Nutrition And Health Exam 1 Notes PDF
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University of Iowa
Madison Walton
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This document is a set of notes on nutrition and health for a university course, likely at the undergraduate level. It covers topics such as diet, food choices, nutrients, and dietary reference intakes.
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lOMoARcPSD|34709684 Nutrition and Health Exam 1 Notes Nutrition and Health (University of Iowa) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Madison Walton (madison.wa...
lOMoARcPSD|34709684 Nutrition and Health Exam 1 Notes Nutrition and Health (University of Iowa) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 Nutrition and Health Lecture Week #1 - Overview of Nutrition - Diet -- the foods and beverages a person eats and drinks - Develops into an eating pattern (person’s usual diet) - Food Choices - Improve health - Increase disease risk - What influences food choices? - Taste (#1 factor) and food preferences - Price - Time - Nutrition and weight control - Physiological influences (food allergy, intolerance) - Emotional comfort/associations - Positive and negative associations - Habit - Cultural meanings attached to food - Product safety (food recalls create hesitation) - Media - Social pressure (positive or negative) - Nutrients - Foods we consume provide us with nutrients - Substances that support growth, maintenance, and repair of body’s tissues -- indispensable to body’s functioning - Essential Nutrients -- body cannot produce for itself - Must consume from food - EX; essential fatty and amino acids - 6 Classes of Nutrients - Energy-Yielding Nutrients - Carbohydrate (4 kcal/g) - Lipids (9 kcal/g) - Protein (4 kcal/g) - Non-Energy Yielding Nutrients - Vitamins - Minerals - Water - Energy (kcal) contributor but not a nutrient - Alcohol (7 kcal/g) - What is a Calorie (kilocalorie)? - Measure of food energy Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Energy -- capacity to do work - Food energy is chemical energy - Calculating Calories - How much of these Nutrients do I need? - Dietary Reference Intakes - Includes - Estimated Average Requirements (EAR): the amount of a nutrient that meets the needs of 50% of the population for a specific function of that nutrient - Used in research and policy - Recommended Dietary Allowances (RDA): known amount of a nutrient, that meets the needs of almost the whole population (98%) - About adequacy or enough - If we have an RDA we have an EAR - Adequate Intakes (AI): amount of a nutrient that appear sufficient to meet the needs of 98% of the population - Adequacy Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Tolerable Upper Intake Levels (UL) - Telling us about toxicity (safety) - Above the recommended amount, it could have toxic effects - Chronic Disease Risk Reduction Intake (CDRR): amount of vitamin or mineral beyond which there’s chronic disease risk - Chronic disease (newly added) - One Last DRI Category - AMDR: Acceptable Macronutrient Distribution Range - CHO: 45-65% of energy (kcal) intake - Protein: 10-35% if energy (kcal) intake - Fat: 20-30% of energy (kcal) intake - Who do DRIs apply to? - Healthy people over 2 - Based on age and gender - Apply to average daily intakes - Assume diets contain a variety of foods - Each DRI category serves unique purpose Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Nutrition Objectives and Research - Healthy People 2020 (most recent guide) - Selected Nutrition and Body Weight Objectives - Chronic Diseases - Food Safety - Maternal, Infant, and Child Health - Food and Nutrient Consumption - Eating Disorders - Physical Activity and Weight Control - Food security - Government Sponsored Surveys - Tell us how we’re doing - NHANES: Nutrition Status Survey (DHHS) -- influence on health (and nutrition), it’s an examination survey - Measures nutrient intake AND - Health status - Lab Tests: cholesterol, blood glucose, etc. - Physical Exams and Measurements: height, weight, blood pressure - Informs “What We Eat in America” reports (tell us exactly how we’re doing in terms of our diet) - General Attitudes About Maintaining a Healthy Diet Nutrition and You: Trends - Roughly 42% of population claims “I’m already doing it” (maintaining a healthy diet and activity level) - More female than male - Nutrition is very important to them personally - 38% “I know I should” - Tends to be ages 35-54 - Want more practical tips to eat better - 20% “Don’t bother me” - More male, less likely to have college education - Least likely to be married - What About College Students? (in terms of diets) - Freshman 15 is myth - Body fat gain is more common in men than women - 5.2% for men - 2.9% for women - More than 50% - Don’t get recommended amounts of fruits/vegetables (5 cups) - 59% say their diet has declined through college - Changing Eating Habits Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Develop SMART goals (making changes to your diet to meet the MyPlate recommendations) - Specific - Measureable - Achievable - Relevant (realistic) - Timely - Important Themes for this Course - 1) Diet Planning Principles - Adequacy, balance, energy control, moderation, variety - 2) Total Diet Approach - Several weeks of time (eating habits) - 3) Food are main source of nutrients - 4) Regular PA - What is normal eating? Beginning to eat when your hungry and continue eating until you’re satisfied; it’s flexible and varies in response to your emotions Assignment 1.1 and 1.2 Concept Check - Malnutrition includes deficiencies, imbalances, and excesses of nutrients, alone or in combination, any of which can take a toll on health over time - Causes of death linked to nutrition: Heart disease, cancers, strokes, and diabetes - Identify the benefits associated with combining regular physical activity with a nutritious diet: Reduced body fat and increased lean tissue - Stress is the environmental factor is most likely to have the greatest impact on a person's health - Which list most accurately represents the categories of nutrition and weight-related objectives included in the publication of Healthy People 2020? Chronic Diseases, Food Safety, Maternal/Infant/Child Health Assignment 1.3 Concept Check - The body requires 6 types of nutrients: Carbohydrates (CHO), Lipids (fats), Proteins, Vitamins, Minerals, Water - Three energy-yielding nutrients are carbohydrates, proteins, and fat - Which macronutrient can yield energy and provide materials that form structures and working parts of body tissues? Protein - Micronutrients assist in all body processes - Which of the six classes of nutrients is foremost in quantity and must constantly be replaced? Water Assignment 1.4 Concept Check - Over 80% of our population consumes too few servings of fruit and vegetables each day, leading to the development of chronic disease more likely Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Which