Understanding Normal and Clinical Nutrition 12th Edition Test Bank by QuentinAxel

Chapter 01- An Overview of Nutrition

Understanding Normal and Clinical Nutrition 12th Edition Rolfes Test Bank 1. Which statement about nutrition’s role in a person’s life is FALSE? a. Nutrition is the science of the nutrients in foods and their actions within the body. b. Nutrition is the study of human behaviors related to food and eating. c. Careless food choices can contribute to chronic disease. d. Chronic diseases progress slowly. e. A diet is defined as a restrictive food plan designed for weight loss. ANSWER: e 2. Your classmate prefers to consume strawberries rather than other fruits. Based on what you’ve learned about influences on food choices, what would be the most likely reason your classmate prefers strawberries? a. Strawberries are cheap. b. He likes the flavor and taste of strawberries the most. c. Strawberries are a convenient snack. d. Strawberries are a nutritionally rich food. e. Eating strawberries is a habit. ANSWER: b 3. At a party with friends, Janine drinks wine and eats hors d’oeuvres, even though she is not hungry. This is an example of a food choice based on . a. habit b. social interaction c. emotional turmoil d. negative association e. comfort eating ANSWER: b 4. A person who eats a granola bar from a vending machine is most likely making a food choice based on: a. Habit b. Availability c. Body image d. Environmental concerns e. Cultural values ANSWER: b

Chapter 01- An Overview of Nutrition 5. Which individual is making a food choice based on values? a. A woman who avoids gluten due to allergies b. A child who spits out his mashed potatoes because they taste too salty c. A teenager who mindlessly eats potato chips while watching television d. A man who eats oatmeal each day without exception e. A Catholic woman who fasts on Good Friday to honor religious custom ANSWER: e 6. The motive for people who tend to prefer foods they grew up eating is most likely related to their a. values b. body image c. ethnic heritage d. negative association

e. economy ANSWER: c 7. Farah is a movie fan and always eats a big bucket of buttery popcorn at the theater. Her food choice is most likely based on . a. regional cuisine b. values c. Ethnic value d. positive association e. functional value ANSWER: d 8. Which of the following is an example of an ultra-processed food? a. Skim milk b. Swiss cheese c. Chicken nuggets d. Sunflower seeds e. Apple juice ANSWER: c 9. Which of the following does NOT represent one of the six classes of nutrients? a. water b. lipids c. phytochemicals d. carbohydrates e. protein ANSWER: c

Chapter 01- An Overview of Nutrition 10. An apple is composed primarily of a. fats b. Water and carbohydrates c. proteins d. phytochemicals e. vitamins and minerals

ANSWER: b 11. Which is the simplest nutrient? a. Minerals b. Water c. Protein d. Carbohydrates e. Vitamins ANSWER: a 12. Why are vitamins and minerals sometimes called micronutrients? a. The body requires only small amounts (milligrams and micrograms) daily. b. They provide only small amounts of energy for the human body. c. They do not contain carbon. d. They are fat-soluble. e. They yield energy. ANSWER: a 13. Calories or kcalories are a measure of a. heat b. potential c. surface d. work e. light ANSWER: a 14. Which nutrient has the greatest energy density? a. Protein b. Water c. Carbohydrate d. Fat e. Vitamins ANSWER: d

energy.

Chapter 01- An Overview of Nutrition 15. Which of the following statements about essential nutrients is FALSE? a. They must be obtained from food. b. They are also called “more than just necessary” nutrients. c. They cannot be made in sufficient quantities by the body. d. They meet the body’s physiological needs. e. There are about 100 nutrients essential for the human body. ANSWER: e 16. Which nonnutritive substance contributes energy, but does not sustain life? a. Fats b. Sugar c. Artificial sweeteners d. Alcohol e. Phytochemicals ANSWER: d 17. What happens when the body uses energy-yielding nutrients? a. The bonds between the atoms break and release energy. b. The body converts them into storage compounds. c. A person’s energy stores are depleted. d. The amount of water in the body decreases. e. A person’s body mass increases. ANSWER: a 18. Which energy-yielding nutrients are found in part of the structural component of muscles and help regulate digestion? a. fats b. alcohols c. proteins d. carbohydrates e. vitamins and minerals ANSWER: c 19. The international unit for measuring food energy is a. kilojoules b. kilograms c. kilometers d. kilonewtons e. kiloliters ANSWER: a

Chapter 01- An Overview of Nutrition 20. Which of the following statements accurately describes vitamins? a. Vitamins are inorganic and do not provide energy. b. Vitamins are indestructible. c. Almost every action in the body requires the assistance of vitamins. d. Vitamins A, D, E, and K are water-soluble vitamins. e. Cooking vegetables at high temperatures helps maintain the vitamins. ANSWER: c 21. There are a. 8 b. 13 c. 16 d. 23 e. 26

vitamins and each has its own special dietary role to play.

ANSWER: b 22. Which of the following statements about minerals is FALSE? a. Minerals are found in bones and teeth. b. Minerals influence fluid balance and distribution. c. There are six minerals known to be essential to human nutrition. d. Minerals are inorganic and do not provide energy. e. Lead is a mineral and an environmental contaminant. ANSWER: c 23. Which essential nutrient provides the environment in which nearly all the body’s activities take place? a. proteins b. carbohydrates c. water d. alcohol e. vitamins ANSWER: c 24. Which of the following terms is defined as the science of how nutrients affect the activities of genes and how genes affect the activities of nutrients? a. Genetic counseling b. Nutritional genomics c. Genetic metabolomics d. Nutritional genetics e. Biochemical nutrition ANSWER: b

Chapter 01- An Overview of Nutrition 25. Research always begins with a. a problem or a question b. an experiment c. a theory d. a prediction e. interpretations

ANSWER: a 26. When conducting research, an educated guess like, “Diets rich in fiber always lead to good health,” is called a

. a. theory b. prediction c. hypothesis d. correlation e. deduction ANSWER: c 27. Which of the following best describes randomization? a. repetition of an experiment and getting the same results b. process of choosing members of experimental and control groups without bias c. personal account of an experience d. experimentation on subjects who do know to which group they’ve been assigned e. knowledge that experimental results were based in fact ANSWER: b 28. What is a weakness of an epidemiological study? a. Findings on some human beings cannot be generalized to all human beings. b. Results from animal studies cannot be applied to human beings. c. Cause and effect cannot be proven. d. Codes of ethics prevent certain treatments. e. The list of possible causes of disease can be narrowed. ANSWER: c

Chapter 01- An Overview of Nutrition 29. Which is a strength of laboratory-based studies? a. It cannot apply results from test tubes or animals to human beings. b. It can determine the effects of a variable. c. Results from animal studies can be applied to human beings. d. The list of possible causes of disease can be expanded. e. It can control variables that may influence the prevention of a disease. ANSWER: b 30. Researchers benefit from a large sample size because a. chance variation is less likely to affect the results b. any placebo effect is eliminated c. it increases the likelihood of double-blind results d. the control group will be more like the experimental group e. experimenter bias is less likely to have an effect

ANSWER: a 31. Your research findings suggest “the less vitamin C, the fewer colds.” What do your findings suggest? a. no correlation b. a positive correlation c. a negative correlation d. a placebo effect e. validity ANSWER: b 32. Which of the following statements describes a double-blind experiment? a. The experimental and control groups take turns getting each treatment. b. Neither subjects nor researchers know which subjects are in the control group and which are in the experimental group. c. Neither group of subjects knows whether they are in the control or experimental group, but the researchers do know. d. Both subject groups know whether they are in the control or experimental group, but the researchers do not know. e. Neither the subjects nor the persons having contact with the subjects know the true purpose of the experiment. ANSWER: b

Chapter 01- An Overview of Nutrition 33. Which term describes the process in which a panel of scientists rigorously evaluates a research study to ensure that the scientific method was followed? a. peer review b. systematic review c. research validity d. meta-analysis e. peer replication ANSWER: a 34. To be accepted into the body of nutrition knowledge, research findings must stand up to rigorous, repeated testing in experiments conducted by other researchers. This is called . a. validity b. correlation c. replication d. randomization e. anecdotal evidence ANSWER: c 35. Which part of a research article defines key terms, study design, subjects, and procedures? a. references b. introduction c. abstract d. methods e. results ANSWER: d 36. You have been asked to help a top nutrition researcher conduct human double-blind experiments on vitamin C. As the subjects walk into the laboratory, you distribute all the vitamin C pill bottles to the girls and all the placebo pill bottles to the boys. The researcher instantly informs you that there are two errors in your research practice. What steps should you have taken to conduct your experiment correctly? a. You should have given all the boys the vitamin C and all the girls the placebo and then told them what they were getting. b. You should have distributed the bottles after randomly assigning the subjects and then told them what they were getting. c. You should have told the subjects which group they were in, while preventing yourself from knowing the contents of the pill bottles. d. You should have prevented yourself from knowing what was in the pill bottles and distributed the bottles randomly to the subjects. e. You should have allowed the subjects to decide whether they take vitamin C or the placebo, and then given them the opposite of what they requested. ANSWER: d

Chapter 01- An Overview of Nutrition 37. Which of the following is NOT a category of the Dietary Reference Intake (DRI)? a. Estimated Average Requirements (EAR) b. Recommended Dietary Allowances (RDA) c. Adequate Intakes (AI) d. Tolerable Upper Intake Levels (UL) e. Anthropometric Measurements (AM) ANSWER: e 38. The lowest continuing intake of a nutrient that will maintain a specified criterion of adequacy is called a “nutrient ________.” a. allowance b. requirement c. tolerable limit d. adequate intake e. recommendation ANSWER: b 39. The Estimated Average Requirement (EAR) for a nutrient meets the needs of about a. 5% b. 25% c. 50% d. 75% e. 98%

of the population.

ANSWER: c 40. Which of the following statements best describes the Recommended Dietary Allowance (RDA) for a nutrient? a. It is set more than twice as high as the average person needs. b. It is the minimum amount that the average person needs in her/his diet. c. It is designed to meet the needs of nearly all people. d. It is designed to prevent deficiency diseases of about half of the general population. e. It is reflective of current dietary preferences and trends. ANSWER: b 41. The Recommended Dietary Allowance (RDA) for a nutrient meets the needs of about a. 5% b. 25% c. 50% d. 75% e. 98% ANSWER: e

of the population.

Chapter 01- An Overview of Nutrition 42. Which of the following statements accurately describes nutrient intakes? a. Higher nutrient intakes are always safer than lower intakes. b. Nutrient intakes below the EAR decrease the risk of deficiency. c. A typical nutrient intake falling between the RDA and the EAR is almost always adequate. d. Nutrient intakes above the RDA are required to be safe. e. Nutrient intakes above the UL put an individual at risk of toxicity. ANSWER: e 43. Which of the following is defined as the maximum daily amount of a nutrient that appears safe for most people and beyond which there is an increased risk of adverse side effects? a. EER b. UL c. AI d. RDA e. DRI ANSWER: b 44. Which of the following statements about the Estimated Energy Requirement (EER) is FALSE? a. It is the average dietary energy intake that will maintain energy balance in a person with a healthy body weight and level of physical activity. b. EER is measured in kcalories per day. c. Food energy is needed to sustain a healthy and active life. d. UL for energy are based on a person’s age, sex, weight, and height. e. Any dietary intake in excess of energy needs results in weight gain. ANSWER: d 45. What is the Acceptable Macronutrient Distribution Range (AMDR) for carbohydrates? a. 5 to 10% b. 15 to 20% c. 25 to 40% d. 45 to 65% e. 70 to 80% ANSWER: d

Chapter 01- An Overview of Nutrition 46. Which of the following statements about nutrient recommendations worldwide is FALSE? a. Fewer than 20 nations have nutrient standards similar to those in the United States. b. Standards in other countries may reflect differences in data interpretation. c. Food habits and physical activities of people in other countries affect their published nutrient standards. d. Some countries use recommendations developed by the Food and Agriculture Organization and the World Health Organization. e. Nutrient recommendations from international groups are sufficient to maintain health in healthy people worldwide. ANSWER: a 47. Which of the following statements accurately describes Dietary Reference Intakes? a. They are used to treat people with diet-related disorders. b. They assess the adequacy of all required nutrients. c. They aid in the planning and evaluation of diets for healthy people. d. They are used to assess the adequacy of vitamins and minerals only. e. They can be used diagnose diet-related disorders. ANSWER: c 48. Sun is extremely thin, is losing muscle tissue, and is becoming prone to infections. Which term best describes Sun’s condition? a. undernutrition b. overnutrition c. nutrient overdose d. anthropometric e. subclinical ANSWER: a 49. Which of the following is NOT a nutrition assessment used by a trained health care professional? a. historical information b. physical examinations c. anthropometric measurements d. personality profile screening e. laboratory tests ANSWER: d

Chapter 01- An Overview of Nutrition 50. Which of the following terms is defined as an account of a client’s disease risks? a. health history b. drug history c. diet history d. anthropometric history e. psychological history ANSWER: a 51. You are a health care professional tasked with taking anthropometric measurements of a client. Which of the following would you measure? a. body weight b. blood pressure c. blood iron level d. cholesterol levels e. serum electrolytes ANSWER: a 52. Which statement accurately describes physical exams as a nutrition assessment tool? a. Hair and posture can provide clues to nutrient imbalances. b. Physical symptoms typically reflect deficiency in one particular nutrient. c. Unlike other assessment techniques, exams yield firm results. d. Physical exams cannot detect nutrient toxicity. e. Exams can reveal covert changes in the body. ANSWER: a 53. Which of the following reflects the correct sequence of stages in the development of a nutrient deficiency? a. declining nutrient stores, abnormal functions within the body, and overt signs b. abnormal functions within the body, declining nutrient stores, and overt signs c. abnormal functions within the body, overt signs, and declining nutrient stores d. declining nutrient stores, overt signs, and abnormal functions within the body e. overt signs, abnormal functions, and declining nutrient stores ANSWER: a 54. A diet history provides clues to a. subclinical b. primary c. secondary d. covert e. anecdotal ANSWER: b

deficiencies.

