lisa mayo, rdh, bsdh concorde career college. cho lipids pro vitamins minerals water
TRANSCRIPT
Lisa Mayo, RDH, BSDH
Concorde Career College
Board Review DH227Nutrition
CHOLipidsPROVitaminsMineralsWater
Classes of Nutrients
Organic compounds made of carbon, hydrogen, oxygenProvide energy most abundant during metabolismYield 4kilocalories/gramMonosacchies: Single Sugars. (glucose, fructose,
galactose)Disaccharides: Double Sugars (sucrose, lactose, maltose)Polysaccharides: Complex. (starch, glycogen, cellulose,
dextrans)55-65% dietDigestion & Absorption
Review overall summary: little digestion in mouth salivary amylase
Know absorption routes1. Capillaries – bl stream. Water soluble nutrients2. Lacteals – bl stream. Fat soluble nutrients
CHO
Monosaccharides1. Glucose: blood sugar/dextrose
Main fuel for brain and needed for RBCsBody uses this form bestSources include many foods, such as grapes, oranges,
corn, carrots
2. Fructose: levulose/fruit sugar Sweetest of all sugars Sources include fruits, honey, corn syrup
3. Galactose: component of milk sugar Body converts glucose to galactose in mammary
tissue during lactation – makes lactose in breast milk Sources include milk/dairy products
CHO
Disaccharides1. Sucrose (table sugar)
Furnish 1/3 of total COH intake in the average Western diet made of glucose and fructose Sources include sugar beets, sugarcane or maple
syrup, fruits and vegetables
2. Lactose (milk sugar) Made up of glucose and galactose Sources include milk products
3. Maltose (plant sugar) Made up of 2 glucose molecules Forms as a starch in grains
CHO
Polysaccharides1. Starch
Plant storage form of glucose (amylase and amylopectin) Nutritionally most important CHO Digestible/breaks down at as low rate Stores energy Sources include rice, potatoes, pasta and legumes
2. Glycogen Provides 12-24 hours of stored energy Animal equivalent of starch Provides a food storage system in animal/humans
(glycogenesis) In liver, it regulates blood sugar for the brain In muscle, it serves as an energy source for muscle
contraction Not significant as a food course
CHO
Polysaccharides1. Dextrans
An energy source for caries-producing bacteria, such as S.mutans
2. Fibers Should consume 20-35g/day Dietary: cellulose/hemicellulose: good source of
fiber – found in bran, legumes, and all vegetables. Not digestible in water
Functional: added to foods and dissolves in water to form a gel (sources include legumes, apples, cabbage)
Total fiber: sum of dietary and functional fibers
CHO
Blood Glucose Regulation1. Glycogenesis: glucose stored as glycogen2. Glycogenolysis: glycogen broken down to
glucose3. Gluconeogenesis: glucose synthesized from
non-CHO
**Will review in BIOCHEM slides**
CHO
Hormones1. Insulin
Released in response to high bl sugar from pancreases B-cells. Increase glucogenesis in liver and muscle cells also promotes fat storage
2. Glucagon Released in response to low bl sugar from pancreas A-
cells. Stimulates glucogenolysis in liver also gluconeogenesis
3. Epinephrine Produced in adrenal glands in response to fight or flight Promotes glycogenolysis in muscle and some liver cells
4. Kidneys Glucose spills into urine if excessive
CHO
Digestion: digestive enzymes come from pancreas and cells of intestinal walls1. Polysaccharides (Starch)
Initial digestion begins in the mouth will enzyme salivary amylase (breaks down into maltose)
2. Disaccharides (SLM) Digestion occurs in the walls of the small intestine Sucrose: enzyme sucrose breaks down sucrose into
glucose and fructose Lactose: enzyme lactase breaks down lactose into
glucose and galactose Maltose: enzyme maltase breaks down maltose into 2
molecules of glucose
3. Monosaccharides: enter capillaries and glucose goes into blood to be used as energy
CHO
FunctionsProvide energy (4kcal/gram)Needed for the brain and RBCsSpare PRO – PRO can supply energy, however
its main function is to build tissue and replace cells (ie:growth)
Aid in the oxidation (burning) of fats to prevent ketosis
Furnish fiber for normal peristalsisDietary requirement and nutrient sources –
130g per day, easy to obtain
CHO
Carbohydrates may be clinically defined asa. Polyhydroxyl aldehydesb. Polyhydroxyl ketonesc. Compounds with carbon, hydrogen,
oxygen as a ratio of 1:2:1d. None of the abovee. All of the above
Question
Carbohydrates may be clinically defined asa. Polyhydroxyl aldehydesb. Polyhydroxyl ketonesc. Compounds with carbon, hydrogen,
oxygen as a ratio of 1:2:1d. None of the abovee. All of the above
Answer
Which of the following complex carbohydrates (CHO) CANNOT be digested by humans?
