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HTH SCI 3BB3 Midterm: BB3 midterm notes.

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Department
Health Sciences
Course Code
HTHSCI 3BB3
Professor
Teresa Mccurdy

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Nutrition Notes
Nutrition Matters
Nutrition-Related
-Cancer, Heart Disease, Stroke — Canada’s Nutrition-Related Deaths
-Cancer, Heart Disease, Stroke and Diabetes — US Nutrition-Related Deaths
Mediterranean Diet Pyramid
-Base every meal off of veggies, fruit and whole grains (plant based, not processed)
-Fish/seafood two times a week
-Short term diets don’t help
-Slow, sustainable, incremental changes will work
Leading Causes of Premature Death
Diseases caused by:
-feet (physical activity)
-forks (diet)
-fingers (smoking)
Impact of Nutrition in Different Countries
-A healthy diet can offset the risks of other bad behaviours (like smoking)
-Macronutrients (proteins carbs fats) supply energy — water is a macronutrient that doesn’t
supply energy
-In Canada, our priority is prevention of obesity and prevention of chronic diseases
Units of Energy
-One calorie (1/1000 of a Kcal) is the amount of heat it takes to raise one gram of water one
degree celsius
-One calorie is equal to 4.18 joules
-CARB: 4 Kcalories/gram
-LIPID: 9 Kcalories/gram
-PROTEIN: 4 Kcalories/gram
-ALCOHOL: 7 Kcalories/gram
Micronutrients
-only needed in small amounts — include vitamins and minerals
-they’re needed for co-factors and co-enzymes
-these don’t supply calories, but they allow body processes to occur
Genes vs. Lifestyle
-Obesity genes aren’t the main culprit behind rising obesity levels
-Diet and lifestyle are more likely to cause obesity than genetics
The Science of Nutrition
Nutritional Research Studies
-Experimental group (variable being tested is present)
-Control group (variable being tested is absent)
-Sometimes there isn’t an intervention
-Observational studies can include epidemiology, which looks at diet, health and disease
patterns in a population
Nutrition Notes
Dietary Planning
Dietary Reference Intakes (DRIs)
-a set of nutrient reference values for vitamins, minerals, macronutrients and energy
-Four types
-EAR — estimated average requirements (50% of the population)
-RDA — recommended dietary allowance (based on EAR, but encompasses needs of
97% of the population)
-AI — adequate intake (value used if there is insufficient data to calculate RDA, our best
guess)
-UL — tolerable upper intake level (amount below which there is little chance of adverse
health effects)
Estimated Energy
Requirements (EER)
-Used to calculate
calories to maintain
stable weight in
healthy individual
-Based on gender,
weight, height and
activity level
Acceptable
Macronutrient
Distribution Rate
(AMDRs)
Recommendations:
-CARBS: 45-65%
-FAT: 20-35%
-PROTEIN: 10-35%
Example:
-2100kcal x 0.5% = 1050 kcal from carbs
-1050 kcal/4 kcal/gram = 263 grams of carbs
Food Labels
-5% or less, it’s low
-15% or more, it’s high
Mnemonic for Diet Planning
-Adequacy
-Balance
-Calorie control
-Nutrient Density
-Moderation
-Variety
Nutrition Notes
Assessment of Nutritional Health
-Analysis of nutrients in dietary intake
-Anthopometric (BP, height, weight)
-Medical hx and lab measurements
Normal Blood Values of Nutritional Reference
Hematocrit (ml/100 ml)
-Men: 0.43 - 0.52
-Women: 0.37 - 0.46
Hemoglobin (g/L)
-Men: 140-174
-Women: 123-157
Ferritin 10-250 ug/L
Iron: 7-36 nmol/L
Assessing Nutrient Deficiencies
Inadequate Intake
-Dietary evaluation, Medical history, Physical exam and Lab tests
Decreased stores and tissue levels
-Lab tests, anthropometrics
Altered biochemical and physiological functions
-Lab tests
Physical signs and symptoms of deficiency
-Physical exam and anthropometrics
Canadian Healthy Eating Index (CHEI)
-Average CHEI score was 58.8%
-We want to increase this score by 20% by 2015
Review of Digestion and Metabolism
Digestion — the process of breaking food down to be absorbed by the body
Absorption — the process by which food moves into the body from GI
Transit time — the amount of time it takes for food to pass the length of the GI tract
- We want the nutrients to absorb slower, but transit time to be faster
Gut Microbiota
-obesity, cancer, inflammation, CVD and liver disease have all been linked with gut microbiota
-We can affect the bacteria in our body by what we eat (feed the good bacteria)

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Description