Chapter 01- An Overview of Nutrition 55. Which of the following defines a subclinical deficiency? a. a nutrient deficiency caused by inadequate dietary intake of a nutrient b. a nutrient deficiency caused by something like a disease condition or drug reaction that reduces absorption, accelerates use, hastens excretion, or destroys the nutrient c. a deficiency in the early stages, before the outward signs have appeared d. a deficiency that exhibits conflicting outward signs, requiring laboratory diagnosis e. an iron deficiency ANSWER: c 56. What We Eat in America collects data on the kinds and amounts of food people eat. It is an example of a national ________. a. nutrition survey b. health goal c. trend d. health examination e. anthropometric measurement ANSWER: a 57. Researchers collect data to assess a population’s nutrition status. Which of the following statements is true for the United States today? a. Congress uses the research data to regulate the food supply and establish policy on food assistance programs. b. The Healthy People program met its 2020 goal to improve consumption of fruits and vegetables. c. The food industry uses research data to establish research priorities. d. The Healthy People program did not meet its 2020 goal for improving physical activity. e. Obesity rates are in decline for the first time in decades. ANSWER: a 58. What is the purpose of the Healthy People program? a. to establish the DRI b. to identify national trends in food consumption c. to identify leading causes of death in the united states d. to set goals for the nation's health over the next 10 years e. to decrease health care costs ANSWER: d

Chapter 01- An Overview of Nutrition 59. Chronic diseases are responsible for a. 12% b. 25% c. 50% d. 70% e. 85%

of adult deaths in the United States.

ANSWER: d 60. Of the top seven causes of death in the United States, how many are linked with diet? a. 1 b. 2 c. 4 d. 5 e. 7 ANSWER: c 61. What is the leading cause of death in the United States? a. cancers b. heart disease c. strokes d. suicide e. accidents ANSWER: b 62. Which statement best explains the association between a risk factor and the development of a disease? a. Anyone with a risk factor will develop the disease. b. The absence of a risk factor guarantees freedom from the disease. c. The fewer risk factors for a disease, the better the chances for good health. d. Interventions must be targeted to each individual risk factor. e. Risk factors tend to be short-lived, so their presence does not predict long-term risk of disease. ANSWER: c 63. What is the most prominent risk factor in the United States, contributing to one of every five deaths each year? a. poor dietary habits b. tobacco use c. alcohol consumption d. physical inactivity e. unsafe driving ANSWER: b

Chapter 01- An Overview of Nutrition 64. Approximately what percentage of people in the United States are overweight or obese? a. 10% b. 20% c. 40% d. 60% e. 80% ANSWER: d 65. For those who do not smoke or drink alcohol excessively, the one choice that can influence chronic disease risks more than any other is . a. diet b. avoiding toxins c. hand washing d. physical activity e. safe sex ANSWER: a 66. What is the best source of nutrition information? a. reputable news outlets b. medical doctor c. registered dietitian d. health food store manager e. Internet ANSWER: c 67. Which title is bestowed on an individual who specializes in providing nutrition services through organized community efforts? a. dietetic technician b. registered dietitian c. certified nutritionist d. dietetic technician, registered e. public health dietitian ANSWER: e

Chapter 01- An Overview of Nutrition 68. Which title is granted by alternative educational programs and sounds authoritative but lacks the credentials of an RDN? a. dietetic technician b. registered dietitian c. certified nutritionist d. dietetic technician, registered e. public health nutritionist ANSWER: c 69. Which title is given to a person who has a minimum of a bachelor’s degree from an accredited university, has completed a supervised practice program, and has passed a national examination administered by the Academy of Nutrition and Dietetics? a. medical doctor b. registered dietitian nutritionist c. certified nutritionist d. certified nutrition therapist e. registered nutritional consultant ANSWER: b 70. Which title is given to a person who has a minimum of an associate’s degree from an accredited university and assists registered dietitians? a. dietetic clerk b. nutritional assistant c. dietetic technician d. nutrition porter e. public health dietitian ANSWER: c 71. The ability to interact effectively with people from diverse cultures is called

ANSWER: cultural competence 72. Minerals and water are

nutrients because they do not contain carbon.

ANSWER: inorganic 73. A personal account of an experience or event, which does not make for reliable scientific information, is called a/an ____________________. ANSWER: anecdote 74. The lowest continuing intake of a nutrient that will maintain a specified criterion of adequacy is called a/an ____________________. ANSWER: requirement

Chapter 01- An Overview of Nutrition 75. Something that is out in the open and easy to observe is said to be

ANSWER: overt 76. A condition or behavior associated with an elevated frequency of a disease but not proved to be causal is called a ____________________ . ANSWER: risk factor 77.

is the mental activity of rationally and skillfully analyzing, synthesizing, and evaluating information. ANSWER: Critical thinking Match the correct answer with the appropriate term. a. 1 b. 16 c. 40 d. Vitamins e. Phytochemicals f. Fat g. Water h. Hypothesis i. Energy j. Calorie k. Placebo l. Alcohol m. Randomization n. Anecdote o. Healthy People p. Diet history q. Drug history r. Overnutrition s. Laboratory testing

t. Subclinical deficiency 78. Nutrient found in 60% of the human body ANSWER: g 79. An energy-yielding nonnutrient ANSWER: l 80. An organic micronutrient ANSWER: d

Chapter 01- An Overview of Nutrition 81. A measure of heat energy ANSWER: j 82. The capacity to do work ANSWER: i 83. Nonnutrient compounds found in plants ANSWER: e 84. An energy-yielding nutrient ANSWER: f 85. Number of nutrients known to be essential to humans ANSWER: c 86. Energy (kcal) required to increase temperature of 1 kg of water 1°C ANSWER: a 87. Number of essential minerals in the human diet ANSWER: b 88. A personal account of an event ANSWER: n 89. A sham treatment in controlled research studies ANSWER: k 90. Choosing experimental members without bias ANSWER: m 91. A tentative solution to a scientific problem ANSWER: h 92. Record of eating behaviors ANSWER: p 93. National public health initiative ANSWER: o 94. Record of all prescribed and over-the-counter medications ANSWER: q 95. Clinical examination of blood and urine ANSWER: s 96. Excess energy or nutrition ANSWER: r

Chapter 01- An Overview of Nutrition 97. A nutrient deficiency before outward signs have appeared ANSWER: t 98. The choices a person makes regarding food are highly personal. List and describe five factors that influence a person’s food choices. ANSWER: Preferences: As you might expect, the number one reason most people choose certain foods is taste— they like the flavor. Two widely shared preferences are for the sweetness of sugar and the savoriness of salt. High-fat foods also appear to be a universally common preference. Habit: People sometimes select foods out of habit. They eat cereal every morning, for example, simply because they have always eaten cereal for breakfast. Eating a familiar food and not having to make any decisions can be comforting. Ethnic Heritage and Regional Cuisines: Among the strongest influences on food choices are ethnic heritage and regional cuisines. People tend to prefer the foods they grew up eating. Every country, and in fact every region of a country, has its own typical foods and ways of combining them into meals. These cuisines reflect a unique combination of local ingredients and cooking styles. Marketing: Food companies spend billions of dollars building brand loyalty and enticing busy customers with convenience foods. Social Interactions: Most people enjoy companionship while eating. It’s fun to go out with friends for a meal or share a snack when watching a movie together. Meals are often social events, and sharing food is part of hospitality. Social customs invite people to accept food or drink offered by a host or shared by a group—regardless of hunger signals. Availability, Convenience, and Economy: People often eat foods that are accessible, quick and easy to prepare, and within their financial means. Consumers who value convenience frequently eat out, bring home ready-to-eat meals, or have food delivered. Positive and Negative Associations: People tend to like particular foods associated with happy occasions—such as hot dogs at ball games or cake and ice cream at birthday parties. By the same token, people can develop aversions and dislike foods that they ate when they felt sick or that they were forced to eat in negative situations. Similarly, children learn to like and dislike certain foods when their parents use foods as rewards or punishments. Emotions: Emotions guide food choices and eating behaviors. Some people cannot eat when they are upset. Others may eat in response to a variety of emotional stimuli—for example, to relieve boredom or depression or to calm anxiety. Values: Food choices may reflect people’s religious beliefs, political views, or environmental concerns. Body Weight and Image: Sometimes people select certain foods and supplements that they believe will improve their physical appearance and avoid those they believe might be detrimental. Such decisions can be beneficial when based on sound nutrition and fitness knowledge, but decisions based on fads or carried to extremes undermine good health. Nutrition and Health Benefits: Many consumers make food choices they believe will improve their health.

Chapter 01- An Overview of Nutrition 99. Name and describe the energy-yielding nutrients. How is the energy measured? How does the body use energy? ANSWER: The energy-yielding nutrients are carbohydrates, fat, and protein, which are measured in calories or kcalories. Because fat provides the most energy, it has the highest energy density—9 kcal/g. Carbohydrates and protein each yield 4 kcal/g. When the body uses carbohydrate, fat, or protein to fuel its activities, the bonds between the nutrient’s atoms break. As the bonds break, they release energy. Some of this energy is released as heat, but some is used to send electrical impulses through the brain and nerves in order to synthesize body compounds and to move muscles. Thus, the energy from foods supports all of the body’s movements from quiet thought to vigorous sports. If the body does not use these nutrients to fuel its current activities, it converts them into storage compounds, to be used between meals and overnight when fresh energy supplies run low. If more energy is consumed than expended, the result is an increase in energy stores and weight gain. 100. Describe the double-blind technique and why it is important to research studies. Include a discussion of the importance of controls. ANSWER: Double Blind: When both the subjects and the researchers do not know which subjects are in which group, the study is called a “double-blind experiment.” Being fallible human beings and having an emotional and sometimes financial investment in a successful outcome, researchers might record and interpret results with a bias in the expected direction. To prevent such bias, the pills are coded by a third party, who does not reveal to the experimenters which subjects are in which group until all results have been recorded. Controls: Research studies include control groups, which are similar in all possible respects to the experimental group, except for the treatment. This is accomplished through randomization. Ideally, the control group receives a placebo while the experimental group receives the studied treatment.

Chapter 01- An Overview of Nutrition 101. Compare and contrast the four categories of Dietary Reference Intakes (DRIs). ANSWER: Estimated Average Requirements (EAR): The committee reviews hundreds of research studies to determine the requirement for a nutrient—how much is needed in the diet. The committee selects a different criterion for each nutrient based on its roles in supporting various activities in the body and in reducing disease risks. An examination of all the available data reveals that each person’s body is unique and has its own set of requirements. Men differ from women, and needs change as people grow from infancy through old age. For this reason, the committee clusters its recommendations for people into groups based on sex and age. Even so, the exact requirements for people of the same sex and age are likely to be different. Using this information, the committee determines an Estimated Average Requirement (EAR) for each nutrient—the average amount that appears sufficient for half the population. Recommended Dietary Allowances (RDA): Once a nutrient requirement is established, the committee must decide what intake to recommend for everybody—the Recommended Dietary Allowance (RDA). The EAR is probably closest to everyone’s need. If people consumed exactly the average requirement of a given nutrient each day, however, approximately half of the population would develop deficiencies of that nutrient. Recommendations are therefore set greater than the EAR to meet the needs of most healthy people. Adequate Intakes (AI): For some nutrients, such as vitamin K, there is insufficient scientific evidence to determine an EAR (which is needed to set an RDA). In these cases, the committee establishes an Adequate Intake (AI) instead of an RDA. An AI reflects the average amount of a nutrient that a group of healthy people consumes. Like the RDA, the AI may be used as nutrient goals for individuals. Tolerable Upper Intake Levels (UL): The recommended intakes for nutrients are generous, yet they may not be sufficient for every individual for every nutrient. Nevertheless, it is probably best not to exceed these recommendations by very much or very often. Individual tolerances for high doses of nutrients vary, and somewhere beyond the recommended intake is a point beyond which a nutrient is likely to become toxic. This point is known as the Tolerable Upper Intake Level (UL). 102. Why are the EER and AMDR such important metrics? ANSWER: Estimated Energy Requirement (EER): The energy recommendation—the Estimated Energy Requirement (EER)—represents the average dietary energy intake (kcalories per day) that will maintain energy balance in a person who has a healthy body weight and level of physical activity. Balance is key to the energy recommendation. Enough food energy is needed to sustain a healthy and active life, but too much can lead to weight gain and obesity. Because any amount in excess of energy needs will result in weight gain, no upper level for energy has been determined. Acceptable Macronutrient Distribution Ranges (AMDR) People don’t eat energy directly; they derive energy from foods containing carbohydrates, fats, and proteins. Each of these three energy-yielding nutrients contributes to the total energy intake, and those contributions vary in relation to one another. The DRI committee has determined that the composition of a diet that provides adequate energy and nutrients and reduces the risk of chronic diseases is 45 to 65% of kcalories from carbohydrate, 20 to 35% of kcalories from fat, and10 to 35% of kcalories from protein.

Chapter 01- An Overview of Nutrition 103. Explain how the four assessment methods are used to detect energy and nutrient deficiencies and excesses. ANSWER: To prepare a nutrition assessment, a registered dietitian (or registered dietitian nutritionist); dietetic technician, registered; or other trained health care professional uses historical information, anthropometric measurements, physical examinations, and laboratory tests. One step in evaluating nutrition status is to obtain information about a person’s history with respect to health status, socioeconomic status, drug use, and diet. The health history reflects a person’s medical record and may reveal a disease that interferes with the person’s ability to eat or the body’s use of nutrients. The person’s family history of major diseases is also noteworthy, especially for conditions such as heart disease that have a genetic tendency to run in families. Economic circumstances may show a financial inability to buy foods or inadequate kitchen facilities in which to prepare them. Social factors such as marital status, ethnic background, and educational level also influence food choices and nutrition status. A drug history, including all prescribed and over-the-counter medications, may highlight possible interactions that lead to nutrient deficiencies. A second technique that may help to reveal nutrition problems is taking anthropometric measures such as height and weight. The assessor compares a person’s measurements with standards specific for sex and age or with previous measures on the same individual. A third nutrition assessment technique is a physical examination looking for clues to poor nutrition status. Visual inspection of the hair, eyes, skin, posture, tongue, and fingernails can provide such clues. In addition, information gathered from an interview can help identify symptoms. The examination requires skill because many physical signs and symptoms reflect more than one nutrient deficiency or toxicity—or even nonnutrition conditions. Like the other assessment techniques, a physical examination alone does not yield firm conclusions. Instead, physical examinations reveal possible imbalances that must be confirmed by other assessment techniques, or they confirm results from other assessment measures. A fourth way to detect a developing deficiency, imbalance, or toxicity is to take samples of blood or urine, analyze them in the laboratory, and compare the results with normal values for a similar population. Laboratory tests are most useful in uncovering early signs of malnutrition before symptoms appear. In addition, they can confirm suspicions raised by other assessment methods. 104. Imagine that you are in charge of What We Eat in America, a national nutrition survey. Some people have suggested eliminating the survey because of budget constraints. How would you respond? ANSWER: National nutrition surveys gather information about the population’s dietary, nutritional, and related health status. The data provide valuable information on several nutrition-related conditions, such as growth retardation, heart disease, and nutrient deficiencies. National nutrition surveys often oversample high-risk groups (low-income families, pregnant women, adolescents, the elderly, African Americans, and Mexican Americans) to glean an accurate estimate of their health and nutrition status. The resulting wealth of information from the national nutrition surveys is used for a variety of purposes. For example, Congress uses this information to establish public policy on nutrition education, food assistance programs, and regulation of the food supply. Scientists use the information to establish research priorities. The food industry uses these data to guide decisions in public relations and product development. The Dietary Reference Intakes and other major reports that examine the relationships between diet and health depend on information collected from these nutrition surveys. These data also provide the basis for developing and monitoring national health goals.