a. Starchb. Glycogenc. Amylosed. Cellulose
Question
Which of the following complex carbohydrates (CHO) CANNOT be digested by humans?
a. Starchb. Glycogenc. Amylosed. Cellulose
Answer
Which of the following is (are) an important site(s) for CHO digestion?
a. Mouthb. Stomachc. Small intestined. A and Be. B and C
Question
Which of the following is (are) an important site(s) for CHO digestion?
a. Mouthb. Stomachc. Small intestined. A and Be. B and C
Answer
Artificial Sweeteners: nonnutritive sweeteners, non-CHO and non-caloric1. Aspartame
Active ingredient in NutraSweet and EqualComposed of 2 aa aspartate acid, phenylalanine,
methanolNot stable in heat therefore not suitable for
cooking; used in beverages and chewing gumAdverse effects – headaches, dizziness, and
seizuresProvide calories, but little is needed for sweeting200 times sweeter than sucroseNot recommended of epileptics or pt’s with PKU4kcal/g
Sugars
Artificial Sweeteners: nonnutritive sweeteners, non-CHO and non-caloric2. Saccharin
2. Active ingredient in Sweet-n-Low3. Used in soft drinks and table sweeteners, 300 time sweeter than
sucrose4. Promoter (not a cause) of cancer tumor development. Zero
kcal/g
3. Acesulfame-K, 2. Active ingredient in Sunette and Sweet One3. Stable in heat4. Used in gums, creamers, gelatin products5. 200 sweeter than sucrose
4. SucraloseActive ingredient in SplendaStable in heat600 times sweeter than sucroseSucralose made from sugar. Made by chlorinating sucrose.
Sugars
Artificial Sweeteners: nonnutritive sweeteners, non-CHO and non-caloric5. Neotame
2. Approved in 2002 by FDA3. Often blended with other sweeteners4. No amino acids are absorbed – therefore does not
need to carry PKU warning5. Stable in heat6. 8000 times sweeter than sucrose – little is needed
Sugars
Sugar Alcohols Sorbitol: made from glucose Mannitol: made from mannose and galactose Xylitol: derived from cellulose products, such as wood straw and
pulp cane5 carbon sugar alcohol (polyol); sucrose is a 6-carbon sugarAbsorbed slowly and completely from the small intestines – little
or no insulin is metabolized during the absorption processAntimicrobial – S.mutans are attracted to xylitol over other
sugars; however, the bacteria cannot metabolize xylitol and therefore die
Nutritive sweeteners, CHO, sugar-like compounds that provide calories
Do not promote tooth decay because they metabolize at a slower rate
Not readily absorbed by small intestine, therefore can cause diarrhea
Not metabolized by oral bacteria so considered non-cariogenic 4kcal/g
Sugars
The main function of CHO is to:a. Repair body tissuesb. Neutralize acids and basesc. Provide energyd. Regulate metabolism
Question
The main function of CHO is to:a. Repair body tissuesb. Neutralize acids and basesc. Provide energyd. Regulate metabolism
Answer
CHO can be stored in the liver and muscle as:a. Lipidsb. Fiberc. PROd. Glucosee. Glycogen
Question
CHO can be stored in the liver and muscle as:a. Lipidsb. Fiberc. PROd. Glucosee. Glycogen
Answer
Carcinogenicity of sugar containing foods1. Increases when sweets are in liquid form2. Increases with frequency intake3. Decrease when eaten with non-cariogenic
foods4. Decreases if sucrose is replaced by honey and
baked goodsa. 1,2b. 2,3c. 2,4d. 3,4
Question
Carcinogenicity of sugar containing foods1. Increases when sweets are in liquid form2. Increases with frequency intake3. Decrease when eaten with non-cariogenic
foods4. Decreases if sucrose is replaced by honey and
baked goodsa. 1,2b. 2,3c. 2,4d. 3,4
Answer
Organic compounds composed of carbon, hydrogen, oxygen
Triglycerides account for 95% of all lipids (fats and oils)
Lipids
1. Triglycerides3 fatty acids with glycerol backboneIncludes saturated (no double bonds) and
unsaturated (mono/poly unsaturated)
2. PhospholipidsIncludes lecithins and are part of lypoPROVLDL, LDL, HDL, Chylonicons
3. SterolsCholesterol is the most well know
Lipids
1. Saturated fatty acidsLess than 10% total calories neededCarry minimum number of hydrogen atoms
