Krause Food Nutrition Care Process 13th Edition Mahan

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Mahan: Krause’s Food and the Nutrition Care Process, 13th Edition

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Chapter 3: The Nutrients and Their Metabolism

MULTIPLE CHOICE

Which of the following hormones promotes a decrease in serum glucose levels? a.

Epinephrine

Glucagon

Glucocorticoid

Insulin

ANS: D Insulin is released in response to increases in blood glucose levels and promotes the cellular uptake of glucose. Glucagon is released when blood glucose levels decrease and is responsible for promoting glycogen breakdown and gluconeogenesis to increase blood glucose. Glucocorticoid works similarly, particularly in the stressed state. Epinephrine also promotes increases in blood glucose as an energy source in response to emotional state, as in the “fight-or-flight” situation.

REF: p. 39

Dietary fiber delays gastric emptying time and shortens intestinal transit time. What metabolic effect may result from this in a person with diabetes mellitus? a.

Reduction in blood glucose level

Increase in blood glucose level

Decrease in ketone production

Increase in glucose absorption

ANS: A Because of its effects on the gastrointestinal tract, interference with absorption of glucose by dietary fibers results in decreased uptake of glucose in the small intestine. This can be seen in decreased postprandial increases in blood glucose levels. As ketone production occurs during the fasted and starvation states of metabolism, no changes in ketone production would be seen after eating fiber.

REF: p. 38

What is the major end product of the digestion of dietary carbohydrate? a.

Fructose

Sucrose

Mannose

Glucose

ANS: D Glucose is the primary end product of starch digestion because starch is composed of chains of glucose. Although disaccharidases in the brush border result in the release of the monosaccharides fructose and galactose, the amount of these monosaccharides does not come close to that of glucose. Mannose is an undigestible hemicellulose.

REF: p. 36

What is the energy source for the central nervous system under normal conditions? a.

Ketone bodies

Glucose

Fatty acids

Amino acids

ANS: B Glucose is the obligate energy source for the brain and nervous system. As glucose and glycogen stores are depleted, amino acids are sacrificed for gluconeogenesis to maintain the nervous system. During starvation adaptation, ketones may be used as an energy source for the brain.

REF: p. 33

Which types of fiber function as prebiotics? a.

Fructans

Beta-glucans

Lignins

Pectins

ANS: A Fructans, such as fructo-oligosaccharide and inulin, promote the growth of beneficial bacterial species in the colon. Beta-glucans and pectins are soluble fibers that help reduce serum cholesterol. Lignin is a woody fiber that contributes to short-chain fatty acid production in the colon

REF: p. 37

If you were teaching a patient to reduce the saturated fat in his diet, which of the following would you instruct him to avoid? a.

Olive and peanut oil

Coconut and palm oil

Safflower and corn oil

Canola and cottonseed oil

ANS: B Coconut and palm oil are typical sources of short-chain fatty acids (SFAs) such as lauric and palmitic acids. Olive oil is a source of the monounsaturated fatty acid (MUFA) oleic acid. Peanut oil has the SFA arachidic acid. Safflower, corn, and cottonseed oils provide the polyunsaturated fatty acid (PUFA) linoleic acid, and canola oil provides the PUFA linolenic acid.

REF: p. 43

Which of the following is (are) the best source of omega-3 fatty acids? a.

Fish oil

Corn and safflower oil

Coconut and palm oil

Canola and peanut oil

ANS: A Fish and fish oils provide the highest concentrations of omega-3 fatty acids. Linolenic acid, which is an omega-3 fatty acid, is available from soybean, canola, and walnut oils.

REF: pp. 41, 44

What are the essential fatty acids? a.

Linolenic acid and arachidonic acid

Linoleic acid and arachidonic acid

Linoleic acid and linolenic acid

Eicosapentaenoic acid and phosphatidylcholine

ANS: C Because of the human body’s inability to synthesize omega-3 and omega-6 fatty acids, linoleic and linolenic acids have traditionally been identified as the essential fatty acids. The body can desaturate and elongate both of these fatty acids to produce, respectively, arachidonic acid and eicosapentaenoic acid. Suggestion has been made to apply the term “essential fatty acid” to longer chain fatty acids. Phosphatidylcholine is a phospholipid that is a major component of cell membranes.