Chapter 01- An Overview of Nutrition 105. How are risk factors for chronic diseases determined? What do they mean? ANSWER: Factors that increase or reduce the risk of developing chronic diseases can be identified by analyzing statistical data. A strong association between a risk factor and a disease means that when the factor is present, the likelihood of developing the disease increases. It does not mean that all people with the risk factor will develop the disease. Similarly, a lack of risk factors does not guarantee freedom from a given disease. On the average, though, the more risk factors in a person’s life, the greater that person’s chances of developing the disease. Conversely, the fewer risk factors in a person’s life, the better the chances for good health. 106. Imagine that a friend tells you she was watching her favorite morning news program on television and saw a segment featuring a story on “surprising new findings” about the health benefits of a new over-the-counter product. She found the product at her local drugstore and shows you the package. What advice would you give her regarding her latest discovery? ANSWER: Consumers get much of their nutrition information from Internet websites, television news, and magazine articles, which have heightened awareness of how diet influences the development of diseases. Consumers benefit from news coverage of nutrition when they learn to make lifestyle changes that will improve their health. Sometimes, however, popular reports mislead consumers and create confusion. They often tell a lopsided story quickly instead of presenting the integrated results of research studies or a balance of expert opinions. Tight deadlines and limited understanding sometimes make it difficult to provide a thorough report. Hungry for the latest news, the media often report scientific findings quickly and prematurely—without benefit of careful interpretation, replication, or peer review. Usually, the reports present findings from a single, recently released study, making the news current and controversial. Consequently, the public receives diet and health news fast, but not always in perspective. Reporters may twist inconclusive findings into “meaningful discoveries” when pressured to write catchy headlines and sensational stories. As a result, “surprising new findings” sometimes seem to contradict one another, and consumers may feel frustrated and betrayed. Occasionally, the reports are downright false, but more often the apparent contradictions are simply the normal result of science at work. A single study contributes to the big picture, but when viewed alone, it can easily distort the image. To be meaningful, the conclusions of any study must be presented cautiously within the context of other research findings. Additionally, there are eight red flags revealing nutrition quackery on product packages or in marketing materials. These include the word “natural,” quick and easy fixes, the promise of satisfaction, the idea that one product does everything, the notion of being time-tested or brand new, paranoid accusations, personal testimonials, and meaningless jargon.

Chapter 01- An Overview of Nutrition 107. Imagine that a friend is contemplating a change in college major. He has always had an interest in healthy living and knows he does not want to work in an office setting. You think he should consider becoming a registered dietitian. What would you tell him about the necessary training and career possibilities? ANSWER: A registered dietitian nutritionist (RDN) has the educational background necessary to deliver reliable nutrition advice and care. To become an RDN, a person must earn an undergraduate degree requiring about 60 credit hours in nutrition, food science, and other related subjects; complete a year’s clinical internship or the equivalent; pass a national examination administered by the Academy of Nutrition and Dietetics; and maintain up-to-date knowledge and registration by participating in required continuing education activities, such as attending seminars, taking courses, or conducting research. Dietitians perform a multitude of duties in many settings in most communities. They work in the food industry, pharmaceutical companies, home health agencies, long-term care institutions, private practice, public health departments, research centers, education settings, fitness centers, and hospitals. Depending on their work settings, dietitians can assume a number of different job responsibilities and positions. In hospitals, administrative dietitians manage the foodservice system; clinical dietitians provide client care; and nutrition support team dietitians coordinate nutrition care with other health-care professionals. In the food industry, dietitians conduct research, develop products, and market services.

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Chapter 02- Planning a Healthy Diet 1. Which plants of the bean and pea family have seeds that are rich in protein as compared with other plant-derived

foods? a. turnip b. legumes c. swiss chard d. squash e. scallions ANSWER: b 2. The diet-planning principle that ensures that a diet provides all the nutrients, fiber, and energy in amounts sufficient

to maintain health is called “ a. variety b. adequacy c. moderation d. kcalorie control e. nutrient density

.”

ANSWER: b 3. Fruits contribute

when consumed.

a. vitamin K b. vitamin E c. magnesium d. folate e. vitamin D ANSWER: d 4. By consuming a variety of vegetables every day you gain all of the following nutrients from your diet EXCEPT

. a. niacin b. potassium c. magnesium d. folate e. vitamin C ANSWER: a

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Chapter 02- Planning a Healthy Diet 5. Nutrient dense refers to foods that

a. carry the USDA nutrition labeling b. are higher in weight relative to volume c. provide more nutrients relative to kcalories d. contain a mixture of carbohydrate, fat, and protein e. give the most protein for the consumer’s food dollar ANSWER: c 6. By consuming a variety of grains what do we contribute to our diet? a. vitamin D b. potassium c. calcium d. riboflavin e. vitamin C ANSWER: d 7. A food that provides 100 mg of magnesium and 25 kcal in a serving has a magnesium density (milligrams per

kcalorie) of a. 0.25

b. 0.4 c. 2.5 d. 4 e. 25 ANSWER: d 8. Ranking foods according to their overall nutrient composition is known as a. biological value

b. nutrient profiling c. the risk reduction score d. the healthy eating index e. compositional profiling ANSWER: b

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Chapter 02- Planning a Healthy Diet 9. Choosing a variety of protein foods, including seafood in place of meat or poultry twice a week, will provide

which vitamin? a. riboflavin b. fiber c. selenium d. folate e. niacin ANSWER: e 10. Which of the following products have all the nutrients and fiber found in the original grain? a. pseudo-cereal grains b. enriched grain c. refined grain d. true cereal grains e. whole-grain ANSWER: e 11. Which recommendation is part of the 2015–2020 Dietary Guidelines for Americans? a. Limit kcalories from added sugars and saturated fats. b. Limit protein intake. c. Lower iron intake. d. Reduce seafood consumption. e. Become vegetarian. ANSWER: a 12. Which type of flour is finely ground endosperm, which is usually enriched with nutrients and bleached for

whiteness; sometimes called white flour? a. cured flour b. enriched grain c. refined flour d. wheat flour e. whole-wheat flour ANSWER: c

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Chapter 02- Planning a Healthy Diet 13. Which seed grows into a mature wheat plant that is especially rich in vitamins and minerals? a. sesame b. chia c. bran d. germ e. poppy ANSWER: d 14. Which two major nutrients are supplied by the fruit group? a. vitamins D and E b. vitamins A and C c. protein and calcium d. B vitamins and iron e. vitamin K and magnesium ANSWER: b 15. How much fruit juice (100%) is equivalent to 1 cup of fresh fruit? a. 1/4 cup b. 1/2 cup c. 1 cup d. 1½ cups e. 2 cups ANSWER: c 16. All of the following statements are true EXCEPT: a. White flour refers to refined flour. b. Most whole wheat is made from red wheat. c. Any flour made from the endosperm of the wheat kernel is wheat flour. d. White bread is a whole-grain product only if it is made from whole white wheat. e. Refined-grain products contain germ and bran as well as endosperm. ANSWER: e

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Chapter 02- Planning a Healthy Diet 17. According to the USDA Food Patterns, which of the foods listed below would qualify as a healthy source of

protein? a. nuts b. bacon c. luncheon meats d. sweet potatoes e. marbled meats ANSWER: a 18. Within the USDA Food Patterns, in which food group do legumes belong? a. dairy b. fruits c. grains d. protein e. oils ANSWER: d 19.

can be added to correct or prevent a widespread nutrient deficiency or to balance the total nutrient profile of a food. a. Refined flour b. Enriched flour c. Moderation d. Whole grain flour e. Fortified flour ANSWER: e

20. kCalories from which of these foods would most likely be part of someone’s discretionary kcalorie allowance? a. jam b. watermelon c. raw carrots d. brussels sprouts e. green beans ANSWER: a

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Chapter 02- Planning a Healthy Diet 21. The principle of providing foods in proportion to one another and in proportion to the body’s needs is known as

“

.” a. nutrient profiling b. nutrient density c. kcalorie control d. moderation e. balance ANSWER: e 22. What assessment tool is designed to measure how well a diet meets the recommendations of the Dietary

Guidelines? a. Healthy Eating Index b. Supplemental Nutrition Assistance Program c. Dietitian's Comparative Effectiveness Plan d. U.S. Public Health Nutrient Assessment Barometer e. U.S. Preventive Services Task Force Guide ANSWER: a 23. In the MyPlate icon, which food group is shown separate from the plate? a. fat b. dairy c. carbohydrate d. micronutrients e. protein ANSWER: b 24. A popular term used to denote foods that contribute energy but lack protein, vitamins, and minerals is a. empty-kcalorie foods

b. variety c. moderate foods d. kcalorie control e. sustainable diets ANSWER: a

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Chapter 02- Planning a Healthy Diet 25. Which food group is most typically consumed in amounts greater than the amounts recommended by the USDA? a. dairy b. fruits c. vegetables d. protein foods e. grains ANSWER: d 26. Food lists, formerly called “exchange lists,” were originally developed for people with a. diabetes

b. cancer c. cardiovascular disease d. life-threatening obesity e. neurological impairments ANSWER: a 27. A measure of the nutrients a food provides relative to the energy it provides; the more nutrients and the fewer

kcalories, the higher the a. moderation

b. kcalorie foods c. nutrient density d. variety e. balance ANSWER: c 28. With food lists, to which group are olives assigned? a. fat b. meat c. carbohydrate d. meat substitute e. fruit ANSWER: a

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Chapter 02- Planning a Healthy Diet 29. Whole-grain flour contains all parts of the grain except for the

a. bran b. husk c. germ d. endosperm e. heart ANSWER: b 30. The only original part remaining in refined-grain products is the a. bran

b. husk c. germ d. endosperm e. chaff ANSWER: d 31. Adding calcium to an orange juice product is an example of nutrient a. enrichment

b. restoration c. fortification d. mineralization e. adulteration ANSWER: c 32. Solid fats are not usually liquid at room temperature; they are commonly found in most foods and derived from

animals and vegetable oils that have been a. processed b. combined with sugars

c. hydrogenated d. oxygenated e. nutrient dense ANSWER: c

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Chapter 02- Planning a Healthy Diet 33. Which of the following typically contain more saturated and trans fats than most oils? a. solid fats b. kcalorie control c. added sugars d. proteins e. carbohydrates ANSWER: a 34. What are added to foods during processing, preparation, or at the table? a. added sugars b. kcalorie control c. Oils d. fats e. solid fats ANSWER: a 35. By law, what mineral must be added to refined flours during the enrichment process? a. iron b. iodine c. calcium d. magnesium e. copper ANSWER: a 36. What is the first guideline from The 2015–2020 Dietary Guidelines for Americans that encourages healthy eating

patterns? a. All segments of our society have a role to play in supporting healthy choices. b. Focusing on variety, nutrient density, and amounts helps a person meet nutrient needs within kcalorie limits. c. Limit intake of added sugars, saturated fats, sodium, and alcoholic beverages. d. Appropriate kcalorie levels support adequate nutrition, good health, and a healthy body weight throughout

life. e. People will need to make shifts in their food and beverage choices to achieve a healthy eating pattern. ANSWER: d

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Chapter 02- Planning a Healthy Diet 37. The federal mandate for enrichment of grain products in the United States was initiated in the

a. 1880s b. 1900s c. 1920s d. 1940s e. 1960s ANSWER: d 38. Which one of these nutrients must be used to enrich grains? a. zinc b. folate c. protein d. calcium e. sodium ANSWER: b 39. The most highly fortified foods on the market are a. frozen dinners

b. imitation foods c. enriched breads d. ready-to-eat breakfast cereals e. canned fruits and vegetables ANSWER: d 40. Which guideline acknowledges that all segments of our society have a role to play in supporting healthy choices? a. first b. third c. fifth d. fourth e. second ANSWER: c

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Chapter 02- Planning a Healthy Diet 41. Which of the items below does a healthy eating pattern limit? a. a variety of protein foods, lean meats b. sodium no more than 2300 milligrams per day c. a variety of vegetables d. fat-free or low-fat dairy including milk, yogurt e. fruits, especially whole fruits ANSWER: b 42. Textured vegetable protein is usually made from a. soybeans

b. corn stalks c. a variety of legumes d. cruciferous vegetables e. dark green, red, and orange vegetables ANSWER: a 43. What variety of protein foods are included in healthy eating patterns? a. milk, yogurt, cheese, and fortified beverages b. seafood, lean meats, eggs, and soy products c. whole grains d. oils e. a variety of vegetables—dark green, red and orange—and beans and peas ANSWER: b 44. The patterns of eating that promote health and provide food security for the present population and for future

generations is called “ a. sustainable diets b. balance

.”

c. adequacy d. nutrient profiling e. moderation ANSWER: a

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Chapter 02- Planning a Healthy Diet 45. Omega-3 fatty acids are commonly found in

a. oils b. crabs c. peanuts d. fatty fish e. chicken ANSWER: d 46. In northern climates during winter months, young children on vegan diets can readily develop rickets because of

which deficiency? a. vitamin A b. vitamin E c. vitamin B12 d. vitamin C e. vitamin D ANSWER: e 47. According to updated nutrition labeling laws, the content of which of these two minerals must be listed on the

Nutrition Facts panel? a. calcium and iron b. zinc and phosphorus c. fluoride and chloride d. chromium and magnesium e. copper and potassium ANSWER: a 48. A food label ingredient list reads in the following order: Wheat flour, vegetable shortening, sugar, salt, and

cornstarch. What item would be found in the SMALLEST amount in this food? a. salt b. sugar c. cornstarch d. wheat flour e. vegetable shortening ANSWER: c

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Chapter 02- Planning a Healthy Diet 49. Which vitamin is found only in animal-derived foods? a. vitamin E b. vitamin C c. vitamin B12 d. vitamin D e. vitamin A ANSWER: c 50. Vegan diets exclude what kind of products? a. seeds b. all animal products c. legumes d. nuts e. soy products ANSWER: b 51. On the updated Nutrition Facts panel, the content of which of these vitamins must be provided? a. vitamins A and C b. vitamin D c. thiamin and riboflavin d. vitamin B6 and niacin e. vitamins E and K ANSWER: b 52. Food labels express the nutrient content in relation to a set of standard values known as the “ a. Daily Values

.”

b. FDA Standards c. Dietary Reference Intakes d. Recommended Dietary Intakes e. USDA Intake Standards ANSWER: a

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Chapter 02- Planning a Healthy Diet 53. Population groups such as sedentary older men, sedentary younger women, and active older women have a daily

energy need of approximately a. 1200 b. 1500 c. 1800 d. 2000 e. 2400

kcalories.