(hydrogenation)Remain solid at room temperatureIncrease serum cholesterol levelsSources include beef, lard, animal fats
2. Monounsaturated fatty acidsLess than 10% total calories neededContain a point of unsaturation linkage (double
bond) with no hydrogen atomViscous in formMaintain serum cholesterol levelsSources include canola and olive oils
Lipids Types
3. Polyunsaturated fatty acidsNo more than 10% of total calories neededContain 2 or more points of unsaturation (double
bond)Liquid in consistencyDecrease serum cholesterol levelsSources include vegetable oils
4. Essential fatty acids (NBQ) Must be obtained from diet Linoleic: Omega-6. Sources: vegetable oils,
sunflower and safflower Linolenic: Omega-3. Sources: fish, mackerel,
tuna, salmon, plant oils, canola, olive, peanut
Lipids Types
Provide concentrated source of energy – 9kcal/g
Provide insulation to maintain body temperature and protect organs
Carry fat-soluble vitamins A,D,E,KProvide satiety (fullness)Provide flavor and texture to foods
Lipid Functions
Fat-soluble Will not dissolve in water. Must be carried by
lipoPRO carriersFood Sources
Saturated: hard when cold except tropical oilsMostly animal sourcesMono: canola oil, peanuts, olive oilPoly: corn oil, safflower oil, fish, margarine
Lipids
LioPRO CarriersHDL: take un-needed CHO back to liverLDL: deliver CHO to all cells in the bodyChylomicrons: dietary triglycerides.
Compromise bulk of carriers in our systemVLDL: takes triglycerides manufactured from
excess CHOs to fat cells for deposit as fat
Lipids
Lipids provide a. essential aab. essential fatty acidsc. vit Cd. sodium
Question
Lipids provide a. essential aab. essential fatty acidsc. vit Cd. sodium
Answer
Which of the following organs is(are) important for the digestion of fat?
a. Pancreasb. Stomachc. Gall bladderd. Intestinal mucosae. All of the above
Question
Which of the following organs is(are) important for the digestion of fat?
a. Pancreasb. Stomachc. Gall bladderd. Intestinal mucosae. All of the above
Answer
Which of the following statements is true about essential fatty acids?
a. Are linoleic and linolenic in humansb. Should compose about 20% of total kcalc. A and Bd. A and C
Question
Which of the following statements is true about essential fatty acids?
a. Are linoleic and linolenic in humansb. Should compose about 20% of total kcalc. A and Bd. A and C
Answer
Made of many amino acids (aa) linked together by peptide bonds: linkage of amine grp and carboxy
Contain the elements carbon, hydrogen, oxygen, nitrogen (sometimes sulfur)
Main function = repair/build tissueStructure unique among other nutrients because
contains NitrogenYield 4kcal/g
PRO
Essential (Indispensable) aa – body cannot synthesize, must obtain from the diet, 9 are essentialPVT MY HILL (acronym)
Phenylalanine, Valine, Threonine, Methionine, Tyrptophan, Histidine, Isoleucine, Leucine, Lysine
Nonessentail (Dispensable) aa- body synthesizes as long as nitrogen is present, not required in the diet (11 of them)
Complete PRO (High Quality)Foods that contain all 9 aaSources: animal foods (fish, meat, eggs, cheese, milk,
soybeans)Incomplete PRO (Low Quality)
Lack 1 or more essential aa (Plant PRO)
PRO
Complementary PRONeed to combine 2 or more PRO to compensate
for deficiencies in aa contentUse of whole grains is important
Physiology begins in the stomach
PRO
Functions1. Structure2. Enzymes3. Hormones4. Antibodies5. Blood clotting6. PRO carriers7. Fluid balance8. pH balance9. Energy – always last resort
PRO
Sources and RDA (recommended dietary allowances)
Animal: egg, vegetables, legumes, rice, grains
PRO is the only fuel with an RDA. 8g/8kg body weight
Dietary guidelines: 12% daily cal come from PRO
Vegetarians:
Lacto-ovo veg: People who include milk/milk products and eggs but exclude meat, poultry, fish, seafood
Lactoveg: People who include milk and milk-products but exclude meats,
poultry, fish/seafood
and eggs
Vegan: excludes all animal derived foods including
meats, poultry, fish, eggs and dairy products.