Nutrition Notes Nutrition Matters Nutrition-Related - Cancer, Heart Disease, Stroke — Canada’s Nutrition-Related Deaths - Cancer, Heart Disease, Stroke and Diabetes — US Nutrition-Related Deaths Mediterranean Diet Pyramid - Base every meal off of veggies, fruit and whole grains (plant based, not processed) - Fish/seafood two times a week - Short term diets don’t help - Slow, sustainable, incremental changes will work Leading Causes of Premature Death Diseases caused by: - feet (physical activity) - forks (diet) - fingers (smoking) Impact of Nutrition in Different Countries - A healthy diet can offset the risks of other bad behaviours (like smoking) - Macronutrients (proteins carbs fats) supply energy — water is a macronutrient that doesn’t supply energy - In Canada, our priority is prevention of obesity and prevention of chronic diseases Units of Energy - One calorie (1/1000 of a Kcal) is the amount of heat it takes to raise one gram of water one degree celsius - One calorie is equal to 4.18 joules - CARB: 4 Kcalories/gram - LIPID: 9 Kcalories/gram - PROTEIN: 4 Kcalories/gram - ALCOHOL: 7 Kcalories/gram Micronutrients - only needed in small amounts — include vitamins and minerals - they’re needed for co-factors and co-enzymes - these don’t supply calories, but they allow body processes to occur Genes vs. Lifestyle - Obesity genes aren’t the main culprit behind rising obesity levels - Diet and lifestyle are more likely to cause obesity than genetics The Science of Nutrition Nutritional Research Studies - Experimental group (variable being tested is present) - Control group (variable being tested is absent) - Sometimes there isn’t an intervention - Observational studies can include epidemiology, which looks at diet, health and disease patterns in a population Nutrition Notes Dietary Planning Dietary Reference Intakes (DRIs) - a set of nutrient reference values for vitamins, minerals, macronutrients and energy - Four types - EAR — estimated average requirements (50% of the population) - RDA — recommended dietary allowance (based on EAR, but encompasses needs of 97% of the population) - AI — adequate intake (value used if there is insufficient data to calculate RDA, our best guess) - UL — tolerable upper intake level (amount below which there is little chance of adverse health effects) Estimated Energy Requirements (EER) - Used to calculate calories to maintain stable weight in healthy individual - Based on gender, weight, height and activity level Acceptable Macronutrient Distribution Rate (AMDRs) Recommendations: - CARBS: 45-65% - FAT: 20-35% - PROTEIN: 10-35% Example: - 2100kcal x 0.5% = 1050 kcal from carbs - 1050 kcal/4 kcal/gram = 263 grams of carbs Food Labels - 5% or less, it’s low - 15% or more, it’s high Mnemonic for Diet Planning - Adequacy - Balance - Calorie control - Nutrient Density - Moderation - Variety Nutrition Notes Assessment of Nutritional Health - Analysis of nutrients in dietary intake - Anthopometric (BP, height, weight) - Medical hx and lab measurements Normal Blood Values of Nutritional Reference Hematocrit (ml/100 ml) - Men: 0.43 - 0.52 - Women: 0.37 - 0.46 Hemoglobin (g/L) - Men: 140-174 - Women: 123-157 Ferritin 10-250 ug/L Iron: 7-36 nmol/L Assessing Nutrient Deficiencies Inadequate Intake - Dietary evaluation, Medical history, Physical exam and Lab tests Decreased stores and tissue levels - Lab tests, anthropometrics Altered biochemical and physiological functions - Lab tests Physical signs and symptoms of deficiency - Physical exam and anthropometrics Canadian Healthy Eating Index (CHEI) - Average CHEI score was 58.8% - We want to increase this score by 20% by 2015 Review of Digestion and Metabolism Digestion — the process of breaking food down to be absorbed by the body Absorption — the process by which food moves into the body from GI Transit time — the amount of time it takes for food to pass the length of the GI tract - We want the nutrients to absorb slower, but transit time to be faster Gut Microbiota - obesity, cancer, inflammation, CVD and liver disease have all been linked with gut microbiota - We can affect the bacteria in our body by what we eat (feed the good bacteria) Nutrition Notes Digestion and Absorption Metabolic Waste - Catabolism produces CO2 which must be removed by the respiratory system - Breakdown of proteins produces nitrogen, which must be disposed of by the urinary system Urea Production - We don’t want ammonia buildup in the blood, so we turn it into urea in the liver - Is excreted in the urine ATP - ADP Cycle - Phosphate has a high energy bond - Harness that energy when you break the bond apart - The energy is used for biological processes ATP Production - Presence of oxygen, nutrients are broken down to form CO2, H2O and ATP - All different nutrients feed on Acetyl CoA - Ticket to mitochondria is oxygen macronutrients —> Acetyl CoA —> Citric acid cycle in the presence of O2 —> electrons transferred to ETC —> produces ATP and H2O In the Absence of Oxygen - NADH shuttles electrons and we need oxygen to create ADP - Without oxygen we make lactate from pyruvate - We create lactate to remove NADH - Then we make Acetyl-CoA, and then goes into the TCA cycle Nutrition Notes Energy Supply - We need constant levels of glucose to keep body processes functioning - Fasted state, fed state Fed State - We have all those lovely nutrients that we’re absorbing - We start absorption — insulin goes up, glucagon goes down - Glucose floods in and feeds all the tissues, and RBCs - First it replenishes our glycogen stores in the