Nutrition Exam Prep: Week 1

Fruit and Vegetable Consumption

What happened in the 1940’s d/t antibiotics? The number of death from
infectious disease decreased and heart and CA replaced infection as the number 1
killer in Canada

T or F – 5 serving of fruits and vegetables a day will decrease your

chances of getting cancer and stroke? True

Give examples of studies who demonstrated the previous statement

1) Jansen, cohort study on 730 men for 10yrs, 44% reduced risk of cancer
2) Johnsen, cohort study, 54506 subjects for 4 years, 28% reduced risk of stroke
3) Kaumudi, cohort study, over 100000 subjects for 8 yrs, 31% reduced risk of
stroke

T or F – According to Kaumudi’s study, each increase of 1 serving of fruit

or veg decreases your risk of getting a stroke by 6%? True

Is there a dose response relationship b/w fruit and veg consumption and
risk of chronic degenerative disease? Yes, according to observational data

What is the key highlighted causal factor in both the initiation and
progression of chronic degenerative disease? Oxidant Stress

Therefore, what did the reductionist mindset of the times lead scientist to
believe? Essential antioxidant nutrients w/in the fruits and veg were responsible
for the observed protective effects against chronic degenerative diseases

What type of studies were then done? Biomarker studies!!

Describe one such study? Stahelin, cohort 4858 males 12 yrs, beta-carotene
21% lower in cancer px

T or F – in the past researches px taking supplements were excluded from

the statistical analysis? True

“Measuring a particular antioxidant nutrient provided

_______________________________. But it did indeed serve as a very valuable fx;
it acted as a _______________ of fruit and vegetable consumption” No insight
into the basis for the observed effect/biomarker

So what is Dr Phil getting at here? Past research was based on the total F&V
package & flavonoids from the fruits and veg could have given the same results
since they are markers consumption.. t/f they don’t prove that BC is what makes
ppl less at risk
T or F – By measuring a marker of such intake, the quality of
investigations is improved, but the conculsion does not change? True
For who is Beta-Carotene and Vit A CI? Cattle workers and mine worker’s?

What happened in the study by Lancet where 20 536 UK adults with CHD
were given vit E, Vit C and BC or placebo? The incidence of events in both
groups was 22.5%

What happened in the NEJM study on 22 071 physicians randomized to

receive BC on alternating days versus placebo? The differences weren’t
statistically significiant

What happened in the NEJM study on 29133 finnish smokers randomized

to 1 of 4 gr (placebo, vit E, BC or both)? There was no effect of vit E on LU CA
incidence or mortality and the BC increased LU cancer incidence by 18% and total
mortality by 8%

What happened in the NEJM study on 18314 subjects who were at high
risk (smokers, asbestos workers, former smokers) randomized to receive
placebo or 30mg BC with vit A? Intervention increased risk of LU CA by 28%,
death from LU CA by 46% and death from heart disease by 26%

T or F – Vit E was shown to increase the risk of stroke and CHF in at risk
px? True

A dosage of how much Vit E is associated with increased risk of death?

150IU/day

What about the studies done on Vit C supplementation? Dietary vit C

demonstrated no effect and supplemental vit C was strongly and directly correlated
to increased incidence of cardiovascular events and strokes in post-menopausal
women with diabetes

T or F -- Supplemented vit C is hereby contraindicated for diabetic

individuals as far as this course is concerned? True

T or F – Intervention with supplemental essential anti-O nutrients failed to

demonstrate beneficial effects on chronic degenerative disease risk? True

Do negative value substances have a high or a low affinity for taking

electrons? High

What does such activity resembles? Oxidants in a biological system

Do positive value substances have a high or a low affinity for donating

electrons? High

What does such activity resembles? Anti-O in a biological system

“Negative value substances gain electrons and are t/f ___________” reduced
“Positive value substances lose electrons and are t/f ___________” oxidized

T or F – Biologically relevant Anti-O are oxidized, quenching a biological

oxidant, such that the oxidant need not satisfy its requirement for an
electron from another source… The oxidant is thereby reduced? True

What happens if they are not quenched by an Anti-O? oxidants will attack
the cell membrane and/ or DNA to satisfy their electron requirement

Various methodologies were dev to deduce anti-O potential, what were

the 2 most popular? TEAC and ORAC

How do you go assessing in vivo anti-O status? Do TEAC/ORAC of whole

blood… measure urinary excretion of DNA waste products… measure damaged
DNA waste products in blood…. Etc.