Also called pure-vegetarians because they eat only
plants
PRO
1. Phenylketonuria: PKU
-Liver cannot metabolize essential aa phenylalanine into non-essential aa tyrosine
-Diet must restrict phenylalanine and avoid nutra-sweet
2. PRO-Malnutrition or PCM
Kwashiorkor: severe PRO deficient manifests itself with severe wasting of body fat. Edema in legs and abdomen
Marasmus: Prolonged Inadequate Food Intake, and/or Deficiency in PRO-cal (starvation)
Muscle waste and weaken and no edema
PRO Disease
Water Soluble: B, C
Fat Soluble: A, D, E, K
Vitamins
Organic nutrients needed by the body in small quantities
Do not contribute energy to the body bur are needed as facilitators of body processes
Fat-soluble VitaminsSoluble in fats and fat solventNot readily excreted and therefore can build
up to toxic levelsStored in liver and fatty tissues
Vitamins
Water-soluble VitaminsInclude all B,C vitaminsEasily absorbed and excreted, therefore, it
is unlikely to reach toxic levelsMain functions include metabolism of CHO,
fats, PRO, blood formation (hemopoiesis)Deficiency of these vitamins affects the
mouth (cheilosis and glossitis)
Vitamins
1. Vitamin A Prevents night blindness, maintain
normal mucous membranes Sources
1. Retinols: Preformed vit A. Found in animal foods such as liver, fish, fortified milk
2. Caritinoids: Vitamin precursors. Found in orange-yellow and dark green vegetables and fruits
Fat-Soluble Vitamins
2. Vitamin D Function as a hormone Sources: sunlight, fortified milk, fish liver oils Nutritional Deficiency and Disease
1. Rickets: in kids, softenng of bones due to failure to calcify normally. Symptoms include bowed legs, enlarged head/joints/rib cage, deformed pelvis
2. Osteomalacia: adults, calcium is taken from bones to make up for insufficient absorption in intestine. Symptoms include bowed legs, bent posture and pain in ribs/pelvis/legs
Assists as1. Absorption of calcium and phosphorus2. Formation and mineralization of teeth and
bones
Fat-Soluble Vitamins
3. Vitamin E Tocopherol – tool in the battle against
cancer and heart attack Function: preserves fats (antioxidants) Sources: vegetable oils, green leafy
vegetables, whole grains Toxicity: interferes with blood coagulation
vit K
At-Soluble Vitamins
4. Vitamin K Function: aids in the formation of blood-
clotting factor prothrombin and helps increase bone density
Sources: green leafy vegetables, synthesized by intestine
Fat-Soluble Vitamins
Which of the following vit interferes with the action of vit K?
a. Cb. Ec. Dd. B1
Question
Which of the following vit interferes with the action of vit K?
