Nutrition Final Study Guide

**DO PRACTICE MATH EXAM GIVEN IN THE NOTE BOOKLET**

**REMEMBER TO BRING A CALCULATOR TO THE EXAM**
**YOU WILL NEED TO KNOW THE ACTIVITY CATEGORIES FROM PG 154 WELL TO DO
CORRECT CALCULATIONS**
Obesity:
Metabolically obese: look normal, but fat content in body makes them obese
Diseases associated with obesity:
1. Hypertension
2. Diabetes
3. Osteoarthritis
4. Coronary heart disease
5. Infertility (mainly in women)
6. Cancer
7. Elevated blood glucose, lipids, cholesterol, uric acid
8. Hyperlipidemia
9. Gall bladder disease
10.Intestinal disorders
11.Menstrual irregularities
12.Endocrine disorders
13.Sleep apnea
14.Metabolic syndrome
15.Reflux syndrome
Goals of healthy people 2010**
1.
2.
3.
4.
5.
6.
7.

Increase fruits and veggies (intake and in schools)

Increase non soda in schools
Increase BMI measuring in schools
Increase schools with nutritious foods
Increase doctors with counseling for nutrition and weight
Decrease sat. fat and sugar
Decrease obesity

Definitions of obesity:
(good criteria- inexpensive, requires minimal training, virtually maintenance
free, repeat values are reliable, measures body fatness)
1. Metropolitan life insurance tables:
a. Know how to read one
b. **use 1959 values
c. **use high and low #s to calculate a range
d. Current body weight/ideal body weight
i. Underweight = more than 10% under IBW
ii. Overweight = 10-20% over IBW
iii. Obese = >20%
iv. Morbidly obese = 100lbs or more over IBW
e. Frame size: (measure around wrist)

i. Small: < or = 6 inch

ii. Medium < or = 6.5 inch
iii. Large < or = 7 inch
iv. X-large < or = 8 inch
2. Body mass index (BMI):
a. ***good in studies to PREDICT DISEASE (especially diabetes)
b. Kg/square meters
c. Meets all of good criteria except for measuring fatness
d. <18.5= underweight
e. 18.5-24.9= lives longest
f. 25-30= overweight; increase risk of high BP, cholesterol, blood
glucose and blood insulin
g. >30= obese; increased risk of disease (diabetes, heart disease,
cancer, GI tract)
h. >40= morbidly obese
3. Waist to hip measurements:
a. Hip measurement/waist measurement
b. Body fat distribution has greater risk factor for morbidity and
mortality than being overweight or obese
c. Official for marines
d. Said to be better predictor of type 2 diabetes and CVD
e. Where to measure
i. Waist
1. Men: umbilicus
a. >40 inches increases risk of disease
2. Women: ~2 inches above umbilicus
a. >35 inches increases risk of disease
ii. Hip
1. Men: femoral head
2. Women: widest hip point
iii.
f. .75-.80 = mild apple
g. >.80 = very apple
i. The more apple you are, the greater your risk for disease
ii. Greater morbidity
iii. Know some examples of diseases (cancer, hypertension,
diabetes, heart disease, etc)
iv. Fat cells in abdomen are hypertrophic- larger and more
numerous
h. <.75 = pear
i. No relationship to increased risk factors for any known
disease
ii. Hyperplastic fat cells on thighs and butt- smaller and more
numerous
4. Ratio of body fat to lean muscle analysis
a. Under water weighing or hydrostatic weighing
b. Skin fold thickness
c. Electrical bio impedance
d. Infrared analysis
e. Bod Pod
(these above only measure total fat or SAT fat)
f. CT and DEXA

g. Waist to hip
h. Waist to height
i. Found to be pretty reliable
ii. If waist is >1/2 height in inches then increased disease risk
i. Waist circumference
i. Only method that measures where visceral fat is**
ii. Even pear has increased risk of disease when waist
circumference is large
iii. Waist values clearly correlate with increase disease risk
(increased LDL, blood glucose, insulin, BP)
iv. Men:
1. Overweight = 36 inches
2. Obese = 39 inches
v. Women:
1. Overweight = 32.7 inches
2. Obese = 36.6 inches
(these above measure VAT fat)
Types of Body Fat:
1. Subcutaneous adipose tissue (SAT)
a. Insulation
2. Visceral adipose tissue (VAT)
a. Hormones/storage
b. BAD
i. Produces hormones (metabolically active)
ii. Marbled organs -> disease
c. Inflammation
i. Increased
1. CRP
2. Estrogen
3. TNFa
4. Leptin
5. PAI-1
6. IL-6
7. Fat induced adipose factor
8. Metallathiomein
9. Resisten (induces insulin resistance)
3. Brown adipose tissue (BAT)
a. Heat production
b. Good fat
c. Functions:
i. Burns large amounts of fat and carbs to produce heat
1. Burn additional 20% of calories (400-700 calories
more daily)
ii. Regulates temperature
d. Found in humans
e. Mainly in neck/chest
f. Lean people have more
g. Increase BMI = decrease BAT
h. Adults can increase BAT fat
i. With cold temp exposure (66 degrees F)