REF: pp. 41–42

Which of these are primary sources of trans-fatty acids? a.

Vegetable oils and butterfat

Milk and eggs

Flaxseed and canola oil

Margarine and commercially fried foods

ANS: D Trans-fatty acids occur most frequently as a result of hydrogenation of unsaturated fats and oils. This forms a more solidified fat as in margarine or shortening. Commercial cooking with these types of fats contributes to increased intake. Some trans-fatty acids occur more naturally in foods, such as in butter and animal fat, but this is because of bacterial fermentation. Oils do not contain trans-fatty acids.

REF: pp. 44–45

10.

Which fall into the category of isoprenoids?

Glucocorticoid and mineralocorticoid

Lycopene and carotenoid

Cerebrosides and gangliosides

Bile acid

ANS: B Isoprenoids are lipids that contain alternating single and double bonds, allowing for electron transfer, thus providing antioxidant activity. Plant pigments, such as lycopene and the carotenoids, allow for electron transfer during photosynthesis. Glucocorticoids, mineralocorticoids, and bile acids are steroid derivatives of cholesterol. Cerebrosides and gangliosides are structural components of nerve tissue and examples of glycolipids.

REF: p. 46

11.

How do protein-based fat replacers function in commercial food products?

They act as bulking agents.

They promote gelatinization and water retention.

They provide mouth texture.

They act as thickening agents.

ANS: C Protein-based fat replacers tend to provide a fatlike mouth feel to food products. Various carbohydrate-based fat replacers serve other functions, such thickening, gelatinization, and bulking properties in foods.

REF: p. 47

12.

Which of these groups contains only essential amino acids?

Arginine, tryptophan, threonine, serine

Glycine, histidine, isoleucine, leucine

Valine, glutamine, asparagine, alanine

Phenylalanine, threonine, histidine, leucine

ANS: D

Essential amino acids are ones that have carbon skeletons that humans are incapable of synthesizing. These include valine, leucine, isoleucine, methionine, threonine, phenylalanine, tryptophan, lysine, and in the case of infants, cysteine and histidine.

REF: p. 51

13.

What is the name of the process in which the amine group of an amino acid is removed before oxidation for energy?

Transamination

Beta-oxidation

Deamination

Reverse amination

ANS: C Deamination is a necessary step in the use of an amino acid for energy production or gluconeogenesis. Transamination involves the transfer of an amino group from one amino acid to another. Beta-oxidation refers to the catabolism of fatty acids to yield energy. When the amino group is removed, it is routed to the urea cycle. This eliminates the nitrogen component and prevents a reverse in the process.

REF: p. 51

14.

Which step in protein synthesis occurs at the ribosome?

Peptide bonding of amino acids

Ribosomal RNA production

Messenger RNA production

Transfer RNA production

ANS: A The assembly of the peptide chain occurs at the ribosome as protein translation occurs. The production of mRNA, tRNA, and rRNA all occur in the nucleus of the cell as steps in transcription.

REF: pp. 51

15.

Which of the following improves protein quality?

Wine or vinegar marinade

Increasing soybean intake

The Maillard reaction

Exposing meat to sulfur dioxide

ANS: A Marinade promotes denaturation of meat proteins, which improves digestibility and thus protein quality. Soybeans contain a trypsinase that inhibits trypsin activity. Browning that occurs through the Maillard reaction can cause a loss of lysine. Exposing meat to sulfur dioxide or oxidation processes can cause a loss of methionine.

REF: p. 52

16.

Which of the following characteristics are seen in an adult experiencing marasmus?

Muscular wasting and absence of subcutaneous fat

Pitting edema

Hypoalbuminemia and presence of pitting edema

Enlarged fatty liver and hyperalbuminemia

ANS: A Marasmus, or adapted starvation, results in a person losing both muscle and fat mass. This is as opposed to kwashiorkor, technically childhood condition of protein-calorie malnutrition, in which lack of protein intake results in a loss of albumin and the presence of edema. Fatty liver results from buildup of triglycerides in hepatic tissue; however, in the case of starvation, fatty acids are converted into ketones as opposed to being re-esterified into triglycerides. Additionally, albumin synthesis is impaired.

REF: p. 55

17.

Which of the following removes chylomicrons from the blood a few hours after eating?