a. Cb. Ec. Dd. B1
Answer
Vitamin Functions Deficiencies Sources Properties
A Normal vision, PRO synthesis, helps remold bone
Night blindness, imapired tooth formation, keratinized epithelial tissues
Retinols-animal sources, Caritinoids (deep yellow-orange, dark-green veg & fruits)
Found in preformed (active) vit A & provit A
D Bone growth w/the assistance of Ca & Phosphorus
Rickets, osteomalacia, osteoporosis, Ca-deficiency
Sun, fortified milk & products
E Antioxidant Rare Found in many foods including polyunsaturated veg oils
Easily destroyed by heat & exposure to air, toxicity interferes w/blood coagulation
K Clots blood Hemorrhaging Bacteria in GI, liver, cabbage, leafy green veg
Characteristics of fat-soluble vitamins include all of the following EXCEPT:a. Contain carbon, hydrogen, oxygenb. Must be emulsified before they can be absorbed from the dietc. Deficiency symptoms are slow to developd. Unstable to light, heat, oxygene. Toxic with chronic excessive intake
Question
Characteristics of fat-soluble vitamins include all of the following EXCEPT:a. Contain carbon, hydrogen, oxygenb. Must be emulsified before they can be absorbed from the dietc. Deficiency symptoms are slow to developd. Unstable to light, heat, oxygene. Toxic with chronic excessive intake
Answer
1. Thiamin (B1)Function: helps provide energy to brain,
heart, CNSNutritional Deficiency and Disease: Beri-Beri
which damages nervous and cardiovascular systems
Sources: pork, enriched whole grains, legumes, milk, nuts, peas
Water-Soluble Vitamins
Thiamin Deficiency
2. Riboflavin (B2) Function: essential for growth and production of
RBC, prevents cheilosis, glossitis, anemia Sources: milk, green leafy veg, legumes Properties: sensitive to light (milk should be
stored in cardboard/opaque containers)
Water-Soluble Vitamins
3. Niacin (B3) Function: needed in RNA and DNA synthesis Nutritional Deficiency and Disease
Pellagra Rough, painful skin Dementia Diarrhea Dermatitis Death
Sources: meat, fish, enriched grains, green leafy veg
Properties: aa tryptophan can be converted to niacin
Water-Soluble Vitamins
4. Folate (Foclain, Folic acid) Function: assists in forming DNA, RNA and
RBC formation Nutritional Deficiency and Disease
Megaloblastic anemia Glossitis Diarrhea Birth defects (spina bifida)
Sources: liver, dark green and leafy veg, OJ
Water-Soluble Vitamins
5. Cobalamin (Cyanocobalamin B12)Function: helps build tissues, maintain nerve
cells, essentail for RBC development, also needed for folate metabolism
Nutritional Def and Disease: found in strict vegetarians, pernicious anemia (weakness, sore tongue, apathy)
Sources: animal or fortified foodsProperties
Intrinsic factor: PRO made in stomach, needed for absorption of B12
Extrinsic factor: must be obtained through foods
Water-Soluble Vitamins
6. Vitamin C (Ascorbic Acid)Functions: promotes synthesis of PRO
collagen (ct), acts as an antioxidantNutritional Def and Disease: Scurvy:
ruptured blood vessels, swollen and bleeding gingiva, delayed wound healing
Sources: strawberries, broccoli, cantaloupe, citrus fruits, potatoes, tomatoes
Properties: no extensive storage, smoker and women on BC pills have increased need
Water-Soluble Vitamins
Vitamin Function Deficiencies
Sources Properties
Thiamin (B1) Energy to brain, heart, CNS
BeriBeri Pork, enriched grains, milk, legumes, nuts
Riboflavin (B2)
Growth, repair, prod. RBCs
Cheilosis, glossitis, fatigue
Milk, enriched grains, eggs, poultry, fish, nuts, legumes
Niacin (B3) RNA/DNA synthesis & metabolism
Pellegra Meat, enriched grains, legumes, yogurt
Amino acid tryptophan can convert to niacin
Pantothenic Acid
Coenzyme in energy metabolism
Rare Many foods
Biotin Coenzyme in energy metabolism, glycogen synthesis
Rare Cauliflower, cooked eggs, peanut, cheese
Vitamin Function Deficiencies Sources Properties
Pyridoxine (B6) Brain function, prod of RBCs
Irritability, depression, muscle weakness, anemia
Meat, poutltry, fish, bananas, white/sweet potatoes
Folate Helps form DNA/RNA/RBC
Megaloblastic anemiaSpina Bifida
Dark green leafy vegetable, orange juice
Need more if on birth control
Cobalamin (B12) Builds tissues, develops RBCs
Pernicious anemiaSore tongue