liver - Anything over what we can store as glycogen, it’s going to turn into triglycerides and be stored as fat - Amino acids are going into the tissues, built up for synthesis of needed proteins - We cannot store protein - Extra carbs and proteins are stored as fat, along with the fat we take in Diagram - Left side is the major use - Right side is the minor use - Middle is the last resort Fasted State - Blood sugar goes down - Glucagon goes up, insulin goes down - We start breaking down glycogen so that it can build up glucose levels in our blood - We are also going to start breaking down our fat stores - A lot of tissues can use fatty acids (like the heart and muscles — not brain or RBCs) - Amino acids, glycerol and lactate start to make glucose out of non-carb sources Glycogenolysis and Gluconeogensis - Liver stores of glycogen are exhausted first - Gluconeogenesis — creation of glucose from non-carb sources (glycerol, lactate and amino acids) - Occurs in the liver Prolonged Fasting (Starvation) - Glucagon goes up, insulin is down, glucose is down - Fatty acids can be used by the heart and muscle - But this allows ketone bodies to start building up - The brain can then adapt to use the ketone bodies - But 1/3 of the glucose still has to go to the brain (can’t survive on just ketones) - RBCs still need to use glucose - Proteins are functional — so you can only lose so much before you can no longer tolerate the loss Nutrition Notes Change in Fuel Usage in Prolonged Fast Urea Excretion - As you fast, more urea is produced because more protein is being broken down - After 3 days, less is being broken down Lipids - AMDR 20-35% Triglycerides - Most of the fats we take in are triglyceride - Each two-carbon chain can make an Acetyl CoA, so we can get a lot of energy from this Fatty Acids - Ratio of omega-3 to omega-6 fatty acids is essential in regulating body functions (inflammation, blood clotting and smooth muscle contractility), and brain growth and development - EPA and DHA are in fish - ALA is the plant source - Omega-3 is anti-inflammatory and anti-coagulant - Omega-6 makes arachidonic acid, which makes prostaglandins (inflammatory) Unsaturated - Has double bonds - double bonds create energy when you break them so they’re better Nutrition Notes Fully saturated - Has no double bonds Fatty Acid Chains - Most fatty acids chains we consume are 14-22 carbons — long chain fatty acids - Long chains go into the lymph vessels and then into the blood (they’re too big to fit) - Shorter fatty acid chains have lower melting temperatures, as do unsaturated fatty acids - Short and medium chain fatty acids (less than 12 carbons) can travel through the blood bound to albumin Trans Fatty Acids - mostly produced by hydrogenation - Ones with the kink (cis) are unsaturated, and they’re liquid at room temperature (like oils) - The kink doesn’t let them bind as strongly to each other - Ones without the kink, but have a double bound (trans) have hydrogen on the opposite side Phosphoglycerides - Two fatty acids attached to a phosphate group - This is water-soluble and makes the phospholipid bilayer (cell membrane) Cell Membranes - Cholesterol — we do need some for stability in the cells - Fatty acids we take in our diet makes up our cell membranes Sterols - Not water-soluble - We don’t need to take a lot in our diet, because our liver is very good at making it - The body makes all the cholesterol it needs, so any extra cholesterol is extra - The plant version of cholesterol blocks cholesterol receptors, so the cholesterol is bound and excreted (it blocks the uptake) - Precursor for vitamin D, bile acids and sex hormones Lipid Absorption - Lipids travel from the GI tract in chylomicrons - Chylomicrons and VLDL are fat delivery systems to cells - LPL on endothelial cells in the vasculature breaks down triglyceride to allow fatty acid absorption Carbohydrate and Fat Metabolism - Fat metabolism and glucose metabolism happen at the same time Nutrition Notes Citric Acid Cycle and ETC - It only occurs when available carbs are present that are required to metabolize fats - If carbs aren’t present, it’ll just turn into ketones Lipid Transport - VLDL and Chylomicron – contain mostly triglycerides which helps with fat delivery into the cell - Chylomicrons come from diet - VLDL come from the liver - Intermediate density lipoprotein comes after the VLDL - LDLs are bad. Start to deposit fat in the blood stream - HDLs is mostly protein – takes up the fat in the blood stream and takes it back to the liver - High density because proteins are heavier than fat Atherosclerosis Development - If we have a bad diet or smoking history – LDLs start to become oxidized. - The macrophages see these oxidized LDLs and are like “AHH” so they try to get rid of them by forming a plaque (foam cells) to cover them up. - A fibrous cap starts to form, eventually that cap may rupture and block the whole artery Nutrition Notes Dietary Fats and Cancer - Certain fats are associated with