Nutrition Midterm Guidance PDF

Nutrition Midterm Guidance Energy in Nutrition (week 1): o Calculating energy requirements ▪ Know what pieces of information you need for the Mifflin-St. Jeor equation. You will not be calculating kcals. Males: REE= 10(weight) + 6.25(height...

Nutrition Midterm Guidance Energy in Nutrition (week 1): o Calculating energy requirements ▪ Know what pieces of information you need for the Mifflin-St. Jeor equation. You will not be calculating kcals. Males: REE= 10(weight) + 6.25(height) - 5(age) + 5 Females: REE= 10(weight) + 6.25(height) - 5(age) - 161 REE=resting energy estimate Total energy estimate = REE x (exercise) o Calculating calories based upon macronutrient count (nutrition labels) ▪ Know kcals for each of the macronutrients and be able to calculate total calories with macros given (e.g., how many calories in an item with 50g carbs and 25g protein?) Fat = 9 kcal/g Carb = 4 kcal/g Protein = 7 kcal/g o Physical activity needs – general recommendations ▪ Cardiorespiratory: adults 150 min of moderate intensity/week 30-60 min of moderate intensity 5x/week 20-60 min of vigorous intensity 3x/week ▪ Resistance: adults should train major muscles group 2-3x/week using a variety of movements Old ppl or previously sedentary ppl – very light-light intensity 2-4 sets each exercise to improve strength and power 8-12 reps to improve strength and power 10-15 reps to improve strength in middle-older ppls 15-20 reps to improve muscular endurance Wait 48 hrs bn resistance training sessions (fuck that) ▪ Flexibility: adults should do 2-3 days/week to improve ROM Hold 10-30 sec to pt of tightness or slight discomfort 2-4 x for total of 60 sec Warm muscles before stretching ▪ Neuromotor: functional fitness ☺ adults 2-3x/week Should improve motor skills, proprioception, and multifaceted activities to improve physical function and prevent falls in old ppl 20-30 min/day Risk from sedentary behavior is independent of physical activity Protein/Amino Acids: o Milk alternatives in infants (general) ▪ Commercially available formula NOT goat’s milk o Protein RDA (adult) and upper limit/tolerable upper intake ▪ Know how to calculate protein needs ▪ RDA (adult) = 0.8g / bodyweight in kg / day Athletes 1.2-1.8 g / bodyweight in kg / day No upper limit o May cause dehydration due to excretion of large amounts of urea/nitrogenous waste from protein catabolism WHO says avoid exceeding 1.5g/kg/day 100-125 g/day for max protein synthesis o Glycogenesis: glucose broken down to form 2 pyruvate (inhibited by ATP) ▪ 3 irreversible enzymatic rxn: 1. Hexokinase 2. PFK – cell is committed to metabolizing glucose for energy, rather than storing it 3. Pyruvate kinase o Glycogenolysis: glycogen breakdown to glucose (for energy) ▪ Liver: glycogen breakdown to increase blood glucose ▪ Muscle: glycogen breakdown for muscle cell energy ▪ Caffeine inhibits this (via glycogen phosphorylase inhibition) o Gluconeogenesis: glucose converted to glycogen (storage) ▪ In liver and skeletal muscle ▪ Inhibited by AMP ▪ 1st step: glucose 🡪 G-6-P Happens fastest during normal blood glucose concentrations Muscle: hexokinase Liver: glucokinase (inducible by insulin) o Protein and athletes ▪ Athletes 1.2-1.8 g / bodyweight in kg / day ▪ Can be up to 3 g/ kg + 1g / kg in supplemental protein Ineffective in muscle gain according to WHO Little effects on performance Retention of nitrogen (might be an indicator of protein status Strength/power and body builders are more at risk for excess consumption  ▪ Diff to quantify max protein ▪ Excess protein can put athletes