ANSWER: d 54. On a food label, how many calories is the "% Daily Value" based on? a. 1200 b. 1500 c. 1800 d. 2000 e. 2400 ANSWER: d 55. What is a feature of the of the updated Nutrition Facts panel? a. Trans fat content is optional. b. Saturated fat content must be listed. c. The content of naturally present sugars is not required. d. Soluble and insoluble fiber contents must be listed separately. e. Unsaturated fats content must be listed. ANSWER: b 56. Which of the following statements is correct about nonvegetarians? a. They easily obtain large quantities of nutrients including folate, vitamin C, and vitamin A. b. They lack vitamin B12, vitamin D, and omega-3 fatty acids. c. They tend to have higher intakes of plant proteins and fiber. d. They lack protein, iron, zinc, and calcium. e. They tend to have higher intakes of saturated fat. ANSWER: e

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Chapter 02- Planning a Healthy Diet 57. A food label that advertises the product as a "rich source of fiber" is an example of a

a. nutrient claim b. health claim c. weight reduction claim d. structure–function claim e. peer-reviewed research claim ANSWER: a 58. According to the FDA, a food label that reads "improves memory" is an example of a a. health claim

b. Daily Value claim c. ingredient claim d. structure–function claim e. nutrient claim ANSWER: d 59. Which of these food labeling claims represents the highest level of significant scientific agreement? a. This cereal promotes a healthy heart. b. This cereal supports heart health. c. This product contains whole grains, which have been proven to reduce the risk of heart disease and certain

cancers. d. Very limited and preliminary scientific research suggests this product can reduce risk for cancers; FDA concludes that there is little scientific evidence supporting this claim. e. Anecdotal evidence demonstrates a clear relationship between consumption of this product and elimination of health risk factors. ANSWER: c 60. What is a characteristic feature of structure–function claims on food labels? a. They are allowed only for unprocessed food. b. They can be made without any FDA approval. c. They can appear only on the Nutrition Facts panel. d. They can state the name of a disease or symptom. e. They must be based on peer-reviewed research. ANSWER: b

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Chapter 02- Planning a Healthy Diet 61. Which food items are consumed in the diet of a lactovegetarian? a. plant foods only b. eggs and plant foods only c. meat, eggs, and plant foods only d. milk products and plant foods only e. fish, eggs, and dairy only ANSWER: d 62. Tempeh is made from a. soybeans

b. any legume c. fermented leafy vegetables d. fermented yellow vegetables e. wheat proteins ANSWER: a 63. An eating pattern that includes milk and milk products, but excludes meat, poultry, seafood, and eggs from the

diet, is known as: a. lacto-ovo-vegetarian diet b. plant-based diet c. lactovegetarian diet d. omnivorous diet e. macrobiotic diet ANSWER: c 64. A philosophical eating pattern based on mostly plant foods such as whole grains, legumes, and vegetables, with

small amounts of fish, fruits, nuts, and seeds, is known as a (an): a. omnivorous diet b. macrobiotic diet c. plant-based diets d. lacto-ovo-vegetarian diet e. lactovegetarian diet ANSWER: b

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Chapter 02- Planning a Healthy Diet 65. In vegetarians, the RDA is higher for

a. iron b. folate c. calcium d. vitamin A e. protein ANSWER: a 66. Which statement describes a feature of iron nutrition in vegetarians? a. Vegetarians adapt to absorbing iron more efficiently and decreasing iron losses. b. Iron utilization is inhibited by the high zinc content in grains. c. The absorption of iron is low owing to the high vitamin C intake. d. More iron deficiency is found in vegetarians than in people eating a mixed diet. e. There are no differences in iron intake or utilization in vegetarians. ANSWER: a 67. “kCalorie-free” is an example of a (an) a. nutrient

claim.

b. health c. meaningless d. fraudulent e. structure-function ANSWER: a 68. Which is typically a characteristic of a vegetarian diet? a. Fat intake is higher. b. Fiber intake is lower. c. Vitamin B12 intake is lower. d. Intakes of vitamins A and C are lower. e. Iron intake is higher. ANSWER: c

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Chapter 02- Planning a Healthy Diet 69. Which of the following food-label descriptions is this: “less than 2 milligrams of cholesterol per serving and 2

grams or less of saturated fat and trans-fat?” a. extra lean b. fat and cholesterol c. less fat d. fat-free e. lean ANSWER: b 70. Statements that characterize the relationship between a nutrient or other substance in a food and its role in the

body is known as: a. structure-–unction claims b. health claims c. nutrient claims d. daily values e. healthy eating ANSWER: a 71. Applying the meal-planning principle of helps ensure a diet that provides sufficient energy and enough of all the nutrients to meet the needs of healthy people. ANSWER: adequacy 72. To calculate the nutrient density of a food item, divide the ____________________.

by the

ANSWER: milligrams; kcalories 73.

refers to a measure of the nutrients a food provides relative to the energy it provides. ANSWER: Nutrient density

74. Diet-planning tools that sort foods into groups based on nutrient content and then specify that people should eat certain amounts of foods from each group are called plans. ANSWER: food group 75. The plant foods called —as meats, poultry, and seafood.

contribute the same key nutrients—notably, protein, iron, and zinc

ANSWER: legumes 76. The kcalories remaining in a person’s energy allowance after consuming enough nutrient-dense foods to meet all nutrient needs for a day are called kcalories. ANSWER: discretionary Page 18

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Chapter 02- Planning a Healthy Diet 77. The educational tool developed by the government to remind consumers to make healthy food choices is known as ____________________. ANSWER: MyPlate 78. Diet-planning tools that organize foods by their proportions of carbohydrate, fat, and protein are called “ ___________________ _.” ANSWER: food lists 79. The is the seed that grows into a wheat plant, so it is especially rich in vitamins and minerals to support new life. ANSWER: germ

a. 5 b. 40 c. 78 d. 1/2 cup e. Health claim f. FDA g. Bran h. Iron i. USDA j. Soybeans k. Green peas l. Balance m. Vitamin B12 n. 1600 o. Endosperm p. Nutrient density q. Sodium and hypertension r. Structure-function claim s. 270 t. Orange juice containing added calcium 80. Diet-planning principle of consuming a number of foods in proportion to each other ANSWER: l 81. Measure that shows a food has more iron than another food when expressed per kcalorie ANSWER: p

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Chapter 02- Planning a Healthy Diet 82. Origin of the MyPlate graphic ANSWER: i 83. Number of major food groups ANSWER: a 84. Legume belonging to the starch category of food lists ANSWER: k 85. Part of grain rich in fiber ANSWER: g 86. Part of grain containing starch ANSWER: o 87. Nutrient added in grain enrichment process ANSWER: h 88. Example of a fortified food ANSWER: t 89. Commonly used to make textured vegetable protein ANSWER: j 90. Number of discretionary kcalories in a 2000-kcal diet ANSWER: s 91. Estimated daily energy needed for a sedentary 60-year-old woman in kcalories ANSWER: n 92. Maximum number of grams of fat recommended on a 2000-kcal diet based on the Daily Value ANSWER: c 93. Serving size (equivalent to 1 oz of grains) of cooked rice in the USDA Food Patterns ANSWER: d 94. Claim on food labels requiring FDA approval ANSWER: e 95. Agency that developed the Daily Values ANSWER: f 96. Grams of fat supplied by a 1200-kcal diet that is 30% fat ANSWER: b 97. A health claim allowed on food labels ANSWER: q Page 20

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Chapter 02- Planning a Healthy Diet 98. Claim that does not require FDA approval to appear on a food label ANSWER: r 99. Nutrient commonly added in soy-milk fortification process ANSWER: m 100. The Nutrition Facts panel must provide the important nutrients.

, the

, or both for

ANSWER: nutrient amount; percent Daily Value percent Daily Value; nutrient amount; 101. Why is it important to eat a variety of foods within the same food group from day to day? ANSWER: Variety improves nutrient adequacy. People should select foods from each of the food groups daily and vary their choices within each group for several reasons. First, different foods within the same group contain different arrays of nutrients. Among the fruits group, for example, strawberries are especially rich in vitamin C while apricots are rich in vitamin A. Second, no food is guaranteed to be entirely free of substances that, in excess, could be harmful. The strawberries might contain trace amounts of one contaminant, the apricots another. By alternating fruit choices, a person will ingest very little of either contaminant. Third, as the adage goes, variety is the spice of life. A person who eats beans frequently can enjoy pinto beans in Mexican burritos today, garbanzo beans in a Greek salad tomorrow, and baked beans with barbecued chicken on the weekend. Eating nutritious meals need never be boring. 102. List the nutritional contributions of the five food groups in the USDA Food Patterns. ANSWER: Fruits contribute folate, vitamin A, vitamin C, potassium, and fiber. Vegetables contribute folate, vitamin A, vitamin C, vitamin K, vitamin E, magnesium, potassium, and fiber. Grains contribute folate, niacin, riboflavin, thiamin, iron, magnesium, selenium, and fiber. Protein foods contribute protein, essential fatty acids, niacin, thiamin, vitamin B6, vitamin B12, iron, magnesium, potassium, and zinc. Milk and milk products contribute protein, riboflavin, vitamin B12, calcium, potassium, and, when fortified, vitamin A and vitamin D. Oils are not a food group, but they are important because they contribute vitamin E and essential fatty acids.

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Chapter 02- Planning a Healthy Diet 103. Define the Dietary Guidelines for Americans, including their purposes, and how they play a role in food politics. ANSWER: The Dietary Guidelines for Americans is an evidenced-based document used to develop federal food, nutrition, and health policies and programs. The guidelines help translate the nutrient recommendations of the DRI into food recommendations. By law, the Dietary Guidelines for Americans are reviewed and revised as needed every 5 years. Each edition shares some similarities with previous editions but also sets precedents. For example, the current edition, the 2015–2020 Dietary Guidelines for Americans, focuses on eating patterns—the foods and beverages a person consumes over time. This edition recognizes that “healthy eating patterns and regular physical activity can help people achieve and maintain good health and reduce the risk of chronic disease throughout all stages of the lifespan.” The controversy surrounding the release of the 2015–2020 Dietary Guidelines for Americans is a reminder that food politics plays an ongoing role in defining nutrition policy and healthy recommendations. While most nutrition professionals applauded the work of the Dietary Guidelines committee and its scientific report, many objected to the final report, which had been substantially revised, claiming that those revisions reflected the special interests of the food industry and politicians. Specific wording became vague and a new chapter on sustainable diets had been deleted. Food sustainability recognizes that foods and beverages have a large environmental impact—from farm to plate to waste—and that a sustainable food supply is essential to a healthy population and planet both for today and in the future. Many in the food industry opposed the inclusion of sustainability and convinced politicians that sustainability was outside the scope of providing dietary guidance. 104. Describe the purpose and use of the USDA’s MyPlate tool. ANSWER: The USDA created MyPlate as an educational tool to illustrate the five food groups and remind consumers to make healthy food choices from each of the five food groups. The MyPlate icon divides a plate into four sections, each representing a food group—fruits, vegetables, grains, and protein foods. The sections vary in size, indicating the relative proportion each food group contributes to a healthy diet. A circle next to the plate represents the milk group (dairy). The MyPlate icon does not stand alone as an educational tool. It is accompanied by a wealth of information on the website www.choosemyplate.gov. Consumers can choose the kinds and amounts of foods they need to eat each day based on their height, weight, age, sex, and activity level. Information is also available for children, pregnant and lactating women, and vegetarians. In addition to creating a personal plan, consumers can find daily tips to help them improve their diet and increase physical activity. A key message of the website is to enjoy food, but eat less of it by avoiding oversized portions. 105. Define processed, refined, enriched, fortified, and whole-grain. ANSWER: Processed foods are foods that have been treated to change their physical, chemical, microbiological, or sensory properties. Fortified foods are foods to which one or more nutrients that were not original to the food or were present in insignificant amounts only have been added. Refined foods are those from which the coarse parts of a food are removed. When wheat is refined into flour, for example, the bran, germ, and husk are removed, leaving only the endosperm. Enriched foods are those in which specific nutrients lost during the food’s processing have been replaced so that the food meets a specified standard. Whole grain is a grain product that maintains the same relative proportions of starchy endosperm, germ, and bran (but not the husk) as was in the original grain.

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Chapter 02- Planning a Healthy Diet 106. Describe the information that must be provided on the updated Nutrition Facts panel of the food label. ANSWER: Serving Sizes: Because labels present nutrient information based on one serving, the Nutrition Facts panel must identify the size of the serving. The Food and Drug Administration (FDA) has established specific serving sizes for various foods and requires that all labels for a given product use the same serving size. Nutrient Quantities: In addition to the serving size and the servings per container, the content of kcalories and select nutrients must be provided. The content of the nutrient must be given in both a quantity (such as grams) and as a percentage of the nutrient’s Daily Value, or if there is no Daily Value, the quantity by weight only. The calories and nutrients are total food energy (kcalories), total fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrate (which includes dietary fiber and sugars, including added protein The Nutrition Facts panel must also present nutrient content information for vitamin D, calcium, iron, and potassium. 107. Explain the Daily Values ANSWER: Food labels list the amount of some nutrients in a product as a percentage of its Daily Value, which makes the numbers more meaningful to consumers. The Daily Values reflect dietary recommendations for nutrients and dietary components that have important relationships with health. The “% Daily Value” column on a label provides a ballpark estimate of how individual foods contribute to the total diet. 108. Define and explain the purpose of front-of-package labels. ANSWER: Some consumers find the many numbers on Nutrition Facts panels overwhelming. They want an easier and quicker way to interpret information and select products. Food manufacturers have responded by creating front-of-package labels that incorporate text, color, and icons to present key nutrient facts.