foods should form the basis of a nutritious diet? Whole foods that include ordinary milk and milk products; meats, fish, and poultry; vegetables and beans; fruits; and grains - A nutritious eating pattern should consist of each of the following characteristics: calorie control, moderation, adequacy - Taste prevails as the #1 factor driving people’s food choices - Eating away from home (e.g., at a restaurant) can negatively impact a person's diet in all the following ways: eating away from home increases intakes of calories, sodium, fat, and added sugar and also reduces intakes of fruits and vegetables Assignment 1.5 and 1.6 Concept Check - What is the first step in the scientific method? Observation and question - Each of the following is true about valid nutrition information: slow, well designed, unbiased, and repeatable - Six stages of behavior change in order: Precontemplation, Contemplation, Preparation, Action, Maintenance, Adoption/Moving On - Goals should be set for specific outcomes - Which action is most closely associated with the adoption/moving on stage of behavior change? After months or a year of maintenance without lapses, move on to other goals Assignment 1.7 and 1.8 Concept Check - List of convenience foods that are all nutrient-dense: ready-to-cook fresh vegetables, canned beans, and frozen vegetables - What source of information is linked to nutrition quackery? Anecdotal Evidence - Professional health organizations are the best Internet sources for credible nutrition information Nutrition and Health Lecture Week #2 - Dietary Guidelines - Components of a Nutritious Diet - Adequacy - thinking about enough; does our diet provide enough calories, nutrients and fiber to maintain health - Balance - making sure we have enough food groups in proportion to another - Moderation - need to set limits (added sugars, saturated fats) - Variety - within a food group (certain extent between food groups -- more balance - Select foods within the same food group but are different - Energy Control (kilo or calorie control) - stay in range of calories yet still get all of our nutrients - Nutrient Density - (mg per kcal) what amount of (g) a nutrient do I get per calorie consumed? - EX: 300 mg calcium in 1 cup milk - 85 kcal fat-free milk - 150 kcal whole milk Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - 300 mg / 85 kcal = 3.5 mg per cal - 300 mg / 150 kcal = 2 mg per kcal - Fat-free milk has more mg of calcium per kcal and thus is more nutrient dense than the whole milk - Energy Density - how much energy or kilocalories a food provides for the amount of food I consume? - EX: 857 kcal per 1 cup peanuts - 55 kcal per 1 cup popcorn - Popcorn has lower energy density (fewer kcal per cup than peanuts) - Calories in the numerator, amount is constant - High energy densities are more concentrated calories (athletes) - Dietary Guidelines: History and Development - 1980-2015 (updated every 5 years) - Currently have 2020-2025 Guidelines - Focus of the Dietary Guidelines - Purpose - Provide evidence-based advice throughout all stages of the lifespan - 2020 Guidelines are the first to cover infants and toddlers (up to 2 years of age) - Recommendations aim to: - Promote health - Prevent chronic disease - Meet nutrient needs by providing food and beverage recommendations - Targeted Audience - Policymakers, nutrition educators, and health professionals - Produced by - USDA (US Department of Agriculture) and HHS (Health and Human Services) - How often - Updated every 5 years - 4 Stages of Developing the Dietary Guidelines Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Committee Report vs. Dietary Guidelines - Committee prepares a report that is a complete review of the science - Leading nutrition, diet, public health experts write the report - USDA and HHS write Dietary Guidelines - Public engagement strengthens the process - USDA and HHS committed to a transparent, inclusive, and science-driven process - The Departments added new steps for engagement and kept the public informed - The Specific Dietary Guidelines - Healthy Eating Index based off of the quality of someone’s eating diet - Score between 80-100 (meeting guidelines), 60-80 (needing improvement) - 4 Guidelines - 1) Follow a healthy dietary pattern at every life stage - First set to focus on infants and toddlers (lifestage approach) Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - 2) Customize and enjoy nutrient dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations - 3) Focus on meeting food group needs with nutrient dense foods and beverages, and stay within calorie limits - 4) Limit foods and beverages higher in added sugars, saturated fats, and sodium, and limit alcoholic beverages; moderation - 1st Guideline - At every life stage (infancy → older adulthood) it’s never too early or too late to eat healthfully - For about the first 6 months of life, exclusively feed infants human milk and continue for the first year (longer if desired) - Feed infants iron-fortified infant formula during the first year of life when human milk is unavailable - Provide infants with supplemental Vitamin D beginning soon after birth - At about 6 months, introduce infants to nutrient-dense complementary foods along with potentially allergenic foods - Encourage infants and toddlers to consume variety of foods from all food groups - Include foods rich in iron and zinc, particularly for infants fed human milk - From 12 months → older adulthood, follow a healthy dietary pattern across the lifespan to meet nutrient needs - Help achieve a healthy body weight and reduce the risk of chronic disease - What is a Dietary Pattern? - Foods and beverages consumed over the course of any given - Day, week, or year - Represents totality of what individuals habitually eat and drink - And these act synergistically to affect health - Examples - Healthy U.S. - Style Dietary Pattern - Healthy Mediterranean-Style Dietary Pattern - Healthy Vegetarian Dietary Pattern - DASH Dietary Pattern (Dietary Approaches to Stop Hypertension) - 2nd Guideline - A healthy dietary pattern can benefit all individuals regardless of age, race, or ethnicity, or current health status Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - The Dietary Guidelines provides a framework intended to be customized to individual needs and preferences, as well as the foodways of the diverse cultures in the US - 3d Guideline - Nutrient dense foods provide vitamins, minerals, and other health-promoting components and have no or little added sugars, saturated fat, and sodium - A healthy dietary pattern consists of nutrient dense form foods and beverages across all food groups, in recommended amounts, and within calorie limits - The core elements that make up a healthy dietary pattern include: - Vegetables of all types -- dark green; red and orange; beans, peas, and lentils; starchy; etc. - Fruits; whole fruit rather than juices - Grains; at least half which are whole - Dairy; including fat-free or low-fat milk, yogurt, and cheese, and/or lactose-free versions and fortified soy beverages and yogurt as alternatives - Protein Foods; including lean meats, poultry, and eggs; seafood; beans, peas, and lentils; nuts, seeds, and soy products - Oils; including vegetable oils and oils in foods (seeds and nuts) - Only about 10% of population reaches the guidelines for vegetables - 4th Guideline - Small amount of sugars, saturated fat, or sodium can be added to nutrient dense foods and beverages to help meet food group recommendations, but foods and beverages high in these components should be limited - Limits are: - Added sugars - less than 10% of calories per day starting at age 2 - Saturated fat - less than 10% of calories per day starting at 2 - Sodium - less than 2,300 mg per day -- and even less for children younger than 14 - Alcoholic beverages - drinking in moderation by limiting intake to 2 drinks or less in a day for men and 1 drink or less in a day for women - Saturated Fats - Animal products - fatty meats, whole milk, cheese, icecream, tropical oils - Dietary Guidelines, 2020-2025 - Science-based recommendations Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Limiting intakes of added sugars and alcoholic beverages as recommended by the Committee, but doesn’t include changes to quantitative recommendations Nutrition and Health Module 3 - My Plate - My Plate = USDA’s Food Guidance System - Visual Representation of the Dietary Guidelines and USDA Food Patterns - Dietary Guidelines are implemented through MyPlate - MyPlate is used by professionals to help people become more aware of and informed about making healthy food and beverage choices - USDA’s Start Simple with MyPlate Campaign - 2011 - MyPlate developed - Proportionality - Benefits of Icon - Intent is to prompt consumers to think about building a healthy plate at meal times - Moving away from snacking/grazing - Supports Dietary Guidelines (in response to 2010 Guidelines) - Relevant themes - Easy-to-understand, action-oriented messages - USDA Goals - Provide easy-to-understand icon that delivers healthy eating messages - Empower people with information to make healthy food choices - Audience for MyPlate - Individuals and families (expanded to include them) - Federal agencies that oversee nutrition programs - Organizations and industry involved in providing nutrition advice to general public - Developing MyPlate Food Intake Patterns - Specific recommendations in terms of how much food from each food group - 4 Steps: - 1) Determine calorie (estimated energy requirement) needs - Age, sex, height, activity levels, weight - 2) Set nutrient goals - Based on age and sex (not PA) - What level of nutrients should each food intake pattern strive for? - Goals based on Dietary Reference Intakes* and/or Dietary Guidelines standards for - 9 Vitamins - 8 Minerals - 8 Macronutrients (protein, carbohydrates, fats) Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Separate nutrient goals set for each age/sex group based on their needs - *from National Academy of Sciences Institute of Medicine - 3) Calculate nutrient profiles for each food group, based on - Determine amount of a nutrient each food group provides - Food consumption - EX: What is the Vitamin A content of a typical dark green vegetable? - Cooked spinach 943 µg per cup (15% total consumption) - Cooked broccoli 153 µg per cup (36% total DGV cons.) - Nutrient Profiles - A profile is calculated for all nutrients in each food group and subgroup - Calculations are based on most “nutrient dense forms” or each food -- lean or lowfat, with no sugar added - 4) Construct food intake patterns that meet goals (put this all together) - Establish initial amount from each food group - Compare resulting nutrient content to nutritional goals - Change amounts from food groups stepwise - Identify groups or subgroups that are the most feasible nutrient sources - Check amounts recommended against typical consumption - Remaining calories after nutrient needs were met were identified as “discretionary (empty) calories” - Empty Calories (left over) - A concept first described by the 2005 Dietary Guidelines Advisory Committee originally as discretionary calories - Essential calories are the calories needed to meet nutrient requirements when consuming foods in lean, low-fat, and no-added sugar forms Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Empty (Discretionary) Calories May be used to: - Increase amount of food selected from a food group - Consume foods that aren’t in the lowest fat form -- such as 2% milk or medium-fat meat or items that contain added sugars - Add oil, fat, or sugar to foods - Consume alcohol (for those who consume alcohol) - Note: they may also be eliminated for individuals trying to lose weight - Range could be from 150-500 in this class - The 85-15 Guide - Percentage of calories needed to meet food group needs with nutrient-dense choices and percentage left for other uses - Generally 85% of calories are needed per day to meet food group recommendations healthfully, in nutrient-dense forms - 15% of remaining calories are available for other uses (added sugars and saturated fats) - MyPlate Food Groups and Current Intake (*Figure 2-6) - Vegetables: - Dark-Green Vegetables - Broccoli, chard, spinach, kale, mustard greens, collards - 2 cups of raw, leafy greens count as 1 cup on MyPlate - Red and Orange - Fresh, frozen, canned - Tomatoes, peppers, carrots, sweet potatoes, winter squashes - Consume far less than the recommendations - Beans, Peas, and Lentils (Legumes) - Legumes are either a vegetable or protein food - Cooked from dry, can, or frozen - Lima, pinta, (not green beans), split peas, black beans - Starchy Vegetables - Fresh, frozen, or canned - Plantains, white potatoes, peas, corn Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Other Vegetables - Celery, asparagus, beets, avocado, cauliflower, mushroom, onion, etc. - Fruits: - 1/2 cup of dried (more concentrated) fruit counts as 1 cup - Choose whole fruits (not the juice) - Grains: - Make 1/2 our grains whole - Make substitutions to eat whole grains instead of refined grains - Left image ages 19-30, right image ages 31-59 - What are whole grains? - Millet, Oats, Quinoa, Popcorn , Whole wheat breads/pasta, Brown rice (dark rye, pumpernickel) - What is an ounce? - 1 slice of bread; 1/2 cup of rice, pasta, cooked cereal; 3 cups popcorn; 1 cup ready to eat cereal - Grains are listed in ounces for recommendations (assists measurement) - Dairy - 1.5 ounces of hard (cheddar/swiss) cheese = 1 cup; 1/3 cup shredded cheese; 2 cups cottage cheese = 1 cup of dairy (not very nutrient dense) - Dairy Alternative = soy milk Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Protein Foods - Vegetarian protein sources include: egg (1 = 1 oz), tofu (1/4 cup = 1 oz), dried beans and peas (1/4 cup = 1 oz), nut butter (1 Tbsp = 1 oz), nuts and seeds (1/2 ounces = 1 oz) - Men often