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