cancer - Types of fats consumed matters - Mono-unsaturated fats decreases risk of breast cancer Assessing Fat Intake - Fats are less satiating so you need to eat more to feel full CARBOHYDRATES - Carbs aren’t bad — you just need to choose the healthy ones (the less processed the better) - AMDR 45-65% - RDA is 130 g/day (which is the amount of glucose required by the grain) Refined Carbohydrates - Estimated that 13% of calories are added sugars - Canada’s Food Guide recommends more unrefined/unprocessed carbohydrates - Strips carbs of their nutrients when they’re refined - Bran layer has fibre - Endosperm makes flour Monosaccharides - They’re all 6-carbon sugars but they have different structures - Fructose is in fruit - Lactose is Galactose and Glucose - Glucose + Fructose is table sugar (sucrose) Complex Carbohydrates - These are polymers — tons of sugars put together - Alpha carbs are easily digested - Beta carbs are harder to digest — but in the large intestine there are bacterial enzymes that can partially break them down - Animal storage polysaccharides are stored as glycogen - Plant storage polysaccharides are stored as starch (alpha bonds) - Cellulose cannot be digested by human enzymes Fibre Sources - Two types: soluble and insoluble - Soluble fibres can absorb fibre, it traps things into a gelatinous mass, makes us feel full and helps us to excrete cholesterol and bile acids (fibre decreases transit time) - And then our body creates more bile acids - Soluble fibre, we can’t digest, but stuff in our large intestine can Nutrition Notes - Insoluble helps to decrease transit time (makes things go faster) - Stimulates peristalsis Glycolysis, CAC and ETC - Not enough carbs affects fat metabolism - This causes ketone problems - Because you aren’t in the starved state, you’re getting glucose from other sources, you won’t use the ketones, they’ll build up in your blood and lower pH Glycemic Response - Fibre slows absorption which is good - It avoids those spikes in blood sugar Effect of Glycemic Index on Nutrient Absorption - Glycemic index is the response of your blood sugar to certain carbs - Glycemic index less than 55 is considered low, 70 or more is high (compared to glucose, which is 100) - Glycemic load is low if it is < 11, high if it is 20 - 50g serving of potato chips: 26g carb x GI of 75 (0.75 x 26g = 19.5) Glucose Uptake - if it’s the adipose tissue and skeletal muscle — insulin sensitive receptors — glucose can get into liver and brain without insulin, but into your muscles and adipose tissue, it needs these glucose receptors to transpose to the surface — which is done with the insulin molecule (kinda like the key to the receptor) - GLUT4 is the insulin-sensitive transporter in muscle and adipose tissue Diabetes - Type II Diabetes is on the rise - Pre-diabetes can go on for 10 years - Preventable with exercise and diet - Most are type II - Type I is autoimmune Long-Term Complications - Constant exposure to high levels of blood glucose causes glycation of proteins - These altered proteins are thought to link together, forming advanced glycation enzymes (AGEs) - We want to reduce these Diverticulitis - Caused by low fibre diet — increased transit time and strain on colon wall - Excess pressure causes pouches called diverticula (condition called diverticulosis) - If feces are caught in the diverticula, and causes inflammation and pain and infection, this is diverticulitis Celiac Disease - Average time for diagnosis is 12 years - Destroys villi in the small intestines Nutrition Notes - Requires environmental trigger, genetic disposition and auto-antigen - Auto-antigen crosses intestinal wall to trigger immune response - Gut walls get leaky, and immune response flattens villi and enflames intestines - Makes it difficult to absorb nutrients - Just because you have the genetic disposition, doesn’t mean you have celiac — you need to have the leaky membranes, which usually come from the trigger (which is usually some sort of GI infection) Symptoms - CLASSIC: Abdominal pain, diarrhea, weight loss, poor growth, irritability, constipation, vomiting, poor appetite, protuberant abdomen (bloating) - ATYPICAL: Anemia, osteoporosis, short stature, functional hyposplenism, dental defects, recurrent mouth ulcers, amenorrhea, infertility, low birth weight infants, premature delivery, autoimmune hepatitis, liver disease Diagnosis - Blood test first, then biopsy - Don’t stop eating gluten foods until you’re done being tested Treatment - Gluten free diet for life Challenges of a Gluten Free Diet - Social determinants of health - Availability is no longer an issue Water and Electrolytes - Imbalances in fluid and electrolytes can come about very rapidly and have devastating consequences - But, they can also be alleviated more rapidly than any other nutrient deficiency Functions of Water - Digestion and chemical processes - Temperature - Solvent - Transportation - Lubrication - Protect
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