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Chapter 02- Planning a Healthy Diet 109. Other than the Nutrition Facts panel, what other information on the food label can help consumers identify healthier food choices? ANSWER: The Ingredient List: All packaged foods must list all ingredients. The ingredients are listed in descending order of predominance by weight. Knowing that the first ingredient predominates by weight, consumers can learn much about the products. Compare the ingredients of these cereal products, for example: One begins “puffed mill corn, sugar, corn syrup, molasses, salt…: The other begins “100 percent rolled oats.” In this comparison, consumers can see that the second product is more nutrient-dense. Front of package labels: Some food manufacturers use front-of-package labels that incorporate text, color, and icons to present key nutrient facts. In general, consumers find front-of-package labeling a quick and easy way to select products. Nutrient claims on labels: Have you noticed phrases such as “good source of fiber” on a box of cereal or “rich in calcium” on a package of cheese? These and other nutrient claims may be used on labels as long as they meet FDA definitions, which include the conditions under which each term can be used. For example, in addition to having less than 2 mg of cholesterol, a “cholesterol-free” product may not contain more than 2 g of saturated fat and trans fat combined per serving. The accompanying glossary defines nutrient terms on food labels, including criteria for foods described as “low,” “reduced,” and “free.” When nutrients have been added to enriched or fortified products, they must appear in the ingredients list. Some descriptions imply that a food contains, or does not contain, a nutrient. Implied claims are prohibited unless they meet specified criteria. For example, a claim that a product “contains no oil” implies that the food contains no fat. If the product is truly fat-free, then it may make the no-oil claim, but if it contains another source of fat, such as butter, it may not. Health claims on labels: Health claims describe a relationship between a food (or food component) and a disease or health-related condition. In some cases, the FDA authorizes health claims based on an extensive review of the scientific literature. For example, the health claim that “Diets low in sodium may reduce the risk of high blood pressure” is based on enough scientific evidence to establish a clear link between diet and health. In cases where there is emerging—but not established—evidence for a relationship between a food or food component and disease, the FDA allows the use of qualified health claims that must use specific language indicating that the evidence supporting the claim is limited. A qualified health claim might claim that “Very limited and preliminary research suggests that eating onehalf to one cup of tomatoes and/or tomato sauce a week may reduce the risk of prostate cancer. The FDA concludes that there is little scientific evidence supporting the claim.” Structure–function claims on labels: Unlike health claims, which require food manufacturers to collect scientific evidence and petition the FDA, structure–-function claims can be made without any FDA approval. Product labels can claim to “slow aging,” “improve memory,” and “build strong bones” without any proof. The only criterion for a structure–function claim is that it must not mention a disease or symptom. Unfortunately, structure–-function claims can be deceptively similar to health claims, and most consumers do not distinguish between different types of claims.

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Chapter 02- Planning a Healthy Diet 110. List and discuss the health benefits of a vegetarian diet. ANSWER: Healthier body weight: Vegetarians tend to maintain a lower and healthier body weight than nonvegetarians. In general, those who eat meat have higher energy intakes and body weights. Vegetarians’ lower body weights correlate with their high intakes of fiber and low intakes of fat. Reduced risk of diabetes: Obesity and weight gains are strong risk factors for diabetes, which partially explains why nonvegetarian diets are more often associated with diabetes than vegetarian diets. Even when body weight and lifestyle factors are taken into account, vegetarian eating patterns seem to protect against diabetes. Reduced risk of hypertension: Vegetarians tend to have lower blood pressure and lower rates of hypertension than nonvegetarians. Appropriate body weight helps to maintain a healthy blood pressure, as does a diet low in saturated fat and cholesterol and high in fiber, fruits, vegetables, whole grains, low-fat milk products, and protein from plant sources. Decreased risk of heart disease: Meat is associated with an increased risk of heart disease and stroke. The incidence of heart disease and related deaths and the concentrations of blood cholesterol are lower for vegetarians than for nonvegetarians, which can partly be explained by their avoidance of meat. The dietary factor most directly related to heart disease is saturated animal fat, and in general, vegetarian diets are lower in total fat, saturated fat, and cholesterol than typical meat-based diets. The fats common in plant-based diets—the monounsaturated fats of olives, seeds, and nuts and the polyunsaturated fats of vegetable oils—are associated with a decreased risk of heart disease. Furthermore, vegetarian diets are generally higher in dietary fiber, antioxidant vitamins, and phytochemicals—all factors that help control blood lipids and protect against heart disease. Many vegetarians include soy products such as tofu in their diets. Soy products—with their polyunsaturated fats, fibers, vitamins, and minerals, and little saturated fat—may help to protect against heart disease. Lower risk of cancer: Vegetarians have a lower overall cancer incidence than the general population. Their low cancer rates may be due to their high intakes of fruits and vegetables. Some scientific findings indicate that vegetarian diets are associated not only with lower cancer mortality in general, but also with a lower incidence of cancer at specific sites as well, most notably, colon cancer. People with colon cancer seem to eat more meat. Some cancer experts recommend limiting consumption of red meat to no more than 11 ounces a week, with very little (if any) processed meat. Lower risk of osteoporosis, diverticular disease, gallstones, cataracts, and rheumatoid arthritis: Vegetarian diets may help prevent these diseases and conditions.

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Chapter 03- Digestion, Absorption, and Transport 1. You ate a salad for lunch; thereafter, your body breaks down these foods into nutrients in preparation for absorption. This process is called “ .” a. digestion b. ingestion c. excretion d. mastication e. segmentation ANSWER: a 2.

Which of the following defines lumen? a. the flavor of monosodium glutamate b. the opening between the duodenum and jejunum c. the conduit from the mouth to the stomach d. the intestinal enzyme that hydrolyzes dietary nucleic acids e. the continuous inner space within the GI tract ANSWER: e 3. Which of the following statements about taste buds is FALSE? a. They react only with particles in solution. b. Fluid is needed to help dissolve foods for tasting. c. There are five basic taste sensations: sweet, sour, bitter, salty, and umami. d. They can individually sense only one of the basic taste sensations at a time. e. Taste perceptions are influenced by aroma, appearance, and temperature. ANSWER: d

Define “mastication.” a. the act of chewing b. the process of swallowing c. the wavelike contraction of the intestines d. the contraction of the esophagus ANSWER: a 5. What is the primary function of the epiglottis? a. to allow passage from the esophagus to the stomach b. to protect airways during swallowing c. to absorb water and minerals d. to house lymph cells e. to pass food from the mouth to the stomach ANSWER: b

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Chapter 03- Digestion, Absorption, and Transport 6. Which structure is required to prevent entrance of food into the trachea? a. tongue b. epiglottis c. cardiac sphincter d. trachea sphincter ANSWER: b 7. Which organ in the GI tract houses bacteria and lymph cells? a. mouth b. appendix c. liver d. gallbladder e. pancreas ANSWER: b 8. Define bolus. a. enzyme that hydrolyzes starch b. portion of food swallowed at one time c. liver enzymes d. sphincter muscle separating the stomach from the small intestine ANSWER: b 9. Which statement about the stomach is FALSE? a. It churns, mixes, and grinds food. b. It holds a bolus in its upper portion before transferring it to the lower portion. c. It adds digestive juices turning a bolus into chyme. d. It manufactures bile salts to help digest fats. e. It releases chyme little by little through the pyloric sphincter. ANSWER: d 10. The pyloric sphincter opens into the a. large intestine b. rectum

c. small intestine d. colon e. bile duct ANSWER: c

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Chapter 03- Digestion, Absorption, and Transport 11. What is the primary function of the rectum? a. controls functioning of the colon b. absorbs mineral and vitamins from waste materials c. stores waste materials prior to evacuation d. absorbs excess water from waste materials ANSWER: c 12. Which of the following is NOT a muscular action of digestion? a. segmentation b. sphincter contractions c. peristalsis d. stomach action e. salivation ANSWER: e 13. What do sphincter muscles do? a. control peristalsis b. mix food with saliva c. secrete digestive juices into the GI tract d. regulate the flow of food particles along the GI tract e. trigger hormone release ANSWER: d 14. Which term describes the backward flow of stomach contents? a. pepsinogen b. gastric mucosa c. reflux d. catalyst e. bile ANSWER: c 15. Which of the following organs does NOT provide secretions to aid in digestion? a. appendix b. stomach c. salivary glands d. liver e. pancreas ANSWER: a

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Chapter 03- Digestion, Absorption, and Transport 16. What protects stomach cells from acid and disease-causing bacteria? a. hydrochloric acid b. water c. gastric glands d. mucus e. bile ANSWER: d 17. The acidity of gastric juice registers a. above 7 b. 6 c. 5 d. 3 e. below 2

on the pH scale.

ANSWER: e 18. Which of the following is NOT contained in pancreatic juice? a. hydrolysis b. carbohydrase c. lipase d. protease e. bicarbonate ANSWER: a 19. What substance is secreted by the gallbladder to emulsify fats? a. bile b. mucus c. pepsinogen d. digestive enzymes e. gastrin ANSWER: a 20. By the time the contents of the GI tract reach the a. pharynx b. ileum

, the three energy-yielding nutrients have been digested.

c. stomach d. duodenum e. pancreas ANSWER: b Page 4

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Chapter 03- Digestion, Absorption, and Transport 21. What is the name of the projections found on the inner surface of the small intestine? a. villi b. cilia c. mesenteric vessels d. vascular projectiles ANSWER: a 22. Which organ stores bile until it is needed? a. stomach b. gallbladder c. liver d. pancreas e. small intestine ANSWER: b 23. Once food is swallowed, within the GI tract, which would be the most appropriate route for food to pass through? a. jejunum, duodenum, colon, ileum, rectum b. jejunum, ileum, duodenum, rectum, colon c. stomach, duodenum, jejunum, ileum, colon d. stomach, jejunum, duodenum, colon, ileum ANSWER: c 24. Into what region of the intestinal tract does the stomach empty its contents? a. duodenum b. cecum c. jejunum d. ileum ANSWER: a 25. Which principal enzyme of secretion begins carbohydrate digestion? a. saliva b. bile c. gastric juice d. pancreatic juice e. hydrochloric acid ANSWER: a

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Chapter 03- Digestion, Absorption, and Transport 26. When does absorption begin? a. immediately after eating b. within 1 hour after eating c. within 3 to 4 hours after eating d. at least 5 hours after eating e. about 12 hours after eating ANSWER: c 27. In which organ does most absorption take place? a. small intestine b. large intestine c. liver d. gallbladder e. stomach ANSWER: a 28. Water and small lipids cross into the intestines freely; therefore, they are absorbed by a. simple diffusion b. complex diffusion c. facilitated transport d. active transport e. endocytosis

ANSWER: a 29. Glucose moves against a concentration gradient, which requires energy; therefore, it is absorbed by a. simple diffusion b. complex diffusion c. facilitated transport

d. active transport e. endocytosis ANSWER: d 30. What are crypts? a. projections on the inner surface of the small intestine b. tubular glands that secret juices into the small intestine c. cells of the GI tract that secret mucus d. hairlike projections that trap nutrient particles and transport them to cells e. glands that store bile ANSWER: b Page 6

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Chapter 03- Digestion, Absorption, and Transport 31. What happens to the enzymes present in foods we consume? a. hydrolyzes in the GI tract b. absorbed undigested by the stomach c. absorbed intact by the small intestine d. passed through the GI tract and excreted in the stool e. absorbed undigested in the bloodstream. ANSWER: a 32. What do intestinal microvilli do? a. secret bile salts b. secret mucus c. transport nutrient particles into cells d. transport pancreatic enzymes e. stimulate peristalsis ANSWER: c 33. Which statement about the absorptive system is FALSE? a. Cells of the intestinal tract are specialized to absorb different nutrients. b. Fat-soluble nutrients pass through villi and enter the lymph. c. The small intestine is about 25 feet long. d. The many folds and villi of the small intestine increase its surface area, which helps nutrient absorption. e. If one part of the GI tract becomes dysfunctional, one’s diet should be adjusted accordingly. ANSWER: c 34. Which of the following would a dietitian recommend to enhance digestion and absorption? a. Eating several snacks per day so the GI tract is not overwhelmed b. Combining different food groups c. Avoiding meat and fruit at the same meal d. Taking enzyme pills or powder periodically for system rejuvenation e. Eating only one type of food at each meal in order to avoid overstimulation of acid ANSWER: b 35. When a water-soluble nutrient molecule has been absorbed, it enters the bloodstream and is guided to the ________. a. liver b. heart c. lungs d. kidneys e. gallbladder ANSWER: a Page 7

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Chapter 03- Digestion, Absorption, and Transport 36. How is blood flow routed through the body? a. heart to arteries to capillaries to veins to heart b. heart to capillaries to veins to arteries to heart c. heart to veins to arteries to capillaries to heart d. heart to veins to capillaries to arteries to heart e. heart to arteries to veins to capillaries to heart ANSWER: a 37. How is blood routed through the digestive system? a. heart to arteries to capillaries (intestines) to hepatic portal vein to capillaries (liver) to hepatic vein to heart b. heart to capillaries to arteries (intestines) to hepatic portal vein to arteries (liver) to hepatic vein to heart c. heart to arteries to capillaries (liver) to hepatic portal vein to capillaries (intestines) to hepatic portal vein to heart d. heart to capillaries to arteries (gallbladder) to hepatic portal vein to arteries (liver) to hepatic vein to heart e. heart to arteries to capillaries (intestines) to hepatic vein to capillaries (pancreas) to hepatic portal vein to heart ANSWER: a 38. The hepatic portal vein collects blood from the GI tract and conducts it to the a. liver b. heart c. pancreas d. hepatic vein e. spleen

ANSWER: a 39. The exchange of oxygen, nutrients, and waste materials takes place across a. ducts b. venule c. aortic d. capillary e. lymph vessel

walls.