exceed expectation for intake - Using MyPlate Consumer Materials Chapter 2 Pre Assignment Concept Check - The Daily Values (DV) are U.S. dietary recommendations, which are used on food labels and for dietary planning and guidance. - Which nutrients are overconsumed in U.S. diets? Saturated fat and sodium - When diet planning, it is necessary to consume various foods from the subgroups of the main food group (e.g., dark-green vegetables and red and orange vegetables are the subgroups for the main group of vegetables) every day. False - All packages with food labels on them need to display information about every vitamin and mineral contained in the product. False - Functional Foods are whole or modified foods that contain bioactive food components believed to provide health benefits beyond the benefits that their nutrients confer; an example is/are blueberries 2.1 Concept Check - The Dietary Reference Intakes (DRI) has set recommended intake and limits for vitamins, minerals, and: carbohydrates, fiber, lipids, protein, water, and energy - The EAR establishes the average nutrient requirements for given life stages and gender groups that researchers and nutrition policy makers use in their work? Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - When determining calorie percentage range, 10–35% of calories should come from which macronutrients? Protein - The DRI apply to: healthy people only - The EER is set at a level predicted to maintain body weight for an individual of a particular age, gender, height, weight, and physical activity consistent with good health. 2.2 and 2.3 Concept Check - All of the following are key recommendations provided by the Dietary Guidelines: decreasing calories from added sugars and saturated fats, focusing on variety, nutrient density, and amount, following a healthy eating pattern across the life span - How much dried fruit equals 1 cup of fruit? 1/2 cup - What is the equivalent amount of meat to 1 tablespoon of peanut butter? 1 ounce - Solid fats, added sugars, and alcohol are considered empty calories and reduce nutrient density - Use oil instead of solid fats, when possible 2.4 Concept Check - Everyone's energy needs vary according to all of the following: gender, activity level, age - Individuals eating a 2,000-cal diet should aim for getting how many servings of vegetables per day? 2 1/2 cups - On the USDA MyPlate, fruits and vegetables should take up half the plate - Food Lists for Diabetes and Weight Management was originally developed for use not only by individuals with diabetes, but also people concerned about calories - One medium potato or piece of fruit is equivalent to the size of what common object? Tennis Ball 2.5 Concept Check - What has to be included on a food label? Essential warnings, such as alerts about ingredients that often cause allergic reactions or other problems, the name and address of the manufacturer, packer, or distributor, the ingredient list in descending order of predominance by weight and in ordinary language - Servings per container are the number of servings per box, can, or package - Health claims describe a relationship between a food or its components and a disease or health condition - A food that claims to be high fiber must have how many grams of fiber? 5 g - What does "Facts Up Front" refer to? Voluntary labeling initiative that puts various easy-to-read nutrition information on the front of the package Nutrition and Health Module 4 (Lecture 7) - Food Labels - What Food Labels MUST Include - The common or usual name of the product - The name and address of the manufacturer, packer, or distributor - Can be very vague (top or bottom of package; series of letters/numbers) Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - The net contents in terms of weight, measure, or count - Specific fluid ounces - Ingredients, in descending order of predominance by weight - Information within parentheses relates to original ingredient - Essential warnings (allergens) - Soy, milk, eggs, nuts - The nutrition contents of the product - Nutrition Facts panel - Required components - Only 50 % of people use/look at the Nutrition Facts panel - Nutrition Facts Panel - Includes the serving size and servings per container - The total, saturated, and trans fat all have to be included - Cholesterol, Sodium, Total Carbohydrates (dietary fibers and sugars), and Proteins must also be listed - Vitamins A and C are required - Calcium and Iron required - Daily Values (Nutrient Standards) - Nutrient standards that are printed on food labels - Based on nutrient and energy recommendations for a general 2,000 calorie diet - Why Are Daily Values Used on Labels? - DRI values vary from group to group - On a label, one set of values must apply to everyone - The Daily Values (DV) reflect the needs of an “average” person - Certain DV will be updated to reflect current DRI intake recommendations - Sodium, Dietary Fiber, and Vitamin D - DV are ideal for allowing comparison amongst foods - Because the DV apply to all people, they are much less useful as nutrient intake goals for individuals - Claims (2) Included on Food Label - 1) Nutrient - Descriptive Terms - EX: trans fat-free: less than 0.5 grams of both saturated and trans per fat per serving - 2) Health - Approved List - EX: “soluble fiber from daily oatmeal in diet low in saturated fat and trans fat may reduce the risk of heart disease” - Qualified Health Claims Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Claims backed by weaker evidence (label must state strength of evidence) - Structure-Function Claims - Describe beneficial effect of substance on body - Doesn’t make reference to a specific disease - Legal but largely unregulated - Changes to Nutritional Facts Panel - FDA oversees changes - Features a refreshed design - Reflects updated information about nutrition science - Updates to serving sizes and labeling requirements for certain package sizes - Much larger font for calories given - Serving size is bolded and in larger font (servings per containing is listed above) - Percent Daily Values still based on a 2,000 calorie diet but now match the DRIs for Sodium, Fiber, and Vitamin D - Total sugars - Vitamins A and C no longer listed - Vitamin D, Calcium, Iron, and Potassium added - Inverse relationship between amount of Sodium in food and Potassium - When Are These Changes Being Made? - Original implementation date -- July 26, 2018 - May 2018: FDA announces compliance date extension to Jan 1, 2020 - Front of Package Labeling - Institute of Medicine calls for model front-of-package system that all manufacturers should be using - Package should include calories per serving - Basis of symbol should be (calories per serving) - Saturated fat - Trans fat - Sodium - Added sugars - Need something less confusing (just these listed above) - Smart Supermarket Shopping - Best locations for products (sell best) - Eye level - End of aisles “end caps” (better deals/products) - Cash