1.
2.
3.
4.
5.
6.
7.
8.

Regular exposure
Non-shivering
Want cold skin but not cold core
Dont eat more to compensate
Soak in cold baths
Get outdoors in cold weather
Keep ambient indoor temps low
***shouldnt do with people who have intermittent
claudication or Raynauds

Hormones:
1. Leptin
a. Should decrease hunger
b. Obese become leptin insensitive
c. From belly fat
2. Ghrelin
a. Tells us were hungry
b. Made in stomach
c. We should eat to a time and not to hunger signals
3. Adiponectin
a. Helps insulin move sugar into cells
b. Made by belly fat
c. Obese make less
Metabolic syndrome:
-

Endocrine disorder
No specific treatment because it affects many body systems
o Clean up diet
o Exercise
Criteria:
o Need 5 out of 5
o Even just 1/5 criteria increases risk of disease

Causes of Obesity:
-

Genetics:
o 40% more likely to be obese if one parent is obese
o 80% more likely to be obese if both parents are obese
o Ability to make hormones (leptin, insulin) and distribution of fat seems
to be genetically determined
o Maternal obesity and high VAT fat increases risk for obesity and
diabetes in unborn and its off-spring
Non-genetic factors
o Hypothalamic factors influencing eating behavior
Metabolism
Neurotransmitters
Hormones
GI stretch receptors
Sensory signals
Neurobiochemical factors (drugs, endorphins)
Exercise (normalizes appetite)

Sleep
Mood
GI bacteria
Ratio and strands influence obesity
Gut flora can protect against or predispose to obesity
Less obese bacteria from high polysac fiber plant
based diet
More obese bacteria from high fat, high sugar, low
fiber, aspartame
Bacteria and influence on gene expression and
metabolism can change in a day
o Maternal and long term diet have greatest impact
o Environmental factors
Social occasions
Distracted eating
Having wide variety of food
Family members influence
Energy in:
o Amount = kcals eaten
o Composition
Fat eaten
SAT-> more weight gain
Carbs eaten
Simple, sugar, hi Glycemic index = worst
Proteins eaten
Alcohol consumed (slows down metabolism especially in
women)
o Pattern
Largest meal at night and circadian rhythm (promote obesity)
Liquid vs solid
Pre-meal intake
Alcohol-> eat more
Salad -> eat less
Broth -> eat less
Energy stored:
o Amount = kcal stored in body (3500 kcals/1lb of fat)
o Composition
Fat vs fat free mass
o Distribution
Apple vs pear
** VAT vs SAT vs BAT
Energy out:
o Basal metabolic rate (BMR)
Measured:
Directly (body temp while in cold chamber)
Indirectly
o Respiratory quotient (not accurate)
o Thyroid gland function test (commonly done)
Raised by:

More lean muscle mass*** (more mitochondria)

Growth phases
Fever, heat exposure happens immediately
Some diseases (wasting, hyperthyroid)
Cold climate (shivering-> brown fat)- happens over time
Thermic effect of food
Thermogenesis: the production of body heat
Dietary thermogenesis: the production of heat from processing
food
Expend energy by digesting food
Expend energy by activating brown fat cells
Energy burned from macronutrients
Fat: 9kcal/gram contributed, only 4% of this used to
process
Carbs: 7kcal/gram contributed, only 7% used to process
Protein: 7kcal/gram contributed, up to 30% used to
process
Exercise expenditure
All activity burns kcals
Includes:
Exercise
Spontaneous activities (sneezing)
ADLs
Fidgeting
Productive muscle contractions (work)
Unproductive muscle contractions (shivering)
Isometric contraction

Using Fat as fuel or storage:

-

Fat cell goes into blood vessel with

o Sudden stress
o Cortisol/norEpi
o Ephedrines
o Caffeine
o Calcium*
o Lipases
o Glucagon
From blood vessel to muscle cell with
o Chromium
o Carnitine (cofactor VitC)
o B vitamins
o Exercise*
Low to moderate intensity
Vigorous exercise needed to rid of VAT
Stimulation of beta-oxidation
o Starvation states (ketosis)
Inadequate kcals
Inadequate carbs
o Extreme stress response

Glycogen depleting exercise

Long term high intensity in unfed state
Short term extremely high intensity

Successful weight loss programs (3 pronged approach)

-

Setting correct kcal intake (not less than 1200 kcal

Regular exercise (at least 60% max HR for 45-60 min most days of the week;
using large muscle groups)
Behavioral modification/counseling

Food Pyramid
-

** be familiar with the my plate design (which categories of food go in which

depicted areas)

What are the EAAs and functions/therapeutic uses (PVT TIM HALL)
-

Lysine: Herpes
Leucine, Isoleucine, Valine
Theonine: Glycine
Methionine: provides sulfur *most limiting AA, homocysteine is metabolite
Phenylalanine: Melanin, Thyroxine, Catecholamines DA/NorE/E
Tryptophan: 5HT, Melatonin Norm B vitamins can help keep tryptophan levels
up
- Arginine
- (Histidine essential in children)
Which EAA is most limiting: Methionine

Ring AAs: Tryptophan, Phenylalanine, Tyrosine

Sulphur AA: Methionine, Cystine, Cysteine
BCAAs: Leucine, Isoleucine, Valine

Catecholamine Pathway = Tyrosine Dopa Dopamine NorE E

Cofactors: B6, Iron
Know Related Diseases:

Tryptophan Serotonin Melatonin *Cofactor: B6

Enzymes required for AA digestion and where are they produced

HCL and enzymes

From stomach, pancreas, small intestine
Most gut absorbed AAs used by the liver

Know ways to improve digestions and absorption of protein

problems with alkaline stomach pH and inadequate pancreatic proteases

Improve with:
o Betaine hydrochloride (not if prone to ulcers)
o Pancreatic enzymes (trypsin and chymotrypsin)
o Chew food until it is liquid
o Cook proteins until tender/soft
o Avoid large amounts of water or beverages w/protein meals (dilutes HCl)

Plant and Animal Enzyme supplements and usage timing

Plant: Bromelain from pineapple, Papin from papaya
Animal: Trypsin, Chemotrypsin, Bovine, Porcine
-

Must take with a meal to help with protein ingestion

(Between meals for inflammation)

Know how leaky gut causes food allergies

-

Gut is permeable until age two and can be caused by certain diseases
Small amounts of whole proteins can enter and cause allergic reactions because
body treats them as foreign!

Know the MC food allergies:

- Infants/Under 2= Cows Milk
- >2 = Peanuts, Tree Nuts, Cows Milk
- Soy has low allergen risk, rice is low quality protein but non-reactive

Know the 8 functions of proteins

o
o
o
o

Build new body tissues

Repair injured body tissues
Produce essential compounds
Regulate fluid balance (albumin)

o
o
o
o

Regulate acid-base balance

Provide resistance to disease
Provide transport mechanisms
Provide E (4kcal/g) as backup

Know examples of protein structures in the body and what they do

Hemoglobin, Myoglobin blood proteins

Albumin maintain blood oncotic pressure
Collagen structural
Fibrinogen clotting factor

MC excretory route for nitrogenous products: Urinary as urea (80%), Fecal

(10%), Other (10%)

Know that proteins provide nitrogen and that we excrete nitrogen

o
o

Concept of nitrogen balance, positive and negative balance

Balance: N IN = N OUT, imbalance indicates if body is catabolic or anabolic

o
o

Positive N Balance (intake > excretion anabolic)

Growth, Pregnancy, Lactation, Convalescent Periods (recovery), Athletic

Training
Negative N Balance (excretion > intake catabolic)

o
o

Inadequate intake, injury, illness, accelerated protein loss, burns, increased

secretion of thyroxine
*both these groups need up to 20% of their total kcal intake in form of high
quality protein

o
o

How to compute how much nitrogen we intake (Math)

24 hour food diary, determine g of protein eaten

#kcal of protein * %protein = kcal from protein
kcal fr protein / 4kcal/gram = grams from protein
g protein / 6.25 = g nitrogen