Low-density lipoproteins

Lipoprotein lipase

Carnitine

Adrenocorticotropic hormone

ANS: B Lipoprotein lipase is an enzyme that binds the chylomicrons so that triglycerides may be cleaved to release fatty acids into adipocytes. Chylomicron remnants are taken up by the liver and resynthesized into very low-density lipoprotein (VLDL). After VLDL has more triglyceride removed by lipoprotein lipase, it becomes low-density lipoprotein. Carnitine is a co-factor in the transport of fatty acids into the mitochondria of cells.

REF: p. 54

18.

What disease results from a deficiency of niacin?

Scurvy

Beriberi

Pellagra

Rickets

ANS: C In 1918, Joseph Goldberger demonstrated that a high-quality protein diet could cure pellagra. Time passed before research determined that the amino acid tryptophan was a precursor for the vitamin niacin. Scurvy results from deficiency of vitamin C, beriberi from thiamin deficiency, and rickets from vitamin D deficiency.

REF: p. 56

19.

What types of foods are bioflavonoids found in?

Fruits and vegetables

Vegetables only

Fruits only

Meats, fruits, and vegetables

ANS: A Bioflavonoids have antioxidant properties that help reduce capillary fragility and promote the activity of vitamin C. They are widely available in all foods of plant origin.

REF: p. 91

20.

In the treatment of what condition has supplemental CoQ10 been demonstrated to be effective?

Lung cancer

Colon cancer

Congestive heart failure

Pellagra

ANS: C Coenzyme Q10 is a ubiquinone, which has reduction-oxidation properties that allow it to function as an antioxidant. Supplementation of CoQ10 has been shown to be useful in the treatment of cardiomyopathy and congestive heart failure. Food sources of CoQ 10 include fish and fish oils, nuts, and meat.

REF: p. 91

21.

As many as 40% of Americans may be deficient in which of the following vitamin?

Vitamin A

Vitamin E

Ascorbic acid

Vitamin D

ANS: D Vitamin D has been the focus of intense research. More than 50 genes are known to be regulated by vitamin D. The normal adult is presumed to obtain sufficient vitamin D from exposure to sunlight and incidental ingestion through small amounts in foods. However, increasing evidence suggests that vitamin D status is low, especially in people with dark skin, in those who spend little time outside, and in those who live in the northern areas of the country.

REF: 62

22.

Which vitamin functions with the coenzymes NAD and NADP?

Niacin

Riboflavin

Ascorbic acid

Pyridoxine

ANS: A Nicotinamide adenine dinucleotide contains niacin, another word for nicotinamide. Riboflavin is in the coenzymes flavin adenine mononucleotide (FMN) and flavin adenine dinucleotide (FAD). Pyridoxine is in the coenzyme pyridoxal phosphate. Ascorbic acid, or vitamin C, does not function as a coenzyme.

REF: p. 58

23.

How is vitamin D deficiency manifested in adults?

Hypocalcemia

Osteoporosis

Osteomalacia

Hypophosphatemia

ANS: C Osteomalacia is the adult equivalent of rickets. Osteoporosis is associated with aging. Bone density is used as a diagnostic measure of these conditions. Low levels of blood calcium and phosphorus can result from conditions other than vitamin D deficiency.

REF: p. 69

24.

The continued use of antibiotic therapy can reduce bacterial flora in the gut. Which of the following may result from this?

Deficiency in vitamin K

Deficiency in vitamin C

Toxicity of vitamin A

Toxicity of biotin

ANS: A Although vitamin K deficiency is rare, it can occur in long-term antibiotic therapy as intestinal flora produce menaquinones absorbable by humans. Cigarette smoking has been associated with decreased vitamin C serum levels. Vitamin A toxicity is promoted by continuing to take in large doses through supplements. Biotin has not been demonstrated to have toxic effects.

REF: p. 74

25.

To prevent hemorrhagic disease in newborns, which vitamin is administered to infants shortly after birth?

Vitamin C

Thiamin

Vitamin D

Vitamin K

ANS: D Because breast milk is a poor source of vitamin K and the newborn gastrointestinal tract is sterile and has not developed bacterial species, menadione injection is given at birth. Vitamin D supplementation of infants is recommended for breastfed infants and infants fed less than 500 mL of vitamin D fortified formula who do not receive adequate sun exposure. Water-soluble vitamin content of breast milk reflects the intake of the mother. Commercial infant formula must provide nutrients at levels established by law.