registers - Shop the perimeter - Produce, dairy, whole grains, lean meats - Shop from a list Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Less impulse buys and wastes - Don’t go shopping hungry Nutrition and Health Module 5 (Lecture 8) - Food Safety - Food Safety - Illnesses - Symptoms - Onset of symptoms - Duration of symptoms - Prevention - Infections vs. Intoxications - Infections - illnesses caused by specific microbacteria, a virus - Intoxications - food borne illness caused by toxins that microbe produces - Food Borne Illnesses caused by Infection - Salmonella - Food sources - raw eggs and poultry, cross-contamination - Symptoms - abdominal cramping, fever, diarrhea, vomiting - Onset of symptoms = 1-3 days - Duration of symptoms = 4-7 days - Hepatitis A - caused by viral agent - Food sources - none particular (spread from infected food worker; salad bar type items) - Found in urine - Symptoms - diarrhea, dark urine, jaundice - Onset of symptoms - 2 weeks to 3 months E. coli - Food sources - undercooked ground/red meat - Found in digestive tract of cattle - Cross contamination (romaine recalls) - Symptoms - severe diarrhea (often bloody), abdominal pain, vomiting, usually no fever, possible death in children/older adults (seek immediate treatment) - Onset of symptoms = 1-8 days - Duration of symptoms = 5=10 days - Noroviruses (Gastroenteritis) - stomach flu - Food sources - none specifically; spread from infected worker to food - Very easily spread - Symptoms - nausea, diarrhea, headache, low-grade fever - Onset of symptoms = 12-48 hours after exposure - Duration of symptoms = 12-60 hours Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - 90% pathogenicity - Listeria - Food sources - found in soft, wet cheeses (brie, feta, bleu), cold-cuts (deli meats), smoked fish - Special populations - pregnant/breastfeeding women and young children - Symptoms - fever, muscle aches, vomiting (can be fatal for fetal and young children); can cause meningitis - Onset of exposure = 1-21 days - Duration of symptoms = 3-4 days to several weeks - Campylobacter - Food sources - raw milks, uncooked chicken, tap water - Symptoms - diarrhea, vomiting, abdominal cramps, fever - Onset of symptoms = 2-5 days - Duration of symptoms = 2-10 days - Foodborne Intoxication - Staphylococcal Aureus - toxins produced cause these symptoms - Food sources - no particular food (bad hygiene -- spread) found on/in our body naturally - Symptoms - nausea, vomiting, cramps - Onset of symptoms = 1-6 hours - Duration of symptoms = 1-2 days - Pathogenicity for all food-borne illnesses isn’t 100% - Just because exposed, doesn’t mean everyone gets infected Nutrition and Health Module 5 (Lecture 9 CONT) - Preventing Food-Borne Illnesses - Fight BAC! Consumer Campaign - 4 components: clean, separate, cook, chill - 1) Clean - Hands - washed before/after preparing foods - Seafood, eggs, meat - Hot soap and water, clean paper towel - Surfaces - Avoid cross-contamination - Foods - Vegetables and fruits (rinse, cut first) - Seafood, meat, and poultry - 2) Separate - from foods that are ready to eat, raw, or contain harmful microbes - From purchase to preparation to serving/storing - Use clean and separate cutting board for clean produce vs. raw meats - 3) Cook and Chill - Keep cold foods at 40 degrees F or below Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Keep hot foods at 140 degrees F or above - Avoid temperature danger zone - make sure foods aren’t kept > above 40 or less than < 140 for more than 2 hours - Bacteria and viruses are more likely to multiple in this zone - Use proper cooling techniques - Put food into smaller containers to cool quickly - Refrigerator Calculator - days, weeks, opened - How long it is to keep food - Foods should always be thawed in fridge (over 24 hour period) - Effectiveness of HACCP - Developed for industry - Hazard Analysis Critical Control Points - Reduction in - E. coli (Healthy People 2010 goal met) - Salmonella - Still leading cause of hospitalization and deaths - Due to better practices in - Processing - Inspections (making sure you hold processors responsible) - Food establishments - Consumer behaviors - When Making Food Safe: From Farm to Plate Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Other Food Safety Concerns - Mercury - Found in high levels of creditory fish (stored in flesh) - Certain individuals are more susceptible - Pregnant women, breastfeeding women, young children/infants - DO NOT EAT - Swordfish, Shark, Tilefish, and King Mackerel - Large predatory fish (very high levels of Mercury) - Can cause delays in fine motor skills - Limit other fish to 12 oz/week (not in conflict with MyPlate) - Albacore Tuna - only 6 oz/week Chapter 12 Concept Checks - All of these groups are vulnerable to harm from foodborne illness: infants, HIV/AIDS patients, pregnant women, adolescents, elderly - Pasteurization is the heating process that kills most of the pathogens in milk, juices, and eggs to reduce the risk of foodborne illness - These foods are at high risk for causing a foodborne illness: Sprouts, ground meats, raw produce - Antibiotic-resistant bacteria and persistent environmental contaminant (ex. mercury) pose threats to our food supply 12.1 Concept Check - Botulinum is an intoxication microbe and NOT an infectious microbe - Clostridium botulinum is the most infamous toxin because it is so deadly; can be found in canned foods and home fermented foods such as tofu - What population groups are most vulnerable to harm from foodborne illnesses? Older adults - What three conditions are necessary for bacteria and pathogens to thrive in foods? - Bacteria, viruses, fungi, and other microbes capable of causing illness are pathogens 12.6 and 12.7 Concept Check - Common additives to improve food safety and quality include all the following: nitrites, salt, sulfates - Sucralose, aspartame, monosodium glutamate are all FDA-approved flavor enhancers - Fat replacers and artificial fats are used in foods to provide all the following benefits: texture, cooking qualities, taste - What does the application of a common-sense approach to food safety include? Food handling, temperature, and time sitting out Nutrition and Health Module 6 - Digestion and Absorption (Week 4) - Cells, Tissues, Organs and Systems - Cells organized into tissues Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Perform specialized tasks - EX: muscle - Tissues grouped together to form organs - EX: liver - Organs work together as part of body system - EX: digestive system - Body Systems - Cardiovascular - Effect of diet and PA on system - Hormonal and Nervous System - Digestive process, vitamins and minerals - Immune System - Digestive - Digestive and Absorption - Digestive Tract Organs: - Mouth - chews and mixes food with saliva - Esophagus - passage organ (passes food from mouth to stomach) - Stomach - churns, mixes and grinds food; includes acids, enzymes, fluids, to produce that chyme that