What information is provided by urinary urea nitrogen UUN

Reflects the rate of protein catabolism and adequacy of protein intake

o
o

How to use the UUN to determine total nitrogen output (Math)

UUN per 24 hours + 4 = total N output

How to determine if someone is in N balance and how many grams they

should eat (Math)

o
o

determine if N intake = total output (UUN+4) and look at differences

Benefits/function of GH and how to naturally increase it Sleep (delta wave)

and Exercise

anabolic hormone, helps burn fat,

Definition and ex of high and low quality protein foods

High Quality: one that supplies adequate amounts of the 8/9 EAAs (rated 1100)

-- lactalbumin (eggs/dairy) or casein (cows milk) are used as standard

-- Ultimate guide is its ability to support growth, maintenance and

repair

Low Quality: food that is deficient in one or more EAAs or has all in
insufficient qualities

-- Gelatin is 0 b/c lots of AAs but has little methionine, lysine and no
tryptophan

o
o

o
o

Based on:

- Quantity of protein
- Chemical scoring
- Digestibility
- Protein efficiency ratio
o
Highest quality based on chemical scoring Legumes
Highest quality based on digestibility Animal *Lactalbumin
o
o

Why do plant sources have lower digestibility scores? Fiber

o
o

Basics of food combining and how to get all EAAs in a meal: some (esp plant)
food sources are deficient in essential AAs, this can result in negative N
balance and protein deficiency.

- Mixing complementary types of proteins can provide a complete AA profile

Benefits? High quality plant protein, complete AA, inexpensive, easy,

avail, traditional

Definition of marasmus AKA PEM Protein E Malnutrition

starvation, inadequate calories + inadequate protein

Signs/Symptoms: ketosis and wasting

Definition of kwashiorkor

adequate calories, inadequate protein intake, displaced child, MC in first

child
Signs/Symptoms: decreased plasma albumin = severe edema, infection (decr
IGs), intestinal infections cause poor absorption, hair lightens (def in
tyrosine), skin lesions, muscle wasting, fat in liver b/c no ability to create
lipoprotein carriers
o Usually deficient in zinc, iron, other nutrients

o
o
o
o
o

High Protein Diet - > 20% total kcal, > 1.5g/kg ideal body weight
When: Sarcopenia
Low Protein Diet - < 0.6g/kg ideal body weight
When: Kidney Disease

o
o

Sarcopenia: decrease in skeletal muscle (not required for life so its the first
to go)

Risk Groups aging population

Recommended EAAs: Leucine
Recommended Protein Intake: 25-30% protein

What dietary situations cause ketosis?

too few kcals (< 1200kcal/day)

% carbs drops too low (@ 50% total kcal)

When is a ketotic diet recommended: seizure control, but still unhealthy

o
o

Which EAAs are used preferentially by muscle and GI organs: Leucine?

o
o

Short Term and Long Term problems associated with high protein diets

ST hypoglycemia, fatigue, dehydration, constipation (can offset by drinking

water and increase carbohydrates/fiber)

LT mostly w/ animal proteins, kidney stones, disease, gout, osteoporosis,

some CA, heart disease (can be offset but buffering w/ alkalizing foods and
increased water intake)

o
o

Know what acidity is and what foods promote

Acidity: chemical measurement of number of H+ ions, nothing to do with

taste!

Alkaline Blood: more cations

o Vegetables, fruits, some nuts, legumes, grains
Acidic Blood: more H+ ions
o Meats, eggs, fish, seafood require buffering with Ca, Mg, K and Na
Fats, Sugars, Starches no effect on pH

o
o

Know how a high protein diet relates to osteoporosis causes excess loss of
calcium

o
o

What foods promote acidic urine and therapeutic uses for bladder/kidney
health

Plums, cranberries, prunes -- organic acid that is not metabolized and

goes to kidneys to acidify the urine, can be antibacterial

o
o

Know what disease correlates w/ high red and processed and animal protein
diets

total mortality, CVD, CA

Know ways in which animal meat appears to increase disease risk

o
o

How does carnitine appear to increase heart disease in meat eater

Bacteria in gut of red meat eater increases TMAO, increases cholesterol and
atherosclerosis
(Not present in vegetarian diet promoted good gut health)

o
o
o

Who needs 20% protein:

Sarcopenia
Times of growth
Repair
Low calorie intake

Low quality protein

Which groups need the highest g/kg body weight: newborns, lactating
mother, endurance athlete