Animal foods Fortified foods
Lack of intrinsic /extrinsic factor
Vitamin C Synthesis of PRO collagen, antioxidant, wound healing
Scurvy Fruits, vegetables, fortified foods
SmokersNeed more if on birth control
Which of the following is a general function of water soluble vitamins?a. Function as coenzymes for energy metabolismb. Are important for visionc. Are important for regulating Ca levels in the bodyd. Are important for normal blood clottinge. Function to maintain epithelial cells and
mucosal lining
Question
Which of the following is a general function of water soluble vitamins?a. Function as coenzymes for energy metabolismb. Are important for visionc. Are important for regulating Ca levels in the bodyd. Are important for normal blood clottinge. Function to maintain epithelial cells and
mucosal lining
Answer
Inorganic nutrient used in the body for building and regulating functions
Yield no energy to the body, but assist in regulating the release of energy
MacromineralsMajor minerals present in amts greater than 5g
in the bodyCalcium, Sodium
MicromineralsRequired in the diet in amts <100mg/dayIron, Copper, Iodine, Zinc
Minerals
FunctionsForms and maintains bones and teethCoagulates blood
Nutritional Deficiency & DiseaseRicketsOsteomalaciaOsteoporosisWomen at highest risk
SourcesDairy products, broccoli, soy sourcesCalcium-fortified fruit drinks, calcium supplements
Macromineral: Calcium
PropertiesContribute to HBP which can lead to heart
disease, strokeHypertension is not caused by excessive
sodium but aggravates itRecommendations
Reduce sodium intake and increase the use of spices wen cooking
Macromineral: Sodium
FunctionHelps manufacture amino acids and hormones
Nutritional Deficiency and DiseaseAnemiaOral lesionsPatchy tongueBrittle bonesFatigue
SourcesOrgan meats (liver), dried beans, nutsNot found in milk
Micromineral: Iron
FunctionFormation of hemoglobin
SourcesShellfish, oysters, crab, liver, legumes
Micromineral: Copper
FunctionHelps regulate BMR (thyroid gland)
Nutritional Deficiency and DiseaseGoiter
Micromineral: Iodine
FunctionWound healingAids in cell and immune system function
Nutritional Deficiency and DiseaseSkin disorders
PropertiesHighest concentrations found in bones
SourcesSeafood, tofu, milk, eggs, whole-grain breads
Micromineral: Zinc
Diabetes MellitusMetabolic disorder characterized by high blood
glucose levels due to insufficient or ineffective insulin function
When glucose levels are elevated in the blood and cells, tissue damage will result
Normal glucose levels: 70-125mg/dlType I or II
Nutritional Management of Deficiency and Disease
The important nucleic acids that carry the genetic message for protein synthesis to the cytoplasm are
a. DNAb. cDNAc. mRNAd. rRNAe. tRNA
Question
The important nucleic acids that carry the genetic message for protein synthesis to the cytoplasm are
a. DNAb. cDNAc. mRNAd. rRNAe. tRNA
Answer
Type I Insulin-dependent (IDDM) Involves the minority of cases (5-10%)Occurs primarily in kids and young adults – 10-14yrs Islets of Langerhans in pancreas cannot synthesize insulinOnset assoc with a viral infection or hereditaryCharacterized by weight loss with increase appetite
Type IINoninsulin-dependent (NIDDM)Most common (90%)Usually develops in people over 40yrs and is assoc
w/obesityResults from insufficient insulin or improper useCharacterized by weight gain and increased apatite
Diabetes Mellitus
Signs and SymptomsHyperglycemia: abnormally high blood glucose
concentrationAcetone breath: fruity odor as a result of
ketosisKetonemia: ketones in bloodKetonuria: ketones in urinePolydipsia: increased thirstPolyuria: frequent urinationPolyphagia: increased appetite due to need for
energy
Diabetes Mellitus
Chronic ComplicationIncrease in periodontal disease – 3 times more
likely to get perio disease, other infectionsXerostomia - increase decayBlindnessPoor circulationHeart disease – most frequent cause of
diabetes-related deathLoss kidney function
Diabetes Mellitus
HypoglycemiaLow blood glucose levels (brain almost entirely
fueled by glucose)Less than 70mg/dlSymptoms:
ShakinessDizzinessSweatingHeachachesIrritabilityHungerLightheadednessPalpitations (not lowered heart rate!)