REF: p. 74

26.

Which vitamin is involved with normal bone development, epithelial cell formation, and visual pigment formation?

Pyridoxine

Vitamin D

Vitamin A

Ascorbic acid

ANS: C The various forms of vitamin A are involved in vision, gene expression, cellular differentiation, bone development, reproduction, and immune function. Pyridoxine functions in amino acid metabolism and in the synthesis of neurotransmitters. Vitamin D is involved in gene transcription and in calcium and phosphorus homeostasis. Ascorbic acid works in antioxidant activity and is involved in the synthesis of collagen.

REF: p. 60

27.

Which of these vitamins is destroyed by ultraviolet irradiation?

Riboflavin

Vitamin D

Pyridoxine

Niacin

ANS: A Riboflavin is destroyed by ultraviolet light, which is one of the reasons that milk was packaged in cartons. Vitamin D is produced by skin exposure to ultraviolet irradiation. Pyridoxine and niacin are stable in light.

REF: p. 77

28.

The absorption of ingested vitamin D occurs along with the absorption of what?

Protein and lactose

Lipids

Carbohydrates and niacin

Thiamin and glucose

ANS: B Vitamin D is a fat-soluble vitamin and must be transported with dietary lipids. The best dietary sources of vitamin D are fish liver oils. Variable amounts are in butter, cream, and egg yolk. Milk is commonly fortified to provide a dietary source of vitamin D.

REF: p. 62

29. a.

Which set of vitamins is involved in cellular energy production? Ascorbic acid, thiamin, riboflavin, and carnitine

Niacin, ascorbic acid, pantothenic acid, and thiamin

Pyridoxine, vitamin A, thiamin, and riboflavin

Thiamin, niacin, riboflavin, and pantothenic acid

ANS: D Thiamin serves as a coenzyme in relation to glucose, pyruvate, and alpha-keto acid metabolism. Riboflavin serves as a coenzyme in fatty acid oxidation and glucose metabolism. Niacin is important in beta-oxidation, the TCA cycle, and the electron transport system. Pantothenic acid is a part of coenzyme A, which plays a central role in the metabolism of glucose, amino acids, and fatty acids.

REF: p. 74

30.

Which vitamin is needed for transaminases to function during protein metabolism?

Thiamin

Pyridoxine

Riboflavin

Niacin

ANS: B The aldehyde group of pyridoxal phosphate reacts with the a-amino group of an amino acid to stabilize it, allowing for other enzymes to affect the amino acid. Thiamin, riboflavin, and niacin affect protein metabolism through metabolism of the keto body portion of the amino acid.

REF: p. 81

31.

Which best describes the functions of vitamin C?

Enhancing iron absorption and collagen formation

Essential for calcium and phosphate absorption

Biosynthesis of sphingolipids in the myelination of nerve cells

Promotes synthesis and repair of DNA

ANS: A Vitamin C improves iron absorption through reduction of iron to its ferrous form and chelation for absorption. Additionally, vitamin C is involved in collagen synthesis. Vitamin D is necessary for calcium and phosphorus absorption. Pyridoxine promotes biosynthesis of sphingolipids for myelination. Folate functions in single-carbon transfer reactions such as those involved in the metabolism of nucleotides in DNA synthesis.

REF: pp. 58, 88

32.

What condition is evidenced by symptoms of mental confusion, muscular wasting, edema, and peripheral neuropathy?

Niacin deficiency

Vitamin C deficiency

Hypervitaminosis A

Thiamin deficiency

ANS: D Beriberi, the thiamin deficiency disease, includes symptoms of mental confusion, muscular wasting, edema, peripheral neuropathy, tachycardia, and cardiomegaly. Niacin deficiency, pellagra, is evidenced by dermatitis, dementia, and diarrhea. Vitamin C deficiency, or scurvy, presents with swollen and bleeding gums, lethargy, bone weakness, muscle atrophy, and skin lesions. Hypervitaminosis A includes dry lips, nasal passages, and eyes; skin dryness; hair loss; and nail fragility.

REF: p. 76

33.

Which form of vitamin A is a structural component of the visual pigments of the rods and cells in the retina?