at risk for consuming inadequate CHO for glycogen stores o Bones ▪ Protein is acidic ▪ Fruits and veggies supply bicarb which as a buffer Impacted by the amount of Ca+ consumed with protein ▪ More protein = more Ca+ excreted (Ca+ necessary to buffer acidic blood ▪ Research varies 🡪 some say catabolic and some say anabolic effects ▪ Anabolic effects more commonly found in old ppl (women) Protein consumption increases serum IGF-1 o Satiety ▪ Stimulates nucleus tractus solitarius and arcuate nucleus CCK Peptide YY GLP-1 ▪ Diminished brain reward systems Reductions in limbic regions related to food motivates with higher protein breakfast ▪ Important for weight loss o kidneys ▪ Damage usually only a concern if there is previous kidney damage ▪ Stones are debatably a concern at stupid levels and more common in men ▪ Plant sources may be better than animal Nitrogen Use Dose Adverse effect Conditions compounds Carnitine Transports FA across mito 1-2g/day in Diarrhea Keto diets (due to high membrane adults fat content) - Needs Fe, B6, vitamin C, B3 for carnitine synthesis Heart disease (increase -Found in meats like beef or pork available energy to -Absorption saturated at ~2g heart cells) -Depletion: carnitine deficiency 🡪 impaired metabolism Tryptophan Precursor to B3, serotonin, 1-2 g 30 min Drowsiness -Insomnia 1-2d at melatonin, picolinic acid before bedtime Nausea bedtime  -Low: Crohn’s, EtOH, lactose Diarrhea -Adding niacinamide intolerance, fructose intolerance Large dose: may increase efficacy -Malabsorption 🡪 tryptophan Nystagmus -Migraines binds to sugars in GI tract Euphoria -Contra indicated for pregnancy Hyperactivity and anti-depressants (increases efficacy) Glutamine Alanyl-glutamine more stable and 1-30 g/day >30g/day Acute pancreatitis better absorbed 🡪high BUN Peptic ulcers.5-1g Conditionally essential 2-3x/day Fuel source for s. intestine Chemo: 24-20g/day Increase immune function Synth and stored in skeletal muscle Depletion: physical stress, lower muscle mass Contraindication: liver failure, Crohn’s Methionine Essential 1-6 g/day >8g/day and Pancreatitis often in Most toxic AA empty stomach possibly lower combo with selenium, Needed for carnitine and SAM or low protein Increase vitamin E and C, synthesis meal homocysteine beta-carotene levels 🡪 might parkinson’s improve w/ UTI: acidifies urine B6, B9, B12 diaper rash supplements o Phenylketonuria: unable to convert phenylalanine to tyrosine by PAH in the liver ▪ Pathway in Fe dependent ▪ BH4 is cofactor ▪ Autosomal recessive ▪ 1:10,000 in US ▪ Leads to neurologic problems if untreated ▪ Treatment: low protein diet and supplement with phe-free protein ▪ Aspartame contains phenylalanine o Protein digestion, metabolism (destination) ▪ PDCAAs: Protein digestibility corrected AA score Indicator of protein quality Compare limiting AA of a test protein with reference protein (egg/milk) True digestibility of the protein determined by testing fecal nitrogen  Equation: (𝑎𝑚𝑜𝑢𝑛𝑡 (𝑚𝑔) 𝑜𝑓 𝑙𝑖𝑚𝑖𝑡𝑖𝑛𝑔 𝐴𝐴 𝑖𝑛 1𝑔 𝑡𝑒𝑠𝑡 𝑝𝑟𝑜𝑡𝑒𝑖𝑛) 𝑃𝐷𝐶𝐴𝐴𝑆 (%) = (𝑎𝑚𝑜𝑢𝑛𝑡 (𝑚𝑔) 𝑜𝑓 𝑠𝑎𝑚𝑒 𝐴𝐴 𝑖𝑛 1𝑔 𝑟𝑒𝑓 𝑝𝑟𝑜𝑡𝑒𝑖𝑛) * 𝑡𝑟𝑢𝑒 𝑑𝑖𝑔𝑒𝑠𝑡𝑖𝑏𝑖𝑙𝑖𝑡𝑦 Scores: o 100% PDCAAS = milk protein, egg white, ground beef, tuna, some other natural animal products o 94% PDCAAS = Soy o 100 Reference protein: o Infants: human milk o Other: use chart – I don’t have time to memorize that shit o Protein requirements ▪ Adults: Minimum: 0.8g/kg/day AMDR: 10-35% of energy intake ▪ Kiddos: Preterm: 3.5-5g/kg/day 0-12 months: 1.5 g/kg/day 1-3 yrs: 1.1g/kg/day 4-13 yrs: 0.95g/kg/day 14-18 yrs: 0.85g/kg/day o BCAA’s ▪ Leucine, isoleucine, and valine Essential: thought to promote anabolic pathway First site of metabolism in skeletal muscle Oxidation of leucine produces more ATP than gluciose Leucine oxidized well during fasting ▪ Dose: up to 20g/day in divided doses ▪ Upper limit? 