Diabetes Mellitus
Motivation: motivate patient byInvolve them in the decision making processAllow them to choose what should be eliminated from
dietAllow them to be accountable for changing behaviors
Diet Survey – evaluateFrequency of intake – worse times are between mealsConsistency of food – physical formAmt of sugar added to foodsTotal intake
Remember: lactic acid attack begins within the first min of exposure
Diet Counseling
Which of the following is NOT a dietary recommendation for a diabetic?
a. Eat a low complex CHO dietb. Limit fat intake to 30% of Kcalc. regulate CHO and meal spacing
during the dayd. Coordinate food intake, exercise, and medicatione. Limit simple sugars
Question
Which of the following is NOT a dietary recommendation for a diabetic?
a. Eat a low complex CHO dietb. Limit fat intake to 30% of Kcalc. regulate CHO and meal spacing
during the dayd. Coordinate food intake, exercise, and medicatione. Limit simple sugars
Answer
ORAL MANIFESTATIONS OF NUTRITIONAL DISEASES
PrimaryUnder nutrition: env lack of adequate food Under-developed countries
Secondary1. Altered Behaviors: Advanced malignant disease, Infection,
Renal failure, Depression, Anorexia nervosa, Bulimia2. Obesity3. Disorders interfering with ingestion: Oropharyngeal
disease/tumors, ulcerations, pain, neuralgia, neurological syndromes (palsies, myasthenia gravis), malocclusion, TMJ
4. Defective absorption: Chron’s disease, organ failure, tropical sprue, celiac disease
5. Excessive loss of nutrient: chronic blood loss (iron)6. Increased requirements: pregnancy, periods rapid growth
General Malnutrition
1. Minerals: Iron, Ca, Iodine2. PRO deficiency (next slide)3. Hypovitaminoses4. Hypervitaminoses
Specific Nutritional Abnormalities
Kwashiorkor: not enough PROOral Manifestations
1. Glossal edema with scalloping of lateral margins
2. Glossal papillary atrophy (dorsum is smooth and red)
3. Angular cheilitis/fissuring4. Lip pigmentation5. Xerostomia , Saliaosis (enlarged salivary
glands)
Specific Nutritional AbnormalitiesPRO Deficiency
1. Constitutional symptoms: not feel good2. Angular cheilitis3. Atrophic glossitis: smooth bald, smooth patchy red4. Gingivitis5. Stomatitis: ulcerative, burning6. Vitamin C: ascorbic acid7. Vitamin B1: thiamine8. Vitamin B2: riboflavin9. Vitamin B5: niacin, nicotinic acid 10. Vitamin B12: Cobalamin11. Folic acid12. Vitamin D13. Vitamin K
Specific Nutritional AbnormalitiesHypovitaminoses
Vitamin CScurvyGI bleedsPetechiae hemorrhagesGingivitis, hyperplasia, bleedingExaggerated perio d.Tongue normalPrevalence controversial except in fad diets
Specific Nutritional AbnormalitiesHypovitaminoses
Vitamin B1BeriberiPeripheral neuropathyCardiac diseaseEdemaMay have painful or
burning tongueOral symptoms unusual
Specific Nutritional AbnormalitiesHypovitaminoses
B2Common in underdeveloped countriesUS: alcoholicsSevere cold symptoms including sore throatTongue may be sore, purple, pebbly
Specific Nutritional AbnormalitiesHypovitaminoses
B5PellegraCommon Africa/AsiaGen edema and vesiculobullous lesionsSevere glossitis, sometimes with severe
stomatitis and gingivitisGlossal atrophy, glossal edema, glossal
fissuringCombined riboflavin-niacin deficiency not as
rare as other hypovitaminoses
Specific Nutritional AbnormalitiesHypovitaminoses
Vit B12Pernicious anemiaNervous disorders
Specific Nutritional AbnormalitiesHypovitaminoses
Folic acidPart of clinical picture of sprueAtrophic tongueBright red gingivitis
Specific Nutritional AbnormalitiesHypovitaminoses
Vitamin DRickets: kidsOcteomalacia: adultsNo basis for dental caries No clinical oral symptoms, may be
radiographic signs (bone distortion)
Specific Nutritional AbnormalitiesHypovitaminoses
Vitamin KBlood clotting factors
Specific Nutritional AbnormalitiesHypovitaminoses
Severe symptomsHeadache, feverGI: nausea, pain, vomiting, diarrhea,
aggravation of peptic ulcersItching, hay fever. Asthma-like symptoms
(thiamine)Hypercholesterolemia (ascorbic acid)Kidney damage (Vit D)
Specific Nutritional AbnormalitiesHypervitaminoses
Swollen gingiva and capillary fragility are signs of possible deficiency of which of the following?