leaves the stomach - Chyme - passes through digestive system (no longer recognizable of food); highly acidic - Small Intestine - digests CHO, protein, and fat absorbs nutrients - Primary site of digestion and absorption - Large Intestine - reabsorbs water and minerals - Waste (in form of an insoluble fiber, bacteria, unabsorbed nutrients) are passed along with water to the rectum prior to being excreted from the body - Accessory Organs - Salivary Glands - secrete saliva - Saliva begins the process of carbohydrate (starch digestion in mouth) - Liver - produces bile - Bile = detergent-like substance that helps to facilitate the digestion of fats; emulsifier helping us digest and absorb fat - Emulsifier → attracts the water and fat and brings them together; facilitates the digestion of fat - Gallbladder - stores bile until needed - Bile Duct - carries bile from gallbladder to small intestine - Small intestine is where the bile acts in the digestion and absorption of fats Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Pancreas - produces enzymes and bicarbonate - Pancreatic Duct - conducts pancreatic juices (enzymes and bicarbonate) - Enzymes end in -ase - Sphincter Muscles - Strong, circular muscles found at specific points along digestive tract that help to regulate the flow of food and eventually waste from our bodies - Lower (Cardiac) Esophageal Sphincter - helps regulate passage of food from the esophagus into the stomach - Helps prevent food from moving back up from the stomach into esophagus - Heartburn - Pyloric (Valve) Sphincter - regulates passage of food from stomach to the small intestine - Another name for stomach = pylorus - Ileocecal (Valve) Sphincter - helps regulate the passage of food from small intestine to the large intestine - Anus - regulates waste from our large intestine (colon) to the outside of our body - l and Chemical Digestion - Mouth - crushing and grinding action - Tongue moves food particles around (to back of mouth) - Saliva helps moisten food particles - Taste receptors on tongue - Esophagus - after swallowing, food enters this tube - Movement of food from top to bottom occurs via peristalsis - Peristalsis - wavelike muscular contractions that help push the food down esophagus towards the stomach (also occurs in stomach and small intestine) - Epiglottis - small flap of skin that covers the trachea, so when you swallow, the food enters your esophagus and not airway; helps prevent choking - Stomach - cells release gastric juice (water, enzymes, hydrochloric acid); strong in acidity (can damage stomach lining) - Hydrochloric Acid makes chyme - Powerful muscles of stomach help to mix food with gastric juices - Protective mucus lining to help against highly acidic gastric juices - Can be damaged with ulcer - Stomach walls can be expanded to hold capacity of 4 cups - 32 ounces of food/liquid - Gastrin - helps to regulate the digestive enzymes in stomach Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Promotes the release of hydrochloric acid - Signal that the cells of stomach get to release the hydrochloric acid - Gastric inhibitory hormone - inhibits the quick release of chyme at this point from stomach to small intestine; slowing digestion process - Small Intestine - major organ of digestion and absorption - Finishes what both mouth and stomach started - Villi and microvilli (finger-like projections) absorb nutrients which pass into blood or lymphatic system - Lymphatic system absorbs fat-soluble vitamins and large chain fatty acids or large fats - Figure 3-13 shows details of small intestinal lining - Has 3 sections: duodenum, jejunum, and ileum - 1) Duodenum - first part, where digestion is occurring - 2) Jejunum - involved in absorption - 3) Ileum - absorption - Does not have protective mucus lining - Liver - synthesizes bile - Bile is reabsorbed - Gallbladder - stores bile - Cholecystokinin (CCK) - hormone that is stimulated by the presence of fat in small intestine - Stimulates or signals gallbladder (or liver) to release bile - Pancreas - bicarbonate is manufactured - Bicarbonate is going to neutralize the chyme when it gets into small intestine - Secretin - hormone that stimulates the pancreas to release those bicarbonate juices - Manufactures enzymes - Large Intestine - only undigested food is passed to colon - AKA colon (includes rectum) - Undigested food (fiber) provides bulk against which the large intestine muscles work to help excrete that waste - Table 3-2 summarizes digestion Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Food spends least amount of time in mouth, most amount in colon - Methods of Absorption - 3 different methods - 1) Simple Diffusion - process where water and small lipids are absorbed - Able to freely cross the intestinal cells and move into bloodstream or into lymphatic system - 2) Facilitated Diffusion - how water soluble vitamins are absorbed - Specific carrier or change to cell membrane - 3) Active Transport - glucose and amino acids are absorbed - Must move against a concentration gradient (energy required) - Problems in Digestive Tract - Diarrhea - frequent, loose stools occur (aggravated DT) - Could be due to foodborne illness, type of infection; your body is trying to rid itself of some foreign organism - Treatment - bowel rest, consume low-fiber foods, drink plenty of fluids - Constipation - difficult/painful bowel movements - Prevention - high-fiber diet (whole grains), drink plenty of water/fluids, exercise regularly - Gas and Belching - belching (burping), flatulence (gas excretion) and abdominal bloating - Prevention - eat slowly, choose bothersome foods in moderation - Heartburn - burning sensation in chest - Lower (Cardiac) Sphincter weakens - Specific foods or behaviors that can weaken; peppermint, spearmint, chocolate, wine, smoking - Prevention - eating smaller meals, sit up while eating, don’t lay down for 1 hour after eating or exercise for 2 hours after - Gastric Bypass Surgery - treatment for obesity - One of most common types = Roux-en-Y - Creates a new stomach or a pouch (from old stomach) that holds 3-6 ounces of food created - Smaller quantity intake - Bypass Component; fewer calories are consumed - When surgery is done, new pouch/stomach completely bypasses the duodenum and first 15-20 cm of the Jejunum (absorption occurring here) Chapter 3 Concept Checks - The lymphatic system carries waste away from the cells of the body, and the cardiovascular system ensures that the fluid in the body circulates through all of the tissues of the body Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - All of these are examples of the importance of hormones for nutrition: signaling to the body during times of stress, which influences hunger, helping regulate satiety and hunger, signaling to the brain about body fatness, and helping regulate the digestive system - Microvilli help(s) increase absorption in the intestines - Carbohydrates CANNOT be stored in large quantities in the