🡪 500 mg/kg/day for healthy men ▪ Adverse effects: unlikely; correlated with some conditions like DM and CHD ▪ Conditions: Liver failure May attenuate post exercise muscle soreness o Doesn’t appear to help improve performance  o Newborn screening – general ▪ 31 disorders 6 AA 5 FA Many others have nutritional components ▪ Blood spot heall stick 1st screening 24-36 hrs post birth 2nd 5-10 days old 3rd screeninf in case of false + o Marasmus vs Kwashiorkor (general) Disease Marasmus Kwashioker Cause Wasting: severe Edematous wasting: low undernourishment protein Sx Underweight Edema in legs, face, belly inadequate muscle and Inadequate protein in fat blood causes water to Low bone density move out of the blood and Drooping skin into the interstitial space Tx Food all macros Protein Carbohydrates: o Glycemic index of foods (including high/med/low values) ▪ Glycemic index: increase in blood glucose above baseline during a 2 hr period after consuming a defined amount of CHO (usually 50g) compared to the same amount of CHO in another food item Affected by temp, cooking, processing, ripeness, variety, location of growth High: >/=70 o Rapidly digested and absorbed 🡪 rapid increase in blood glucose o Rapid increase in blood glucose 🡪 high insulin response o High insulin response 🡪 rapid fall in blood glucose (hypoglycemia) Moderate: 56-69 Low: /=20  Intermediate: 11-19 Low: 30g/day ▪ RDA Men 19-50: 38 g/day Women 19-50: 25g/day o CVD/Hyperlipidemia ▪ For both 🡪 increase dietary fiber to decrease risk Remember, the test is intended to cover the basic nutrition information from your main Powerpoints and readings rather than our in-depth discussions in the teaching kitchen. Disease Cause Prevelence Sx Treatment Note PKU Autosomal 1:10,000 in Neuologic Low protein diet Aspartame recessive US problems Supplement with contains phe-Free protein phe Tyrosinemia 1:250,000 Skin and Phe and tyr type II WW eyew lesions restrictions Impaired mental dev’t Alkaptonuria Homogentistic 1:250,000 – Oxidation of acid cannot 1 million homogentisti convert to WW c acid 🡪 Black urine  maleyacetoace More Arthritis tate common in -high Slovokia homogentistic acid in urine and tissue Propionic Defect in 1:35,000-70, Vomiting, Restrict acidemia propionic acid 000 WW ketoacidosis, threonine, in body fluids More hypertonia, isoleucine, and leading to common in FTT, valine accumulation Greenland respiratory B7 dependent and Saudi problems Methymalonic Defect in 1:48,000 acidemia methylmalonyl -CoA mutase Homocystinuria Defect in 1:200,000-3 Osteoporosis Low protein diet methionine 00,000 WW Ocular Limit methionine metabolism More changes Supplement *cystanthionin common in Mental cysteine, e B synthase Ireland retardation betaine, folate (homocysteine to cystathionine) High hc and meth Low cyst Maple Syrup Defect in BCAA 1:225,000 Urine smells Restrict BCAA High plasma Urine Disease DH complex WW like maple and thiamine leucine is Thiamine is 1:150 US syrup supplementation more coenzyme Mennonite Acidosis Liver transplant neurotoxic population Vomiting than Lethargy isoleucine Coma and valine Death Urea cycle Urea enzyme Toxic Protein Mild cases disorders defects cause ammonia restriction may be high levels of levels can Supp: citrulline triggered by blood lead to coma, and arginine stress ammonia death Newborn: low body temp, failure to feed