ANSWER: d

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Chapter 03- Digestion, Absorption, and Transport 40. What is the most metabolically active organ in the human body? a. liver b. adrenal gland c. stomach d. small intestine e. brain ANSWER: a 41. Which vehicle provides the passageway from the lymphatic system to the vascular system? a. villi b. hepatic portal vein c. subclavian vein d. common bile duct e. thoracic duct ANSWER: c 42. The lymphatic system collects fluid from tissues throughout the body and directs its flow toward the a. liver b. heart c. spleen d. pancreas e. gallbladder

ANSWER: b 43. What is lymph? a. a light red fluid that stores fat-soluble vitamins b. a clear fluid that contains infection-fighting white blood cells c. a white fluid that contains probiotics d. a greenish fluid that contains abundant platelets and water-soluble vitamins e. a viscous, red fluid that contains red blood cells and platelets ANSWER: b 44. Which term is defined as food components such as fibers that are not digested by the human body but are used as food by the GI bacteria to promote their growth and activity? a. prebiotics b. probiotics c. postbiotics d. symbiotics e. abiotics ANSWER: a Page 9

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Chapter 03- Digestion, Absorption, and Transport 45. Living microorganisms found in foods and dietary supplements that, when consumed in sufficient quantities, are beneficial to health are called “ .” a. probiotics b. prebiotics c. postbiotics d. symbiotics e. abiotics ANSWER: a 46. Which food contains probiotics and has been used for thousands of years to promote a healthy GI tract? a. fish b. yogurt c. poultry d. spinach e. kale ANSWER: b 47. Which statement about gastrointestinal microbes is FALSE? a. The GI tract is home to about 100 trillion microbes. b. Obese people have more diverse microbe populations than do nonobese people. c. Few microbes can live in the stomach. d. GI microbiota play a crucial role in health. e. GI microbiota change in response to short-term and long-term dietary patterns. ANSWER: b 48. Bacteria in the GI tract also produce a. mucus b. several minerals c. glucose

d. several vitamins e. energy ANSWER: d 49. Which two systems coordinate all the digestive and absorptive processes? a. endocrine and thoracic b. portal and lymphatic c. nervous and hormonal d. hormonal and circulatory e. circulatory and nervous ANSWER: c Page 10

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Chapter 03- Digestion, Absorption, and Transport 50. The normal pH of the stomach is about a. 0.75 to 0.95 b. 1.5 to 1.7 c. 2.5 to 2.9 d. 7.5 to 8.0 e. 8.0 to 8.5

ANSWER: b 51. Which of the following is a hormone secreted by the cells in the stomach wall? a. gastrin b. insulin c. secretin d. cholecystokinin e. glucagon ANSWER: a 52. What does gastrin do? a. It stimulates the pancreas to secret bicarbonate-rich juices into the small intestine to maintain a slightly alkaline pH. b. It stimulates stomach glands to release the components of hydrochloric acid to maintain an acidic pH. c. It stimulates the gallbladder to secret bile into the duodenum to emulsify fats. d. It stimulates the pancreas to secret enzyme-rich juices to digest fats and proteins. e. It stimulates the pancreas to secret enzyme-rich juices to slow GI tract motility ANSWER: b 53. Which of the following is a hormone produced by cells in the stomach wall? a. gastrin b. secretin c. glucagon d. gastric-inhibitory peptide e. CCK ANSWER: a

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Chapter 03- Digestion, Absorption, and Transport 54. Which statement accurately describes the pancreas? a. The major hormone controlling the release of pancreatic enzymes is insulin. b. Quick dietary changes improve digestion because of pancreas inefficiency. c. The pancreas can increase the activity of fat-degrading enzymes in response to more fat in the diet. d. In general, the amounts of digestive enzymes secreted by the pancreas remain constant over a wide range of nutrient intakes. e. Pancreatic enzymes can digest protein and fat but not carbohydrate. ANSWER: c 55. Which hormone stimulates the gallbladder to release bile into the duodenum to emulsify fats? a. lipase b. gastrin c. secretin d. cholecystokinin e. glucagon ANSWER: d 56. Which of the following slows GI motility? a. gastrin b. secretin c. prozymogen d. cholecystokinin e. insulin ANSWER: d 57. Which of the following does NOT promote a healthy digestive system? a. pleasant mealtime conversation b. disruptive mealtime environments c. adequate sleep d. physical activity e. nourishing foods ANSWER: b 58. What is intestinal ischemia? a. reduced blood flow to the intestines b. microscopically small fungi c. mucus-secreting intestinal projections d. inflammation of two or more sphincter muscles e. collection of microbes in the intestines ANSWER: a Page 12

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Chapter 03- Digestion, Absorption, and Transport 59. Choking occurs when food slips into the a. pharynx b. larynx c. trachea d. esophagus e. diaphragm

and completely blocks passageways.

ANSWER: c 60. Vomiting expels the contents of the stomach up through the a. esophagus b. larynx c. trachea d. salivary glands e. duodenum

to the mouth.

ANSWER: a 61. Vomiting and diarrhea can lead to life-threatening a. dehydration b. indigestion c. hemorrhoiditis d. acid dysregulation e. ulcers

ANSWER: a 62. Which of the following is one of the most common GI disorders and is characterized by abdominal pain, cramping, and a disturbance in the motility of the GI tract? a. colitis b. irritable bowel syndrome c. celiac disease d. diverticulosis e. reflux ANSWER: b

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Chapter 03- Digestion, Absorption, and Transport 63. Celiac disease is an autoimmune disease characterized by the inflammation of the small intestine that occurs in response to foods that contain . a. gluten b. collagen c. whey d. elastin e. keratin ANSWER: a 64. What terms refers to the sacs that develop in the weakened areas of the intestinal wall? a. constipation b. diarrhea c. diverticula d. colitis e. ulcers ANSWER: c 65. A high-fiber diet can reduce pressure in the rectal veins and help prevent a. reflux b. hiccups c. hemorrhoids

d. peptic ulcers e. vomiting ANSWER: c 66. Foods that produce gas typically are high in a. carbohydrates b. protein c. vitamins d. minerals e. lipids

ANSWER: a

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Chapter 03- Digestion, Absorption, and Transport 67. Which term describes the backflow of stomach acid into the esophagus, causing damage to the esophageal cells and the sensation of heartburn? a. colitis b. watery stools c. lymphatic malabsorption d. gastroesophageal reflux e. celiac disease ANSWER: d 68. Which term describes fermentable oligosaccharides, disaccharides, monosaccharides, and polyols that are commonly found in wheat, onions, some fruits and vegetables, sorbitol, and some dairy? a. antacids b. diverticula c. gluten d. fodmap e. pepsis ANSWER: d 69. Which of the following is NOT a recommended strategy for treating an ulcer? a. avoiding drinking caffeine and alcohol b. minimizing use of aspirin, ibuprofen, and naproxen c. avoiding strenuous activity d. not smoking e. avoiding aggravating foods ANSWER: c 70. What is the typical treatment for ulcers that develop in response to H. pylori infections? a. diets rich in fiber b. surgery c. antacids d. antibiotics e. naproxen ANSWER: d 71. What is the class of enzymes that help digest proteins? ANSWER: proteases 72. The semiliquid mass of partly digested food expelled by the stomach into the duodenum is called “

.”

ANSWER: chyme

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Chapter 03- Digestion, Absorption, and Transport 73. The wavelike muscular contractions of the GI tract that push its contents along are called “

.”

ANSWER: peristalsis 74. The cells of the GI tract that secret mucus are

cells.

ANSWER: goblet 75.

are small vessels that connect arteries to veins. ANSWER: Capillaries

76. The maintenance of constant internal conditions by the body’s control systems is called “

.”

ANSWER: homeostasis 77. The washing of the large intestine with a powerful enema machine is known as colonic hydrotherapy or

ANSWER: colonic irrigation

a. Liver b. Crypts c. Goblet d. Segmentation e. pH f. Gastrin g. Secretin h. Arteries i. Appendix j. Water k. Esophagus l. Gallbladder m. Lipase n. Hepatic portal vein o. Lymph p. Ileocecal valve q. Cholecystokinin r. Villi s. Hydrolysis t. Lymphatic system 78. Conduit from the mouth to the stomach ANSWER: k

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Chapter 03- Digestion, Absorption, and Transport 79. Blind sac containing bacteria and lymph cells ANSWER: i 80. Periodic squeezing by the intestine’s circular muscles ANSWER: d 81. Sphincter separating the small and large intestines ANSWER: p 82. Enzyme that digests fats ANSWER: m 83. Unit of measure expressing a substance’s acidity ANSWER: e 84. A chemical reaction in which one molecule splits into two ANSWER: s 85. Organ that stores bile until needed ANSWER: l 86. Organ that manufactures bile salts to help digest fats ANSWER: a 87. Tubular glands lying between villi ANSWER: b 88. A cell that secretes mucus ANSWER: c 89. Fingerlike projections in the small intestine ANSWER: r 90. Nutrient absorbed by simple diffusion ANSWER: j 91. Carries blood from the heart to tissues ANSWER: h 92. Clear fluid containing white blood cells ANSWER: o 93. Carries blood from GI tract to liver ANSWER: n 94. Tissues and organs that transport fluids toward the heart ANSWER: t Page 17

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Chapter 03- Digestion, Absorption, and Transport 95. Hormone secreted by stomach wall ANSWER: f 96. Hormone that targets the pancreas ANSWER: g 97. Hormone that slows GI motility ANSWER: q 98. Consider the first digestive challenge presented in the text: Human beings breathe, eat, and drink through their mouths. Air taken in through the mouth must go to the lungs; food and beverages must go to the stomach. The throat must be arranged so that swallowing, and breathing do not interfere with each other. How does the human body resolve this? ANSWER: When a mouthful of food is swallowed, it passes through the pharynx, a short tube shared by both the digestive system and the respiratory system. To bypass the entrance to the lungs, the epiglottis closes off the airway so that choking does not occur when swallowing. 99. Briefly explain the digestive actions that take place in the mouth, in the stomach, and in the small intestine. ANSWER: Mouth: The process of digestion begins in the mouth. During chewing, teeth crush large pieces of food into smaller pieces, and fluids from foods, beverages, and salivary glands blend with these pieces to ease swallowing. Fluids also help dissolve the food so that the tongue can taste it; only particles in solution can react with taste buds. When stimulated, the taste buds detect one, or a combination, of the five basic taste sensations: sweet, sour, bitter, salty, and umami, a savory flavor commonly associated with monosodium glutamate. In addition to these chemical triggers, aroma, appearance, texture, and temperature also affect a food’s flavor. The tongue provides taste sensations and moves food around the mouth, facilitating chewing and swallowing. When a mouthful of food is swallowed, it passes through the pharynx, a short tube that is shared by both the digestive system and the respiratory system. To bypass the entrance to the lungs, the epiglottis closes off the airway so that choking doesn’t occur when swallowing. After a mouthful of food has been chewed and swallowed, it is called a “bolus.” Esophagus: The esophagus has a sphincter muscle at each end. During a swallow, the upper esophageal sphincter opens. The bolus then slides down the esophagus, which passes through a hole in the diaphragm to the stomach. The lower esophageal sphincter at the entrance to the stomach closes behind the bolus so that it proceeds forward and doesn’t slip back into the esophagus. Stomach: The stomach retains the bolus for a while in its upper portion. Little by little, the stomach transfers the food to its lower portion, adds juices to it, and grinds it to a semiliquid mass called “chyme.” Then, bit by bit, the stomach releases the chyme through the pyloric sphincter, which opens into the small intestine and then closes behind the chyme. Small intestine: At the beginning of the small intestine, the chyme bypasses the opening from the common bile duct, which is dripping fluids into the small intestine from two organs outside the GI tract —the gallbladder and the pancreas. The chyme travels on down the small intestine through its three segments—the duodenum, the jejunum, and the ileum—almost 10 feet of tubing coiled within the abdomen.

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Chapter 03- Digestion, Absorption, and Transport 100. How do intestinal cells facilitate nutrient absorption? ANSWER: The inner surface of the small intestine looks smooth and slippery, but when viewed through a microscope, it turns out to be wrinkled into hundreds of folds. Each fold is contoured into thousands of fingerlike projections, as numerous as the hairs on velvet fabric. These small intestinal projections are called “villi.” A single villus, magnified still more, turns out to be composed of hundreds of cells, each covered with its own microscopic hairs, called “microvilli.” In the crevices between the villi lie the crypts—tubular glands that secrete the intestinal juices into the small intestine. Nearby goblet cells secrete mucus. The villi are in constant motion. Each villus is lined by a thin sheet of muscle, so it can wave, squirm, and wriggle like the tentacles of a sea anemone. Any nutrient molecule small enough to be absorbed is trapped among the microvilli and then drawn into the cells. Some partially digested nutrients are caught in the microvilli, digested further by enzymes there, and then absorbed into the cells. The cells of the villi are among the most amazing in the body because they recognize and select the nutrients the body needs and regulate their absorption. As already described, each cell of a villus is coated with thousands of microvilli, which project from the cell’s membrane. In these microvilli, and in the membrane, lie hundreds of different kinds of enzymes and “pumps,” which recognize and act on different nutrients. The point here is that the cells are equipped to handle all kinds and combinations of foods and their nutrients. A further refinement of the system is that the cells of successive portions of the intestinal tract are specialized to absorb different nutrients. The nutrients that are ready for absorption early are absorbed near the top of the GI fact, the contrary is often true; foods eaten together can enhance each other’s use by the body. For example, vitamin C in a pineapple or other citrus fruit can enhance the absorption of iron from a meal of chicken and rice or other iron-containing foods. When a nutrient molecule has crossed the cell of a villus, it enters either the bloodstream or the lymphatic system. Both transport systems supply vessels to each villus. The water-soluble nutrients and the smaller products of fat digestion are released directly into the bloodstream and guided directly to the liver, where their fate and destination will be determined. The larger fats and the fat-soluble vitamins are insoluble in water, however, and blood is mostly water. The intestinal cells assemble many of the products of fat digestion into larger molecules. These larger molecules cluster together with special proteins, forming chylomicrons. Because chylomicrons carry fats, they are released into the lymphatic system. They move through the lymph until they can enter the bloodstream at a point near the heart. Consequently, chylomicrons bypass the liver at first. 101. Your friend tells you he is dieting and using the “food separation” technique to lose weight. He eats fruit for breakfast, vegetables for lunch, and proteins for dinner. What advice would you give him regarding the dietary implications of this system? ANSWER: The idea that people should not eat certain food combinations (for example, fruit and meat) at the same meal, because the digestive system cannot handle more than one task at a time, is a myth. The art of “food combining”—which actually emphasizes “food separating”—is based on this myth, and it represents faulty logic and a gross underestimation of the body’s capabilities. In fact, the contrary is often true; foods eaten together can enhance each other’s use by the body. For example, vitamin C in a pineapple or other citrus fruit can enhance the absorption of iron from a meal of chicken and rice or other iron-containing foods.

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Chapter 03- Digestion, Absorption, and Transport 102. Explain how water-soluble nutrients are routed through the vascular system. ANSWER: The routing of the blood leaving the digestive system has a special feature—it is carried to the digestive system (as to all organs) by way of an artery, which (as in all organs) branches into capillaries to reach every cell. Blood leaving the digestive system, however, goes by way of a vein. The hepatic portal vein directs blood not back to the heart but to another organ, the liver. This vein branches into a network of large capillaries so that every cell of the liver has access to the blood. Blood leaving the liver then collects into the hepatic vein, which returns blood to the heart. The liver’s placement ensures that it will be first to receive the nutrients absorbed from the GI tract. In fact, the liver has many jobs to do in preparing the absorbed nutrients for use by the body. Of all the body’s organs, the liver is the most metabolically active. In addition, the liver defends the body by detoxifying substances that might cause harm and preparing waste products for excretion. This is why, when people ingest poisons that succeed in passing the first barrier (the intestinal cells), the liver quite often suffers the damage—from viruses such as hepatitis, from drugs such as barbiturates or alcohol, from toxins such as pesticide residues, and from contaminants such as mercury. 103. Briefly describe the lymphatic system, including how it differs from the vascular system. ANSWER: The lymphatic system provides a one-way route for fluid from the tissue spaces to enter the blood. Unlike the vascular system, the lymphatic system has no pump; instead, lymph circulates between the cells of the body and collects into tiny vessels. The fluid moves from one portion of the body to another as muscles contract and create pressure here and there. Ultimately, much of the lymph collects in the thoracic duct behind the heart. The thoracic duct opens into the subclavian vein, where the lymph enters the bloodstream. Thus, nutrients from the GI tract that enter lymphatic vessels (large fats and fat-soluble vitamins) ultimately enter the bloodstream, circulating through arteries, capillaries, and veins like the other nutrients, with a notable exception—they bypass the liver at first. 104. Compare and contrast prebiotics and probiotics. Give examples of each type. ANSWER: Prebiotics are food components (such as fibers) that are not digested by the human body but are used as food by the GI bacteria to promote their growth and activity. They may reduce the risk of GI infections, inflammation, and disorders; increase the bioavailability of nutrients; and regulate appetite and satiety. Probiotics are living microorganisms found in foods and dietary supplements that, when consumed in sufficient quantities, are beneficial to health. They may alleviate diarrhea, constipation, inflammatory bowel syndrome, ulcers, allergies, lactose intolerance, and infant colic; enhance immune function; and protect against colon cancer. Examples will vary.