muscle and liver cells 3.1, 3.2, and 3.3 Concept Check - Body's cells need energy, oxygen, and nutrients to remain healthy and do their work - Genes direct the making of each cell's protein machinery, including enzymes - What role do organs play in the body? They work together in body systems - What is the role of blood and lymph? Deliver needed materials to all the body's cells and carry waste materials away - The nervous system and hormonal system do all of the following: regulate body processes, govern the act of eating and regulate digestion, respond to the need for food 3.4 and 3.5 Concept Check - Peristalsis moves the digestive tract contents through the esophagus, stomach, and small intestine - Which digestive organs release digestive juices that perform the complex chemical process of digestion? Salivary glands, stomach, pancreas - The small intestine is lined with thousands of folds covered with villi, which make the surface area for absorbing nutrients much greater - The digestive system feeds the rest of the body and is itself sensitive to malnutrition - What may help alleviate the symptoms of Irritable Bowel Syndrome (IBS)? Exercise, antibiotics, and antispasmodic drugs 3.6, 3.7, and 3.8 Concept Check - The kidneys adjust(s) the blood's composition in response to the body's needs, disposing of everyday wastes and helping remove toxins - Where does the body store limited amounts of carbohydrate as glycogen? Muscle and liver cells - Fat is not a required part of every meal since it is stored abundantly Chapter 1 Practice Test 1) The study of nutrients in food and in the body is referred to as nutrition and is sometimes called the study of human behaviors related to food. We get our energy from the foods we eat to move and work. It comes indirectly from the sun by way of plants. Unfortunately, malnutrition is an imbalance of either excess or too few nutrients and can affect health in the long-term, potential development of chronic disease Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 2) Foremost among the six classes of nutrients in foods is water, the most important essential nutrient 3) What is the unit used to measure energy in foods? It is the amount of heat energy necessary to raise the temperature of 1 kg (1 L) of water 1°C. Calorie 4) Single studies must be replicated before findings can be confirmed and considered valid 5) Foods contain phytochemicals, compounds that confer color, taste, and other characteristics of foods. Foods that have been around a long time, such as vegetables, fruit, and meats, are whole foods, while processed foods are foods that may have been subjected to milling, texture alterations, or cooking. Rice, potatoes, or corn are staple foods that provide a foundation for a healthful diet 6) One cup of vanilla milkshake provides 254 cal and 332 mg calcium; one cup of nonfat milk has 86 cal and 301 mg calcium. Choosing the nonfat milk would be an example of applying the principle of nutrient density 7) Carbohydrates are macronutrients made of simple sugars and yield 4 cal/g energy. Proteins are macronutrients made of amino acids and also yield 4 cal/g energy. Fats are macronutrients with the highest energy yield, 9 cal/g energy. 8) How many calories are provided by a food that contains 29 g carbohydrate, 6 g protein, and 1 g fat? 149 9) Many agencies are involved in nutrition policy development, research, and monitoring. Which large program of studies is designed to assess the health and nutritional status of adults and children in the United States by conducting interviews and physical examinations? National Health and Nutrition Examination Surveys (NHANES) 10) Dark leafy greens, red bell peppers, broccoli, and carrots are examples of nutrient dense foods, unlike chips, buns, and donuts Chapter 2 Practice Test 1) What are a set of five lists of values for dietary nutrient intakes of healthy people in the United States and Canada? Dietary Reference Intakes 2) What set of values establishes nutrient requirements for given life stages and gender groups that researchers and policy makers use in their work? Estimated Average Requirements Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 3) The Acceptable Macronutrient Distribution Range (AMDR) sets healthy range intakes for all of the following macronutrients EXCEPT which one? Sugar 4) The term Daily Values appears on food labels 5) A day’s meals that provide 260 g carbohydrate, 30 g protein, and 60 g of fat are 1,700 cal. The percentage of calories from carbohydrate is 61%, the percentage of calories from fat is 32% and the percentage of calories from protein is 7% 6) Consider the day’s meals from the prior question, which provides 260 g carbohydrate, 30 g protein, and 60 g fat. The percent calories from fat is within the recommended level of 20-35%, the percent calories from carbohydrate is within the recommended level of 45-65% and the percent calories from protein is less than the recommended level of 10-35% 7) The Food Patterns suggest that at least half of the grains in a day’s meals be whole grains. Varying food choices among and within foods groups helps to ensure adequate nutrients and also protects against large amounts of toxins or contaminants from any one source 8) The subgroups within the vegetable group in the USDA Eating Patterns are dark green vegetables (spinach), red and orange vegetables (peppers), legumes, starchy vegetables, and others 9) All of the following are recommendations of the Dietary Guidelines for Americans: focus on a variety of foods, limit calories from added sugars and saturated fats, support healthy eating patterns 10) What are the subgroups within the protein foods group in the USDA Eating Patterns? Seafood; meats, poultry, and eggs; and nuts, seeds, and soy products 11) Based on the USDA Eating Patterns, which of the following would be recommended as primary sources of fats in the diet? Olive oil, peanut oil, and oils that occur naturally in fatty fish 12) The Dietary Reference Intakes (DRI) Committee recommends a diet that contains what percentage of its calories from fat? 20-35% 13) The Nutrition Education and Labeling Act of 1990 set the requirements for nutrition labeling information. According to law, every packaged food must state the following: The common name Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 of the product, the name and address of the manufacturer, the net contents in terms of weight, measure, or count, the ingredients in descending order of predominance by weight Chapter 12 Practice Test 1) Microorganisms may cause foodborne illness either by infection or by intoxication. E Coli is a foodborne bacterial infection resulting in severe bloody diarrhea, abdominal cramps, and vomiting that typically lasts 5-10 days. Contaminated water, infested with this organism, can be treated by boiling (heat) the water 2) Temperature is the most critical factor in keeping meat safe to eat. Ground meat and poultry should be