a. Vit Ab. Vit Cc. Vit Dd. Vit Ee. Vit K
Question
Swollen gingiva and capillary fragility are signs of possible deficiency of which of the following?
a. Vit Ab. Vit Cc. Vit Dd. Vit Ee. Vit K
Answer
Which of the following is NOT an indicator in the oral tissues of possible nutritional problems?
a. Dental cariesb. Gingivitisc. Glossitisd. Cheilosise. Xerostomia
Question
Which of the following is NOT an indicator in the oral tissues of possible nutritional problems?
a. Dental cariesb. Gingivitisc. Glossitisd. Cheilosise. Xerostomia
Answer
Which of the following is a major gland that affects BMR?
a. Thyroidb. Pancreasc. Endocrined. Hypothalamus
Question
A. Thyroid
BMR: Basal Metabolic Rate. Measure of energy needed to maintain life at rest (breathing, heart beating, circulation, muscle tone and body temp)BMI: Body Mass Index: reflects weight in relation to height. Not a measure of lean body mass
BMI: weight(kg) or weight(lb) x 705/Ht
Answer
Vegans are at risk for developing deficiencies in which of the following nutrients?
a. CHOb. vit B12c. Proteind. Vit Ae. Vit C
Vegans are at risk for developing deficiencies in which of the following nutrients?
a. CHOb. Vit B12c. Proteind. Vit Ae. Vit C
Calories from food should equal energy needs of the body
Energy needs of the bodyBasal metabolism rate (BMR): measure of
energy needed to maintain life at rest Degree of physical activity: voluntary
component of energy which varies from sedentary to strenuous activity
Specific dynamic activity (SDA): energy required to digest and absorb foods
Weight Control
Which of the following statements is true about the basal metabolic rate?a. Should be measured with a person sleepsb. Is influenced by climate and altitudec. Includes the energy necessary for normal muscle activityd. Includes the specific dynamic energy (SDE)e. Should be measured at an environmental
temperature of 98.6 degrees
Question
Which of the following statements is true about the basal metabolic rate?a. Should be measured with a person sleepsb. Is influenced by climate and altitudec. Includes the energy necessary for normal muscle activityd. Includes the specific dynamic energy (SDE)e. Should be measured at an environmental
temperature of 98.6 degrees
Answer
Self-starvation due to a distorted body image of being overweight
Behavior ProfileFemale, occurs after pubertyCompetitive/obsessive behavior Increased risk with upper SESFamily conflict, overbearing parentsFear of gaining weight
CharacteristicsDramatic weight loss (20-40%) below desirable body weightExcessive exercise, aversion to foods and altered eating
habitsEats 300-600cal/dayAmenorrhea, Lanugo (soft, fine hair)Decreased heart rate caused by slowing metabolism
TxDietary, psychological, 50% who survive = 6 year recovery
Anorexia Nervosa
Episodes of binge eating followed by purging to prevent weight loss (vomit or laxatives)
Behavior profile Female, college-aged student Weight is at or slightly above normal Turns to food for comfort, aware behavior is abnormal Low self-esteem and impulsive behavior
Characteristics Vomits @ least 2x/wk Eats 15,000 or more cal in a binge Calluses on knuckles, depressed
Tx Dietary, psychological
Oral Manifestations Erosion, thermal sensitivity, enlarged parotid glands, cheilosis Recommend NaF rinses or sodium-bicarb rinses to neutralize
acids
Bulmia
CharacteristicsConsumes non-nutritive
substances (soil, paper, coal, lead, paint chips)
Abnormal apatite for things that may be considered foods (raw potatoes, ice cubes, flour)
CausesBiochemical or iron deficiency
TxPsychosocial, environmental,
family guidance approaches
Pica
Which of the following statements is false about anorexia nervosa?a. A state of PRO-energy malnutritionb. More prevalent in females then malesc. Treated with psychiatric and/or psychological counselingd More prevalent than bulimiae. Often seen in individuals descried as perfectionists
Question
Which of the following statements is false about anorexia nervosa?a. A state of PRO-energy malnutritionb. More prevalent in females then malesc. Treated with psychiatric and/or psychological counselingd More prevalent than bulimiae. Often seen in individuals descried as perfectionists
Twice as many people have Bulemia, anorexia more discussed in media
Answer