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Chapter 03- Digestion, Absorption, and Transport 105. List and describe the three major hormones involved in digestion and absorption. Include what each responds to, where each is secreted from, what each stimulates, and the response to each stimulus. ANSWER: Food entering the stomach stimulates cells in the stomach wall to release the hormone gastrin. Gastrin, in turn, stimulates the stomach glands to secrete the components of hydrochloric acid. When pH 1.5 is reached, the acid itself turns off the gastrin-producing cells; they stop releasing gastrin, and the glands stop producing hydrochloric acid. The presence of chyme stimulates the cells of the duodenal wall to release the hormone secretin into the blood. When secretin reaches the pancreas, it stimulates the pancreas to release its bicarbonaterich juices. Thus, whenever the duodenal signals that acidic chyme is present, the pancreas responds by sending bicarbonate to neutralize it. When the need has been met, the cells of the duodenal wall are no longer stimulated to release secretin, the hormone no longer flows through the blood, and the pancreas no longer receives the message and stops sending pancreatic juice. Nerves also regulate pancreatic secretions. Fat in the intestine stimulates cells of the intestinal wall to release the hormone cholecystokinin (CCK). This hormone travels by way of the blood to the gallbladder and stimulates it to contract, which releases bile into the small intestine. CCK also travels to the pancreas and stimulates it to secrete its juices, which releases bicarbonate and enzymes into the small intestine. Once the fat in the intestine is emulsified and enzymes have begun to work on it, the fat no longer provokes release of the hormone, and the message to contract is canceled. 106. Discuss the causes, recommended first aid, and strategies for preventing choking. ANSWER: Sometimes a sip of a beverage or a tiny bit of food “slips down the wrong pipe.” The body’s first response is to cough, and quite often coughing clears the passage. When someone is truly choking, however, food has slipped into the trachea and completely blocked the air passageways. Thus, the person cannot cough—or even breathe. Without oxygen, the person may suffer permanent brain damage within 5 minutes or may even die. For this reason, it is imperative that everyone learn to recognize the universal distress signal for choking (hands wrapped around the throat) and act promptly. Because the larynx is in the trachea and makes sounds only when air is pushed across it, a person choking will be unable to speak. For this reason, to help a person who is choking, first ask “Can you speak?” If the person is coughing, breathing adequately, or able to speak, do not interfere. Whatever you do, do not hit him on the back as the particle may become lodged more firmly in his air passageway. If the person cannot speak or cough, shout for help and perform the Heimlich maneuver. Almost any food can cause choking, although some are cited more often than others: Chunks of meat, hot dogs, nuts, whole grapes, raw carrots, marshmallows, hard or sticky candies, gum, popcorn, and peanut butter. These foods are particularly difficult for young children (especially those 4 years of age and younger) to safely chew and swallow. Each year more than 10,000 children (14 years old or younger) in the United States choke; more than half choke on food. Every 5 days, a child in the United States chokes to death on food. An adult should be present and alert to the dangers of choking whenever young children are eating. To prevent choking, cut food into small pieces, chew thoroughly before swallowing, don’t talk or laugh with food in your mouth, and don’t eat when breathing hard.

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Chapter 03- Digestion, Absorption, and Transport 107. Compare and contrast the common digestive problems of vomiting and diarrhea. ANSWER: Vomiting can be a symptom of many different diseases or may arise in situations that upset the body’s equilibrium, such as air or sea travel. For whatever reason, the contents of the stomach are propelled up through the esophagus to the mouth and expelled. Sometimes the muscular contractions will extend beyond the stomach and carry the contents of the duodenum, with its green bile, into the stomach and then up the esophagus. Although certainly unpleasant and wearying for the nauseated person, vomiting is often not a cause for alarm. Vomiting is one of the body’s adaptive mechanisms to rid itself of something irritating. The best advice is to rest and drink small amounts of liquids as tolerated until the nausea subsides. A physician’s care may be needed, however, if vomiting causes such large losses of fluid as to threaten dehydration. As fluid is lost from the GI tract, the body’s other fluids redistribute themselves, taking fluid from every cell of the body. Fluid leaving the cells is accompanied by salts that are absolutely essential to the life of the cells. Replacing salts and fluid is difficult if the vomiting continues, and intravenous feedings of saline and glucose may be necessary. Vomiting and dehydration are especially serious in an infant, and a physician should be contacted without delay. Diarrhea is characterized by frequent, loose, watery stools. Such stools indicate that the intestinal contents have moved too quickly through the intestines for fluid absorption to take place or that water has been drawn from the cells lining the intestinal tract and added to the food residue. Like vomiting, diarrhea can lead to considerable fluid and salt losses, but the composition of the fluids is different. Stomach fluids lost in vomiting are highly acidic, whereas intestinal fluids lost in diarrhea are nearly neutral. When fluid losses require medical attention, correct replacement is crucial. Diarrhea is a symptom of various medical conditions and treatments. It may occur abruptly in a healthy person as a result of infections (such as foodborne illness) or as a side effect of medications. When used in large quantities, food ingredients such as the sugar alternative sorbitol and the fat alternative olestra may also cause diarrhea in some people. If a food is responsible, then that food must be omitted from the diet, at least temporarily. If medication is responsible, a different medicine, when possible, or a different form (injectable versus oral, for example) may alleviate the problem. Diarrhea may also occur as a result of disorders of the GI tract, such as irritable bowel syndrome or colitis.

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 1. Which of these following foods have ample amounts of carbohydrates? a. plant b. health c. unsweetened d. processed e. low-fat ANSWER: a 2. Which of the following is a monosaccharide also known as “blood sugar”? a. glucose b. maltose c. sucrose d. fructose e. galactose ANSWER: a 3. Which monosaccharide is found abundantly in fruits? a. glucose b. maltose c. sucrose d. fructose e. galactose ANSWER: d 4. A chemical reaction wherein two molecules combine to form one larger product is called “ a. hydrolysis

.”

b. absorption c. disaccharide d. condensation e. polysaccharide ANSWER: d

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 5. Which of the following is a byproduct of the condensation? a. water b. oxygen c. hydrogen d. carbon dioxide e. carbon monoxide ANSWER: a 6. Which of the following is a chemical reaction in which one molecule is split into two molecules? a. hydrolysis b. condensation c. gluconeogenesis d. homeostasis e. phosphorylation ANSWER: a 7. Which of the following unit of sugar is found in all of the three dietary disaccharides? a. sucrose b. glucose c. fructose d. galactose e. high-fructose corn syrup ANSWER: b 8. Maltose, or malt sugar, is a disaccharide composed of a. two glucose units

b. one glucose and one fructose unit c. one glucose and one galactose unit d. one galactose and one fructose unit e. two galactose units ANSWER: a

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 9. Name the animal polysaccharide composed of glucose units. a. fiber b. enzyme c. dextrin d. glycogen e. probiotics ANSWER: d 10. Glycogen is found to only a limited extent in a. meats

b. plants c. milk d. fish e. nuts ANSWER: a 11. Glycogen is defined as a storage form of glucose, manufactured and stored in the body’s a. muscles and liver

b. pancreas and kidneys c. stomach and intestines d. brain and red blood cells e. spleen and lymphatics ANSWER: a 12. What combination of units of sugar are found in lactose? a. two glucose units b. two fructose units c. one glucose and one fructose unit d. one glucose and one galactose unit e. two sucrose units. ANSWER: d

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 13. Which term is defined as a plant polysaccharide composed of many glucose molecules? a. fiber b. glycogen c. lactose d. starch e. sucrose ANSWER: d 14. Pectin from fruit is an example of a a. viscous

fiber.

b. soluble c. fermentable d. functional e. total ANSWER: b 15. Fibers that can be digested by bacteria in the GI tract are called “ a. starchy

.”

b. viscous c. fermentable d. insoluble e. functional ANSWER: c 16. Which of the following enzymes begins digestion? a. amylase b. maltase c. sucrase d. lactase e. pancreatic amylase ANSWER: a

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 17. Which part of the GI tract does NOT actively participate in the digestion of carbohydrates? a. small intestine b. pancreas c. salivary glands d. stomach e. mouth ANSWER: d 18. How are soluble fibers primarily digested in the large intestines? a. with the help of bacterial enzymes b. with the help of pancreatic amylase c. through peristaltic segmentation d. with the help of villus brush border hydrolases e. with the help of liver enzymes. ANSWER: a 19. In which part of the GI tract do enzymes hydrolyze the disaccharides into monosaccharides? a. small intestine b. pancreas c. salivary glands d. stomach e. colon ANSWER: a 20. Which statement about nondigestible carbohydrates is FALSE? a. Dietary fiber lingers in the small intestine. b. They attract water, which softens stool for passage without straining. c. Their small fat molecules contribute some energy. d. They are fermented by bacteria in the GI tract. e. Bacteria adds water, gas, and short-chain fatty acids. ANSWER: a

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 21. Fructose and galactose are mostly metabolized through the

a. liver b. pancreas c. stomach d. small intestine e. colon ANSWER: a 22. Which of the following is NOT a resistant starch? a. milled grains b. legumes c. just-ripened bananas d. cooked potatoes that have been chilled e. green apples ANSWER: e 23. What percentage of people in the world can digest and absorb lactose efficiently throughout their adult life? a. 15% b. 35% c. 50% d. 75% e. 95% ANSWER: b 24. A low-FODMAP diet typically is used to improve the symptoms of a. lactose intolerance

b. irritable bowel syndrome c. lactose deficiency d. colitis e. peptic ulcers ANSWER: b

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 25. Which statement accurately describes lactose intolerance? a. Its prevalence is highest among northern Europeans. b. Symptoms include bloating, abdominal discomfort, and diarrhea. c. Most people who claim to be lactose-intolerant have been clinically diagnosed. d. Eliminating milk products from the diet is required to alleviate symptoms. e. Commercially prepared milk products like Lactaid show no benefits to the lactose-intolerant. ANSWER: b 26. only after 30 minutes of exerciseWhen is glucose available to supply energy to the brain and other tissues? a. only after 30 minutes of exercise b. only after 60 minutes of exercise c. only after eating a meal with carbohydrates d. only after eating a low-carbohydrate meal e. anytime ANSWER: e 27. A friend says he is on the “keto diet” and eats no carbohydrates. His body converts his dietary protein to glucose

through . a. gluconeogenesis b. protein-deleting action c. ketosis d. acid–base balance e. hypoglycemia ANSWER: a 28. Approximately how much of the body’s total glycogen content is found in the liver? a. 1/10 b. 1/4 c. 1/3 d. ½ e. 3/4 ANSWER: b

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 29. How many carbohydrates does the body need each day to prevent ketosis? a. 10 to 25 g b. 50 to 100 g c. 100 to 150 g d. 150 to 200 g e. 200 to 250 g ANSWER: b 30. The liver can store enough glycogen to meet the body’s energy needs for a. 1 day

b. 3 days c. 1 week d. 10 days e. 2 weeks ANSWER: a 31. How does insulin regulate blood glucose levels? a. by raising them b. by lowering them c. by stimulating glycogen breakdown d. by stimulating intestinal carbohydrate absorption e. by stimulating ketoacidosis ANSWER: b 32. What is the “fight or flight” hormone that signals the release of glucose? a. epinephrine b. insulin c. glucagon d. leptin e. gastrin ANSWER: a

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 33. When blood glucose falls, which organ responds first? a. brain b. liver c. muscle d. pancreas e. gallbladder ANSWER: d 34. Which fasting blood glucose level would be considered within the normal range? a. 57 mg/dL b. 77 mg/dL c. 107 mg/dL d. 127 mg/dL e. 170 mg/dL ANSWER: b 35. Which of the following is a typical feature of diabetes? a. Type 1 diabetes is more common than type 2. b. In type 1 diabetes, cells fail to respond to insulin. c. Rates of diabetes have steadily declined over the past decade. d. Dietary management should focus on total carbohydrate intake. e. The best preventive measure for type 1 diabetes is a healthy body weight. ANSWER: d 36. Which statement about hypoglycemia is FALSE? a. It is treated with insulin injections. b. It is defined as an abnormally low blood glucose concentration. c. Symptoms include weakness, rapid heartbeat, sweating, anxiety, hunger, and trembling. d. It rarely occurs in otherwise healthy people. e. It occurs without notice. ANSWER: a

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 37. Which of the following terms describes how quickly glucose is absorbed from a food after ingestion, how high

blood glucose rises as a result, and how quickly blood glucose returns to normal? a. type 2 diabetes b. glycemic index c. hypoglycemic potential d. glycemic response e. insulin resistance ANSWER: d 38. Which fruit has a high glycemic index? a. apples b. watermelon c. bananas d. peaches e. pineapple ANSWER: b 39. A person eating lots of rolled oats, carrots, and legumes would have a diet with a glycemic index that is a. very low

b. low c. moderate d. high e. very high ANSWER: b 40. Beverages account for about a. 10% b. 25% c. 50%

of the added sugars consumed in the United States.

d. 75% e. 90% ANSWER: c

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 41. The American Heart Association recommends limiting added sugars to

and a. 50, 100 b. 75, 125 c. 100, 150 d. 150, 100 e. 125, 50

kcalories per day for women

kcalories per day for men.

