attract fluid c. Insufficient protein in bloodstream -\ EDEMA 3. Acid-base regulators a. Act as buffers 4. Transporter a. Lipids b. Vitamins & Minerals c. Oxygen 5. Antibodies a. Large proteins that fight disease and infections 6. Source of energy a. Provides 4 kcal/gram protein b. Can be converted to glucose - gluconeogenesis c. An expensive source d. Deamination - removal of amine groups Functions - Shape helps determine function - Globular proteins that form RBCs lead to biconcave shape-facilitates oxygen transport Protein Denaturation - Proteins uncoil and lose their shape - Heat - Acid - Mechanical - Protein function is lost In diet - For protein synthesis, all essential amino acids must be available to the cell - Limiting amino acid - Essential amino acid that is missing or in the smallest supply - Slows down or halts protein synthesis - Inadequate energy consumption - Limits protein synthesis 1. Incomplete protein (low quality): insufficient essential amino acid 2. Complete protein (high quality): sufficient amounts of all nine essential amino acids a. Derived from animal sources b. Soybeans and quinoa are most complete plant proteins c. Not found in gelatin 3. Mutual supplementation -- combining two or more incomplete protein sources to make a complete protein 4. Complementary proteins -- in two or more foods combined to supply all nine essential amino acids for complete protein Quality 1. High-quality protein a. Easily digested b. Complete protein 2. Digestibility: depends on source of protein and other foods eaten with it a. Anime protein: 90-99% b. Plant: 70-90% 3. Chemical score a. Amino acid composition b. PDCAAS (protein digestibility corrected amino acid score) i. Digestibility + composition of AA 1. Milk and egg = 1.0 2. Soybeans = 0.91 3. Beef = 0.92 4. Kidney beans = 0.68 Protein Digestion - Chemical digestion begins in the stomach - Hydrochloric acid - Uncoils (denatured) protein - Pepsin begins breakdown of proteins into short polypeptides and amino acids - Digestion continues in the small intestine - Pancreatic enzymes (proteases) complete protein digestion - Enterocytes in the small intestine have different sites that specialize in transporting amino acids, dipeptides, and tripeptides. - High doses of individual amino acid supplements can lead to amino acid imbalances and deficiencies. RDA for Protein - RDA for adult people is 0.8 grams per kilogram body weight per day - Recommended percentage of energy is 10--35% of total energy intake (AMDR) - Protein needs are higher during growth and development (children, adolescents, and pregnant/lactating women) - Protein needs may be higher for athletic people, older adults, and vegetarians - Most Americans meet or exceed RDA Sources - Meats - Dairy products - Eggs - Legumes (including soy) - Whole grains - Nuts - "New foods" (ancient grains, quorn) Amino Acids - Contain C, H, O, and N - Can make other amino acids or be used for energy or stored as fat A diagram of a molecule Description automatically generated with medium confidence 1. Nonessential: body can synthesize them (make them) a. Most are made in the liver 2. Essential: body cannot make them a. 9 amino acids b. Diet  HILLMTVPT I. Conditionally essential amino acid a. Nonessential becomes essential b. Phenylketonuria (PKU) tyrosine becomes conditionally essential amino acid II. Transamination a. Transfer amine group from essential amino acid to different acid group and side chain (R group) b. Produce nonessential amino acids Food Allergies - Protein substances: fish, egg, nuts, milk, wheat, soy, sesame - Celiac disease - Inflammatory response to gluten - Damages small intestine wall - Increases risk of intestinal lymphoma, small bowel cancer 0.8 g/kg 1.2-2 g/kg athlete   High Protein Intake - For healthy people - up to 2g of protein/kg body weight - Fluid needed to flush excess urea from kidneys - Can increase calcium excretion in urine - Not proven to cause bone loss - may be protective against it in the middle - aged and older women - High protein risky for: - Kidney disease or at risk for it - CVD risk - increases cholesterol - Animal proteins - Saturated fat   Vegetarian Diets - Vegetarianism - mostly or entirely of plant origin - People chose vegetarianism for: - Health benefits - Reduced saturated fat and total energy intake - Lower BP - Reduced risk of heart disease - Fewer digestive problems - Reduced risk of some cancers - Reduced risk of kidney stones and gallstones - Ecological reasons - Religious reasons - Ethical reasons - Concerns over food safety - Challenges of vegetarian diets: - Low in some nutrients - Disordered eating - Varied and adequate diet planning - Soy and complementary proteins - Special attention to vitamin B12, D and riboflavin (B2); minerals iron, calcium, and zinc - MyPlate can help with the diet planning   **Protein-Energy Malnutrition** - Disorder caused by inadequate protein and energy intake - Often starts in childhood - Common form of malnutrition worldwide - Acute PEM - thin for the height - Chronic PEM - short for their age - Common forms: - Marasmus - Grossly inadequate energy, protein, and nutrient intake - Chronic food deprivation - Common: 6-18 months - Internal environment: - Growth ceases: age 4 looks like age 2 - Enzymes decrease in supply - GI tract lining - Exacerbates problem - food that does enter body is not completely utilized - Kwashiorkor - 1-3 yrs - Acute food deprivation - Physical appearance: edema of limbs and abdomen - Fluid leaks to interstitial are - Fatty liver due to lack of