Beta carotene

Retinal

Retinoic acid

Retinol

ANS: B Retinal in the rods and cells of the retina contributes to the photosensitivity associated with sight. Beta carotene is a precursor of the active forms of vitamin A. Retinoic acid is the form of vitamin A involved in cellular expression. Retinol is the transport and storage form of vitamin A.

REF: p. 58

34.

In vitamin D metabolism, which version of vitamin D is produced by the liver and then transported to the kidney?

7-Dehydrocholesterol

Cholecalciferol

25-Hydroxycholecalciferol

Calcitriol

ANS: C 7-Dehydrocholesterol is one of the vitamin D precursors in the skin that undergoes transformation to cholecalciferol when the skin is exposed to ultraviolet light. Cholecalciferol travels to the liver, where it undergoes its first hydroxylation, yielding 25-hydroxycholecalciferol. This form, the version most common in blood circulation, travels to the kidney for the second hydroxylation, producing the final active form, calcitriol.

REF: p. 62

35.

Deficiency of which vitamin results in the development of a magenta tongue?

Niacin

Riboflavin

Pyridoxine

Vitamin B12

ANS: B

A purple or magenta tongue is associated with riboflavin deficiency. A red, beefy tongue is seen with niacin deficiency. Glossitis results from vitamin B6 deficiency. Food cobalamin malabsorption is also associated with red, beefy tongue development.

REF: p. 77

36.

The food content of which vitamin is least likely to be reported in food composition tables?

Biotin

Pantothenic acid

Cyanocobalamin

Pyridoxine

ANS: A Biotin, although widely distributed in foods, has had its content determined in relatively few foods. Pantothenic acid is all plant and animal-based foods. Cyanocobalamin is one of the most active forms of vitamin B12. Pyridoxine is the common name for vitamin B6.

REF: p. 87

37.

What is the most common cause of vitamin B12 deficiency?

Vegan diet

Lack of intrinsic factor

Folate deficiency

Lack of transcobalamin

ANS: B Pernicious anemia results from a lack of intrinsic factor, which prevents the absorption of vitamin B 12. Although vegan diets lack vitamin B12, following this type of diet is not as prevalent as factors that interfere with intrinsic factor secretion. Without the intrinsic factor, vitamin B 12 cannot reach intestinal receptor sites so as to be transported by the transcobalamins into blood circulation. A vitamin B12 deficiency may lead to a secondary folate deficiency.

REF: p. 86

38.

Which of the following minerals is considered to be a trace element?

Calcium

Sodium

Iron

Magnesium

ANS: C Trace elements are those needed in quantities less than or equal 15 mg per day. Iron needs decrease below this level, but calcium and magnesium requirements are higher. Sodium is considered to be an electrolyte.

REF: p. 105

39. a.

Which of the following is the most sensitive indicator for determining iron status? Hemoglobin

Hematocrit

Serum ferritin

Serum transferrin

ANS: C Serum ferritin levels correlate closely with total body iron stores. Hemoglobin and hematocrit values are subject to variations in other nutrients and health status and therefore are not specific to determining iron status. Serum transferrin is subject to both iron and protein intakes. Transferrin increases with iron deficiency but decreases in protein deficiency.

REF: pp. 106–108

40.

If a person ate 100 g of each of the following, which one would provide the most calcium?

Tofu

Salmon canned with the bones

Calcium-fortified bread

Yogurt

ANS: D Dairy products are high in calcium that has high bioavailability. Compared with yogurt, salmon with bones and tofu provide less calcium. Bread fortified with calcium may provide additional calcium, but depending on the dietary fiber content, bioavailability may be limited.

REF: p. 98

41.

Which of the following mineral–mineral interactions may lead to impaired absorption of the second mineral when the first mineral is consumed in “toxic” amounts?

Iron and zinc

Zinc and copper

Sodium and potassium

Calcium and phosphate

ANS: B Excessive oral zinc intake interferes with copper absorption because they compete for binding to the carrier protein metallothionein within the mucosal cell. High doses of zinc have been demonstrated to decrease the absorption of iron from supplements, but iron has not been shown to affect zinc absorption. Excessive phosphorus intake results in an imbalance in serum calcium and phosphorus levels; however, increased calcium does not interfere with phosphorus absorption. Sodium and potassium intake do not affect the absorption of each other.

