Quiz Study Guide 1 1 INTRODUCTION TO NUTRITION Energy food provides o Carbohydrates 4 kcal gram o Protein 4 kcal gram o Fat 9 kcal gram o Alcohol 7 kcal gram Essential nutrients amounts and must be consumed in the diet nutrients that are not synthesized by the body in adequate Macronutrients 1 Carbs 2 Proteins 3 Lipids 4 Water Micronutrients 1 Vitamins 2 Minerals Three main rules of nutrients 1 Provide energy 2 Provide structure 3 Regulate body processes 2 NUTRITION AND THE SCIENTIFIC PROCESS NUTRITIONAL ASSESSMENT PART I NUTRITION AND THE SCIENTIFIC PROCESS Experimental Studies o Animal Studies H0 generating o Cell Culture Studies H0 generating o Clinical trials Intervention studies H0 testing Choice of design depends on o Nature of disease o Type of exposure o Available Resources Epidemiologic Research disease frequency in human populations o Descriptive Epidemiology concerned with the distributions and determinants of concerned with the distribution of disease Hypotheses generating Ecological Studies Correlational Studies use data from populations to compare disease frequency between different groups during some time period or in same population at different points in time individuals within a population at the same point in time examine exposure and disease in Cross Sectional Studies E g NHANES designed to assess health and nutritional status of adults and children in US 24 hour recall o Analytic Epidemiology focuses on the determinants of disease by testing hypotheses Observational Case control studies compare group with the disease cases to a similar group without the disease controls with respect to the proportion exposed o Recall bias is an issue those that have a disease want a reason for their disease Cohort studies classify non diseased individuals with respect to exposure follow over a specified period of time and compare rates of disease development o Loss to follow up bias those that drop out of the study differ from those who follow up with the study in a way that s related to the disease Clinical Trials Intervention Studies cohort study yet exposure is assigned by the investigator similar to a prospective The Gold Standard the RCT Randomized Double blind Placebo controlled o Randomization makes the 2 groups similar except for the treatment as far as known and unknown confounders o Placebo effect o Double blind is important so that there is no bias from either the investigator or those being studied a positive negative response by subjects to a treatment regardless of the physiologic efficacy of what they receive often attributed to subject s expectations PART II NUTRITIONAL ASSESSMENT ABCD s of Nutritional Assessment o A nthropometric Measures o B iochemical Test o C linical observations o D ietary intake o 6 key measures Anthropometric measures measurement of human physical dimensions 1 Recumbent Length 2 years Height 2 Weight 3 Head circumference infants 4 Waist circumference adults 5 Body Mass Index BMI weight in kg height in m 2 Malnutrition 5 Overweight 85 95 Obese 95 Crossing 2 or more percentile curves is of concern to the clinician Does not distinguish between excess weight due to adiposity measures a nutrient or metabolite in one or more body evaluating the characteristics of health that can be seen o Limitation non specific one symptom can be associated with various measure dietary intake through direct observation recall muscularity or edema 6 Skin fold measures Biochemical measures fluid s i e blood urine feces during a physical exam Clinical observations diseases Dietary intake questionnaires etc o Direct observation o Diet history o 24 hour recall Single estimate average nutrient intake of a population Multiple estimate individual s usual consumption Measures actual intake not usual intake 4 stage interviewing technique list detailed description estimates review o Diet Record consumed during a defined period record in household measures all foods and beverages Single day estimate average intake of a group Multiple days estimate usual intake of an individual o Food Frequency Questionnaire FFQ enables ranking of individuals on basis of intake to study diet disease relationships Often used in analytical epidemiology studies to examine the relationship between diet and disease 3 NUTRITION RECOMMENDATIONS Healthy merely the absence of disease or infirmity a state of complete physical mental and social well being and not Tools for healthy eating o Dietary Reference Intakes DRIs nutrient recommendations o Dietary Guidelines for Americans general dietary and lifestyle advice Vitamin K dietary fiber calcium vitamin D are all of concern food group recommendations o MyPlate o Dietary Exchanges o Nutrient Values on Labels for meal planning for diabetes or weight loss Core Nutrient Concepts ABCDMV o A dequacy foods chosen provide all the essential nutrients fiber and energy in amounts sufficient to support growth and maintain health o Balance of o Calorie Control of o Nutrient D ensity food groups energy sources and other nutrients ratio of nutrient content to energy content Nutrient dense foods and minerals and relatively few kcal provide substantial amounts of vitamins Nutrient density can change depending on how the food is prepared o M oderation o V ariety not too much not too little important within and among foods groups Dietary Reference Intakes DRI reflect nutrient intake levels for dietary adequacy and optimal nutrition o Estimated Average Requirement o Recommended Dietary Allowance EAR amount that meets the nutrient requirements of 50 of people in a life stage gender group RDA amount that meets the needs of most people 98 in a life stage gender group EAR 2 standard deviations o Adequate Intake amount thought to be adequate for most people to maintain good health AI when there s insufficient evidence to set EAR the Vitamin K All infant DRIs o Tolerable Upper Intake Level UL highest level of daily nutrient intake that is likely to pose no risk of adverse health effects for nearly all persons in the general population o Acceptable Macronutrient Distribution Range AMDR AMDR for Adults 19 years old Macronutrient Carbohydrate Fat Protein Total Energy Intake EI 45 65 20 35 10 35 Estimated Energy Requirement maintain energy balance in healthy normal weight individuals EER energy intake EI that is estimated to How to use the DRIs o RDA AI target intake levels for healthy people o Do not exceed the UL o Consume the energy yielding nutrients within the ranges of