transporter protein to carry fat away - Lack of enzymes to remove toxins - Lack of melanin to retain hair color - Decreased skin integrity - Correcting PEM - Nutrition intervention - Correct electrolytes - Small protein/kcal amounts - Increase amount gradually - as tolerated - Refeeding syndrome   Genetic Disorders - Numerous disorders are caused by defective DNA - Single-gene disorders include: - Phenylketonuria - Sickle cell disease - Cystic fibrosis   Sequence Errors - Generic errors can occur - result in altered protein **METABOLISM** - Sum of all chemical and metabolic processes - Catabolism -- break down molecules - Anabolism -- form building blocks - Liver -- most active processing center and regenerates itself - Carbohydrates -- fructose to glucose, stores glycogen - Lipids -- builds & breaks down triglycerides, phospholipids, & cholesterol - Proteins -- manufactures nonessential amino acids - Dehydration (anabolic) -- simple units combine to complex, water is a byproduct - Hydrolysis (catabolic) -- large molecule is broken apart with the addition of water - ATP -- universal energy currency, potential energy stored in high-energy phosphate bonds - Metabolic pathways -- enzyme-catalyzed reactions that occur sequentially in part of a cell - Phosphorylation -- adding phosphate group to compound when bonds in ATP are broken - Oxidation-reduction reactions -- donating electron;oxidized, gaining electron;reduced - Coenzymes -- organic substance that enhance or are necessary - Cofactors -- minerals required for enzyme function - Glycolysis -- yields energy quickly - Aerobic pathways -- requires oxygen - Aerobic metabolism -- most energy, critical for endurance activities - Glycolysis -- chemical reactions that convert glucose to pyruvate - Lipolysis -- dietary and adipose triglycerides broken down by lipases - β-Oxidation (fatty acid oxidation) -- oxidize free fatty acids - fatty acid -- attached to albumin - Proteolysis -- dietary proteins are digested into amino acids or small peptides - Deamination -- amine group is removed from amino acid **VITAMINS** - Form and activate in the body, can be destroyed by heat, light, water, and air - Overdoses can cause toxicity, with fat-soluble vitamins being most susceptible - B-Vitamins and Energy Metabolism -- essential for energy release - Thiamin (B1) -- energy release from glucose, easily destroyed by heat - Riboflavin (B2) -- coenzyme for energy release from nutrients - Niacin (B3) -- converts nutrients into energy, supports DNA repair - Vitamin B6 (Pyridoxine) -- in amino acid metabolism, neurotransmitter synthesis - Folate -- essential for DNA synthesis, embryo development - Vitamin B12 (Cobalamin) -- supports nervous system, DNA synthesis - Pantothenic Acid -- synthesis of fatty acids, metabolism of macros - Biotin -- coenzyme in fatty acid synthesis, gluconeogenesis - Choline -- not a true vitamin but involved in fat metabolism and neurotransmission **MINERALS** - Iodine -- integral to thyroid hormones for metabolism regulation - Chromium -- assists insulin in glucose transport - Manganese -- Involved in protein, fat, and carbohydrate metabolism - Sulfur -- stabilizes proteins and is required for alcohol detoxification **FLUID AND ELECTROLYTE** - Water -- 50-70% of an adult\'s body weight (\~3/4 lean tissue \~1/4 fat) (75% in children) - 2000 kcal/day needs about 2-3 liters of water - 25-35 ml/kg - 1-1.5 ml per kcal expended - 25 ml/kg sedentary, 30 ml/kg moderately active - 1/3 Extracellular fluid -- Na^+^, Cl^-^ - 2/3 Intracellular fluid -- K^+^, PO^3-^~4~ - ETOH -- diuretic that increases fluid loss through increased urination - Overhydration - over 15 to 20 L daily - Urine -- color indicates level of hydration - Mineral water must contain 250 ppm of dissolved minerals - Sodium -- primary fluid balance regulator (1500 mg/day \[500-2300\]) - Hyponatremia - Hypertension -- \50% above 60 - 1 tsp salt = 2,300 mg Na (40% Na^+^, 60% Cl^-^) - DASH -- dietary approach to stop hypertension (8-10 svg fruits/veg per day) - Potassium -- major positively charged ion - Hypokalemia - Hyperkalemia - Chloride -- fluid balance (with Na), kill bacteria - Phosphorus -- major negatively charged electrolyte, maintain a-b balance **ANTIOXIDANT** - Free radicals --unstable molecules that damage cells by stealing electrons - Antioxidants -- compounds that stabilize free radicals, prevent oxidation of PUFAs and LDL, and reduce cardiovascular disease risk - Vitamin A -- for vision, immune function, reproduction, and cellular communication - Animal products (retinol), orange and dark leafy vegetables (beta carotene) - Deficiency: vision impairment, infections - Toxicity: liver damage; high beta carotene in smokers - Vitamin C (Ascorbic Acid) -- antioxidant, coenzyme, collagen synthesis, immune support - Citrus fruits, tomatoes, potatoes, peppers, broccoli, leafy greens, strawberries - Deficiency: Scurvy, anemia, weakened immune response - Toxicity: (2000 mg/day) nausea, diarrhea, and kidney stones. - Vitamin E (Tocopherols) -- protects cell membranes, reduces heart disease risk, supports nerve and immune functions - Nuts, seeds, vegetable oils. - Deficiency: Erythrocyte hemolysis, neurological issues - Toxicity: can interfere with vitamin K and blood clotting - Selenium -- supports antioxidant enzymes, spares vitamin E - Soil-dependent foods (nuts, seafood) - Deficiency: Keshan disease - Toxicity: Brittle nails, hair loss, nausea, and vomiting from high doses - Phytochemicals -- plant compounds that may reduce cancer and heart disease risk