cooked to the well-done stage. Due to sanitation mistakes made by growers and producers and the difficulty of removing biofilm, raw produce poses a threat of foodborne illness 3) Foods need to be refrigerated immediately after serving a hot meal that was maintained at 140°F in a buffet line yet definitely before 2 hours have passed to prevent bacterial growth 4) Chilling green salads is a must because temperatures above what temperature causes a dangerous change in E. coli bacteria strains, which can make the consumer sick? 50 degrees F 5) Your friend drops food on the floor and says "5-second rule." He picks it up and before he puts it in his mouth, what do you say? "Food that drops on the floor becomes contaminated as soon as it lands." Chapter 3 Practice Test 1) Most nutrients are absorbed into the bloodstream via the intestine and then directed to the liver, which rids the blood of toxins. This nutrient-rich blood goes to the heart, through the lungs, and then back through the heart out to the body cells. Arteries carry blood away from the heart to the cells, and veins carry blood back into the heart 2) True statements about hormones and nutrition: Hormones help regulate the body's reaction to stress, Hormones help regulate hunger and appetite, Hormones carry messages to regulate the digestive system in response to meals or fasting, Hormones can regulate blood glucose levels 3) Churning, mixing, and grinding of food into a liquid mass is completed in the stomach. The pancreas releases bicarbonate to neutralize stomach acid. The small intestine is lined with cells that absorb nutrients into the blood and lymph. Bile is produced in the liver to help emulsify fats for better absorption of lipids. Waste (any unabsorbed nutrients, fiber, bacteria) and some water absorption occurs in the large intestine Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 4) Which of the following choices correctly ranks fluids in order from the most acidic (lowest pH) to the least acidic (highest pH)? gastric juice > coffee > saliva > pancreatic juice 5) The liver converts excess energy-containing nutrients into which two storage forms? glycogen and fat 6) What should be consumed at intervals throughout the day because it can be depleted from its storage? Carbohydrates 7) Lymph vessels in the intestine absorb most of the fats present in a meal to then distribute them to the bloodstream 8) After a calorically dense meal when the stomach is too full, the acidic juices can travel back up the esophagus and cause heartburn 9) The digestive system’s first major task is to break down food to its components. Then, it must absorb the nutrients and some non-nutrients, leaving behind the substances that are appropriate to excrete. To do this, the system works at two levels, one l and the other chemical 10) Where does most of the body's nutrient absorption take place? Small Intestine 11) Bicarbonate is responsible for neutralizing the stomach acid that has reached the small intestine The 7 major categories of nutrition and weight-related objectives included in the publication Healthy People 2020. 1) Chronic Diseases: reduce death rates, annual number of new cases 2) Food Safety: reduce outbreaks, severe allergic reactions 3) Maternal, Infant, and Child Health: reduce occurrence of FAS, reduce blood lead levels 4) Food and Nutrient Consumption: increase vegetables, fruit, whole grains 5) Eating Disorders: reduce proportion of adolescents who with disordered eating behaviors 6) Physical Activity and Weight Control: reduce proportions of those who are obese 7) Food Security: eliminate very low food security among children The 6 stages of behavior change Stage and Characteristics: - Precontemplation: no intention of changing, see no problems with current behavior - Contemplation: admit change may be needed, weigh pros/cons of changing and not changing - Preparation: preparing to change specific behavior, taking initial steps, and setting some goals Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 - Action: committing time and energy to making a change; following a plan set for a specific behavior change - Maintenance: striving to integrate the new behavior into daily life and striving to make it permanent - Adoption/Moving On: former behavior is gone, new behavior is routine Many phytochemicals are believed to be bioactive food components -- food constituents other than the nutrients that alter the body process Many phytochemicals known to have antioxidant activity, and antioxidants in the body protect DNA and other cellular components from oxidative damage Flavonoids (a common and widespread group of phytochemicals) of blueberries; helps maintain mental sharpness Microbial Foodborne Illnesses Caused by microbes (pathogens); infection or by intoxication, mild stomach pain, headache, paralysis and death Some bacteria produce enterotoxins or neurotoxins, poisonous chemicals that they release as they multiply EX: E Coli, Salmonella, Norovirus, Campylobacter, Clostridium Foods (produce normally) high in moisture and nutrients, or chopped or ground Without proper refrigeration, bacteria is likely to grow quickly 6 Basic Needs of the Body’s Cells Energy, and the oxygen with which to burn it Water to maintain the environment which they live Building blocks and control systems Essential nutrients they can’t make themselves; supplied by food Hernia = protrusion of an organ through the wall of a body chamber Ulcer = eroded spot in topmost layers of cell that form a lining; common in esophagus, stomach, upper small intestine Kidney = waste and water removal specialists, filter passing blood Working units = nephrons Liver = processes waste that are pulled out of bloodstream and processes these wastes, either tossing them out into digestive tract with nile, or preparing to be sent to kidneys for disposal in urine Major storage sites = liver and muscles, which store carbohydrate, and the fat cells, which store fat and other related substances Downloaded by Madison Walton ([email protected]) lOMoARcPSD|34709684 Nutrients collected from the digestive system move through a vast network of capillaries that weave among the liver cells Liver -- collects excess energy-yielding nutrients and converts them into two storage forms—glycogen (a form of carbohydrate) and several kinds of lipids, or fats Liver packages fats to be shipped out to other parts of body Where does most of the body's nutrient absorption take place? Small Intestine Bicarbonate is responsible for neutralizing the stomach acid that has reached the small intestine Most nutrients are absorbed into the bloodstream via the intestine and then directed to the liver, which rids the blood of toxins. This nutrient-rich blood goes to the heart, through the lungs, and then back through the heart out to the body cells. Arteries carry blood away from the heart to the cells, and veins carry blood back to the heart. Downloaded by Madison Walton ([email protected])