REF: pp. 115–116

42.

Which of the following provide the most bioavailable source of iron?

Meats, fish, and poultry

Legumes

Fortified grain products

Dark green leafy vegetables

ANS: A From 10% to 30% of the iron in animal sources is absorbed as opposed to 2% to 10% of the iron in plant sources. Part of this is because of heme iron, which does not require digestion before absorption, and part of it is because of a “meat factor,” which enhances iron absorption.

REF: p. 110

43.

Which of the following minerals functions in an antioxidant role?

Chromium

Zinc

Fluoride

Selenium

ANS: D Selenium is a part of the antioxidant enzyme glutathione peroxidase, which acts in the cytosol and mitochondria of cells. Chromium is involved in potentiating insulin function. Zinc is involved in the functioning of numerous intracellular enzymes in regard to metabolism. Fluoride is incorporated into hydroxyapatite to strengthen tooth enamel.

REF: p. 119

44.

Which of the following minerals, through its action as an enhancer of insulin, is involved in maintaining blood glucose concentrations?

Chromium

Zinc

Iron

Selenium

ANS: A Chromium works with insulin in regard to its metabolic roles with carbohydrate, protein, and fat; however, a glucose tolerance factor has not been identified. Zinc plays structural roles in regard to protein, nucleic acid, RNA, and DNA synthesis. ATP production within cellular mitochondria relies on enzymes containing iron. Selenium functions as part of glutathione peroxidase.

REF: pp. 119–120

45.

What is a physical sign of adult iodine deficiency?

Muscle spasm

Simple goiter

Hypertension

Diarrhea

ANS: B Goiter, or enlargement of the thyroid gland, is the way iodine deficiency presents in adults. Muscle spasms are one symptom associated with magnesium deficiency. Inadequate intakes of calcium and

magnesium are thought to be involved in the development of hypertension. Diarrhea has been seen in children with zinc and copper deficiencies.

REF: p. 118–119

46.

What does the serum protein transferrin do?

Transports phosphorus to the bone

Transports iron in the blood for use in heme synthesis

Transports phosphorus from the bone to the tissues

Transports calcium to the bone

ANS: B Transferrin acts as both a storage form of iron and a transport protein, allowing for the transport of heme iron to the bone marrow for hemoglobin synthesis. Phosphorus is transported through the blood as inorganic phosphate. Calcium exists both in ionic form and bound to protein, mostly albumin.

REF: pp. 106–108

47.

Which factor(s) best promote the absorption of iron from food?

Ascorbic acid and vitamin D

Alkaline environment

Ascorbic acid and an acidic environment

Acidic environment

ANS: C Ascorbic acid both reduces ferric iron to ferrous iron and forms a chelate with iron to increase absorption. Passing nonheme iron through the acidic environment of the stomach also reduces ferric to ferrous iron, improving absorption. Vitamin D enhances calcium, and to a small extent, phosphorus absorption.

REF: pp. 107–108

48.

Goitrogens, which inhibit the absorption or utilization of iodine, are found in which foods?

Fish, chicken, and beef

Milk, cheese, and yogurt

Apples, peaches, and pears

Cabbage, turnips, and peanuts

ANS: D Foods containing goitrogens include cabbage, turnips, rapeseeds, peanuts, cassava, sweet potatoes, kelp, and soybeans. The goitrogens can be inactivated by heating and cooking the foods.

REF: p. 119

49.

Deficiency of which mineral causes growth retardation and hypogonadism?

Iron

Iodine

Zinc

Selenium

ANS: C Zinc deficiency can result in mild anemia, decreased taste acuity, delayed wound healing, and alopecia. Iron deficiency results in iron-deficiency anemia, but it also can affect growth and immune function. Iodine deficiency results in growth and mental retardation. Selenium deficiency results in cardiomyopathy.

REF: p. 114

50.

Deficiency of which mineral causes cardiomyopathy or Keshan disease?

Iodine

Zinc

Fluoride

Selenium

ANS: D Keshan disease is named for a province in China where women and children developed cardiomyopathy as a result of selenium deficiency. Iodine deficiency results in goiter and cretinism.

Zinc deficiencies result in growth retardation and immunologic defects. Fluoride deficiencies technically do not exist, although fluoride does have a protective effect in regard to dental caries.

REF: p. 121