What is the TEAC value of vit E, vit C and BC? 1.00, 0.74, 0.34

What does a positive value represent? Anti-O activity

What is the TEAC of Epicathechin gallate? 4.90… it’s the highest

Where do you find this flavanoid? Red wine

Which is the second highest TEAC of flavanoids and where do you find it?
Quercetin with 4.70 and you find it in every plant

Which vitamin contributes to 0.4% of the total Anti-O capacity of an

apple? Vit C

What vitamin contributes to 0.5-2% of the total anti-O capacity of a

blueberry? Vit C

So assuming an anti-O basis for protection against heart disease and CA

may not have been the flaw, what could have been the flaw? Maybe the
type of Anti-O examined

T or F -- Based on in Vivo anti-O studies, the cancer protective effects of

F&V seems to rely not only on the effect of a single anti-O but on other
anticarcinogenic compounds or on a concerted action of several
micronutrients present in these foods? True

T or F – The Anti-O capacity of blood will decrease by 10% 50 min after

consumption of alcohol free red wine? False, it will increase by 10%

T or F – Demonstrating benefit from an intervention in a deficienty

population suggest similar benefit will be achieved from intervention in
an adequate population? FALSE
How is adequacy defined? As recommended nutrient intakes or recommended
daily allowances

What is the only thing not to decrease with age? The sense of smell

Does nutrient intake decrease with age? Apparently so

Can you reduce the risk of infectious diseases in elderly by giving them
supplements? Yes you can because they are so low in them…. Study showed a
reduced incidence of 125%.

T or F – the elderly are often demonstrated to be deficient in essential

nutrients? True

How come? Basal metabolic rate decline with age coinciding with a decrease in
food intake

What else causes nutrient density to decrease? Taste declines with age and
so elderly add salt or sugar to food more

Why does the absorptive capability decline with age? B/c villi of SI atrophy,
and production of digestive secretion decline

Describe the FAMOUS Linxian Trial: Northcentral Rural China, study 1: 30 000
subjects 4 tx gr: Vit A&Z, B2/3, VitC and Molybdenum, BC/E/Se… study 2: 3318
subjects with esophageal dysplasia randomized to placebo or daily multivitamin.
5.25 yrs. Decreased in mortality and CA in gr receiving BC/E/Se only.

Summary *T or F

1) Observational investigation demonstrateda protective effect of F&V

consumption on the incidence of CVD and CA? TRUE
2) Development in pathological science outlined a direct causative role
for oxidants in the initiation and progression of CVD and CA. TRUE
3) It was concluded that the essential AntiO nutrients found in F&V were
NOT the likely consitituents. FALSE
4) Protective associations were demonstrated for essential antiO but the
role of such measure as a biomarker of F&V consumption were
overlooked. TRUE
5) It was demonstrated that Flavonoid constituents of F&V are far
INFERIOR biological antiO than their essential counterparts? FALSE
6) Intervention trials demonstrate no effect from essential nutrient
supplementation on biomarkers of CVD and CA while whole
foods/flavanoid concentrate intervention reproducibly demonstrates
benefits on markers of CVD and CA? True
7) Non Essential antiO consitutents of F&V appear to be the lone answer
behind the protective effects of F&V? FALSE… they are only a significant
key
8) The occasional intervention trial to demonstrate benefit from essential
nutrient intervention fits the whole food model outline so far? TRUE
What are benefits of a F/V diet? Essential Nutrient adequacy, Caloric Balance,
Delivery of functional food/nutraceutical constituents

What does an increased Km value for a given rx indicate? A decreased

binding affinity by an enzyme for its substrate (some mutations take place on
enzymes causing increased Km)

What has research indicated concerning Km? for a number of such enzyme
mutations, that supplementation with high doses of enzymes COFACTOR, the Km of
the rx can be reduced to near normal levels

What prevents cox-sackie-virus induced myocarditis? Se