ANSWER: c 42. Which sugar is sold only in liquid form and is used as a food additive to help preserve freshness and prevent

shrinkage? a. molasses b. invert sugar c. turbinado sugar d. high-fructose syrup e. brown sugar ANSWER: b 43. High-fructose corn syrup is made of roughly 50% fructose and 50%

a. glucose b. maltose c. sucrose d. galactose e. lactose ANSWER: a 44. Which sweetener contains significant amounts of calcium and iron? a. blackstrap molasses b. honey c. brown sugar d. high-fructose corn syrup e. malt syrup ANSWER: a

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 45. Which of the following is common indicator of prediabetes? a. Insulin resistance b. Severe hunger 4-5 hours after a meal c. Bloating and indigestion d. More than two episodes/week of Consumption of carbohydrates ANSWER: a 46. One way to prevent dental caries is to restrict the intake of sugary foods. A more effective way is to a. brush and floss regularly

b. consume raisins between meals c. substitute honey for table sugar d. eat smaller portions of snack foods and space them throughout the day e. drink hot beverages when eating sugary foods ANSWER: a 47. One teaspoon of sugar provides 4 g of carbohydrates and about a. 8

kcalories.

b. 16 c. 32 d. 48 e. 70 ANSWER: b 48. Sports drinks erode tooth enamel because they contain sugar and a. are acidic

b. are alkaline c. resist starch d. offer insufficient fluoride e. an organic base ANSWER: a

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 49. Which nonnutritive artificial sweetener is herb-derived and generally recognized as safe? a. stevia b. aspartame c. saccharine d. sucralose e. advantame ANSWER: a 50. Which statement about sugar alcohols is FALSE? a. They occur naturally in fruits and vegetables. b. They add bulk and texture to processed foods. c. They are found in products labeled “sugar-free.” d. They evoke a low glycemic response. e. They cannot be metabolized by bacteria in the GI tract. ANSWER: e 51. Products that claim to be “reduced calorie” must have a minimum of

fewer calories than the

comparison item. a. 10% b. 15% c. 25% d. 35% e. 50% ANSWER: c 52. Which of the following is NOT a feature of high-fiber foods? a. effective in weight control b. provide a feeling of fullness c. are lower in fat and simple sugars d. provide more energy per gram than processed and junk foods e. prevent constipation. ANSWER: d

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 53. Which food was one of the first recognized for its ability to reduce blood cholesterol and the risk of heart disease? a. seaweed b. legumes c. barley d. bran e. oatmeal ANSWER: e 54. Carbohydrates should provide a. 5 to 9%

of the day's total energy intake to support good health.

b. 10 to 19% c. 20 to 29% d. 30 to 44% e. 45 to 65% ANSWER: e 55. What do cellulose and lignin fibers do in the body? a. lower cholesterol by binding bile b. slow absorption of glucose c. hold moisture in stools d. provide bulk and feelings of fullness e. yield small fat molecules the colon uses for energy ANSWER: d 56. Given the average minimum amount of glucose used by the brain, the Recommended Daily Allowance for

carbohydrate is a. 10 b. 45

g/day.

c. 130 d. 250 e. 400 ANSWER: c

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 57. Why did the DRI committee not set an Upper Level for fiber? a. A body can never have enough high-fiber foods. b. High-fiber foods are so filling, they are not likely to be eaten in excess. c. There are no consequences to an abundance of high-fiber foods. d. Fiber benefits everyone’s GI tract, so the more fiber, the healthier the digestive system. e. There was not enough evidence regarding fiber’s effects on health. ANSWER: b 58. One ounce of a grain (e.g., one slice of bread) provides about a. 5

g of carbohydrate.

b. 10 c. 15 d. 20 e. 25 ANSWER: c 59. Which protein provides about 20 g of carbohydrate in a half-cup serving? a. nuts b. chicken c. red meat d. legumes e. pork ANSWER: d 60. Which of the following is a starchy vegetable and provides about 15 g of carbohydrate per half-cup serving? a. corn b. green beans c. broccoli d. tomatoes e. cauliflower ANSWER: a

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 61. Which food will provide 5 to 8 g of fiber? a. ½ cup cooked oatmeal b. 1 cup of raw bean sprouts c. ½ cup chopped raw carrots d. 1 medium kiwi e. ½ cup black beans ANSWER: e 62. Which statement accurately describes carbohydrate in milk and milk products? a. A cup of chocolate milk provides about 6 g of carbohydrate. b. Most cheeses contain little, if any, carbohydrate. c. Cottage cheese provides about 12 g of carbohydrate per cup. d. A cup of fruit-filled yogurt yields about 3 g of carbohydrate. e. A cup of nonfat milk yields almost 25 g of carbohydrate. ANSWER: b 63. Which statement about food labeling is true? a. “Sugars” amounts include added sugars only. b. Starch numbers are listed as a separate line item. c. “Total carbohydrate” amounts include starch, sugars, and fiber. d. “Total carbohydrate” amounts includes starch and sugars but not fiber. e. “Total carbohydrate” means only refined carbohydrates. ANSWER: c 64. Since the 1970s, total energy intakes increased by almost 300 kcal, all of which came from an increase in

kcalories. a. fat b. protein c. alcohol d. carbohydrate e. lipoproteins ANSWER: d

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 65. Low-carbohydrate diets

. a. are associated with diet-induced diarrhea b. cause frequent bouts of hyperglycemia c. affect weight loss about the same as low-fat diets d. initially cause sugar cravings e. increase appetite ANSWER: c

66. Which statement about the overconsumption of sugary soft drinks is FALSE? a. The liquid form of sugar makes it easier to overconsume kcalories. b. Sweet beverages cost less than other energy sources and are readily available. c. Sweet beverages are energy-dense. d. Most people limit sugar-laden soda consumption to 12 oz per day. e. Drinking water instead of soda can help a person lose 10 pounds in 1 year. ANSWER: d 67. Which of the following is true of carbohydrate cravings and addictions? a. People seek carbohydrates to restore brain glucagon levels. b. The addiction shares some psychological systems involved in rewards and self-control. c. They are regarded as an important public health threat. d. They predict other self-destructive behaviors. e. They are addictive in the same way that drugs are. ANSWER: b 68. Which of the following statements about fructose is FALSE? a. Fructose is metabolized by the liver. b. The liver turns excess fructose into fat, causing a fatty liver. c. Fructose does not stimulate the release of insulin. d. A fresh apple satisfies hunger better than apple juice. e. Fructose suppresses appetite. ANSWER: e

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 69. The glycemic effect of food depends on several things. Which is NOT one of them? a. how the food is ripened b. the time of day the food is eaten c. the combination of foods eaten d. the presence of certain diseases (e.g., type 2 diabetes) in the eater e. how the food was grown ANSWER: e 70. The NHANES studied energy nutrient data over the past 35 years. What were their findings? a. kcalories from carbohydrate decreased from 51% to 42%. b. kcalories from protein increased from 33% to 41% c. kcalories for fat stayed about the same. d. total daily energy intakes increased significantly. e. most people were active enough to use up the extra kcalories they consumed. ANSWER: d 71. Simple carbohydrates composed of monosaccharides, disaccharides, or both are called “

.”

ANSWER: sugars 72. Plant polysaccharides composed of many glucose molecules are

ANSWER: starches 73. Fibers that have gel-forming properties are

ANSWER: viscous, or soluble, fibers 74. The feeling of fullness and satisfaction that occurs after a meal and inhibits eating until the next meal is called ________. ANSWER: satiety 75. The enzyme required to digest the disaccharide lactose into its component monosaccharides is called “

.”

ANSWER: lactase 76. The action of carbohydrate (and fat) in providing energy that allows protein to be used for other purposes is called “ ______ _.” ANSWER: protein-sparing action 77. When blood glucose levels are higher than normal, but below the diagnosis of diabetes, the condition is called ________. ANSWER: prediabetes Page 18

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 78.

are acidic compounds produced by the liver during the breakdown of fat when carbohydrate is not available. ANSWER: Ketone bodies

79. The decay of teeth is

ANSWER: dental caries 80. Sweeteners that yield energy, including both sugars and sugar alcohols, are called “

.”

ANSWER: nutritive sweeteners

a. 20 b. ½ cup c. 1 cup d. Psyllium e. Insulin f. Amylase g. Grain h. Sucrose i. Lactose j. Fructose k. Stevia l. Glycogen m. Glucagon n. Cellulose o. Hydrolysis p. HFCS q. Honey r. Water s. Small intestine t. Large intestine 81. Table sugar ANSWER: h 82. Substance released during condensation ANSWER: r 83. Chemical reaction commonly occurring during digestion ANSWER: o

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 84. A polysaccharide not found in plants ANSWER: l 85. Richest food source of starch ANSWER: g 86. A fiber that cannot be digested ANSWER: n 87. A water-soluble fiber ANSWER: d 88. A monosaccharide found in fruits ANSWER: j 89. Organ that breaks down maltose, sucrose, and lactose ANSWER: s 90. Salivary enzyme ANSWER: f 91. Organ where bacterial enzymes digest fiber ANSWER: t 92. A disaccharide composed of glucose and galactose ANSWER: i 93. Hormone secreted by the pancreas in response to low blood sugar ANSWER: m 94. Hormone secreted by the pancreas in response to elevated blood sugar ANSWER: e 95. Blood glucose level (in mg/dL) signaling hypoglycemia ANSWER: a 96. Sugar formed from nectar gathered by bees ANSWER: q 97. Syrup that is half glucose and half fructose ANSWER: p 98. Serving size of milk yielding 12 g of carbohydrate ANSWER: c 99. An alternative sweetener ANSWER: k Page 20

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 100. Serving size of corn yielding 15 g of carbohydrate ANSWER: b 101. Describe the chemical structures of the dietary carbohydrate family. ANSWER: The dietary carbohydrate family includes

Monosaccharides: Single sugars Disaccharides: Sugars composed of pairs of monosaccharides Polysaccharides: Large molecules composed of chains of monosaccharides Monosaccharides and disaccharides (the sugars) are sometimes called “simple carbohydrates,” and polysaccharides (starches and fibers) are sometimes called “complex carbohydrates.” Glucose, fructose, and galactose are the three monosaccharides most important in nutrition and all have the same numbers and kinds of atoms. Each contains 6 carbon atoms, 12 hydrogens, and 6 oxygens (written in shorthand as C6H12O6), but differ in the arrangement of the atoms. These chemical differences account for the differing sweetness of the monosaccharides. The disaccharides are pairs of the three monosaccharides just described. Maltose is composed of two glucose units. Sucrose is composed of one glucose unit and one sucrose unit. Lactose is composed of one glucose unit and one galactose unit. These carbohydrates—and all the other energy nutrients—are put together and taken apart by similar chemical reactions: condensation and hydrolysis. In contrast to the aforementioned simple carbohydrates, the polysaccharides are slightly more complex, containing many glucose units, and, in some cases, a few other monosaccharides strung together. Three types of polysaccharides are important in nutrition: glycogen, starches, and fibers. Glycogen is a storage form of energy in the body; starch is the storage form of energy in plants; and fibers provide structure in stems, trunks, roots, leaves, and skins of plants. Both glycogen and starch are built of glucose units; fibers are composed of a variety of monosaccharides and other carbohydrate derivatives.

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 102. What are dietary fibers and how are they classified? ANSWER: Dietary fibers are the structural parts of plants and thus are found in all plant-derived foods— vegetables, fruits, whole grains, and legumes. Most dietary fibers are polysaccharides. Starches are also polysaccharides, but dietary fibers differ from starches in that the bonds between their monosaccharides cannot be broken down by digestive enzymes in the body. For this reason, dietary fibers are often described as nonstarch polysaccharides. Researchers often classify dietary fibers according to their solubility in water, their viscosity, and their fermentability. Fibers that dissolve in water are called “soluble fibers,” those that form gels are called “viscous,” and those that are easily digested by bacteria in the colon are “fermentable.” Commonly found in oats, barley, legumes, and citrus fruits, soluble fibers are most often associated with protecting against heart disease and diabetes by lowering blood cholesterol and glucose levels, respectively. Other fibers do not dissolve in water (insoluble fibers), do not form gels (nonviscous), and are less readily fermented. Found mostly in whole grains (bran) and vegetables, insoluble fibers promote bowel movements, alleviate constipation, and prevent diverticular disease. As mentioned, dietary fibers occur naturally in plants. When these fibers have been extracted from plants or are manufactured and then added to foods or used in supplements, they are called “functional fibers”— if they have beneficial health effects. Cellulose in cereals, for example, is a dietary fiber, but when consumed as a supplement to alleviate constipation, cellulose is considered a functional fiber. Total fiber is the sum of dietary fibers and functional fibers.

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 103. Briefly describe lactose intolerance, including its symptoms and causes and any recommended dietary changes. ANSWER: Normally, the intestinal cells produce enough of the enzyme lactase to ensure that the disaccharide lactose found in milk is both digested and absorbed efficiently. Lactase activity is highest immediately after birth, as befits an infant whose first and only food for a while will be breast milk or infant formula. In the great majority of the world’s populations, lactase activity declines dramatically during childhood and adolescence to about 5 to 10% of the activity at birth. Only a relatively small percentage (about 30%) of the people in the world retain enough lactase to digest and absorb lactose efficiently throughout adult life. When more lactose is consumed than the available lactase can handle, lactose molecules remain in the intestine undigested, attracting water and causing bloating, abdominal discomfort, and diarrhea—the symptoms of lactose intolerance. The undigested lactose becomes food for intestinal bacteria, which multiply and produce irritating acid and gas, further contributing to the discomfort and diarrhea. As mentioned, lactase activity commonly declines with age. Lactase deficiency may also develop when the intestinal villi are damaged by disease, certain medicines, prolonged diarrhea, or malnutrition. Depending on the extent of the intestinal damage, lactose malabsorption may be temporary or permanent. In extremely rare cases, an infant is born with a lactase deficiency, making feeding a challenge. The prevalence of lactose intolerance varies widely among ethnic groups, indicating that the trait has a genet ic component. The prevalence of lactose intolerance is lowest among Scandinavians and other northern Europeans and highest among native North Americans and Southeast Asians. An estimated 30 million to 50 million people in the United States are lactose-intolerant. Managing lactose intolerance requires some dietary changes, although total elimination of milk products usually is not necessary. Excluding all milk products from the diet can lead to nutrient deficiencies because these foods are a major source of several nutrients, notably the mineral calcium, vitamin D, and the B vitamin riboflavin. Fortunately, many people with lactose intolerance can consume foods containing up to 6 g of lactose (½ cup milk) without symptoms. The most successful strategies are to increase intake of milk products gradually, consume them with other foods in meals, and spread their intake throughout the day. In addition, yogurt containing live bacteria seems to improve lactose intolerance. A change in the type, number, and activity of GI bacteria—not the reappearance of the missing enzyme—accounts for the ability to adapt to milk products. Importantly, most lactose-intolerant individuals need to manage their dairy consumption rather than restrict it. In many cases, lactose-intolerant people can tolerate fermented milk products such as yogurt and kefir. The bacteria in these products digest lactose for their own use, thus reducing the lactose content. Even when the lactose content is equivalent to that of milk, yogurt produces fewer symptoms. Hard cheeses, such as cheddar, and cottage cheese are often well tolerated because most of the lactose is removed with the whey during manufacturing. Lactose continues to diminish as cheese ages. Many lactose-intolerant people use commercially prepared milk products (such as Lactaid) that have been treated with an enzyme that breaks down the lactose. Alternatively, they take enzyme tablets with meals or add enzyme drops to their milk. The enzyme hydrolyzes much of the lactose in milk to glucose and galactose, which lactose intolerant people can absorb without ill effects. Because people’s tolerance to lactose varies widely, lactose-restricted diets must be highly individualized. A completely lactose-free diet can be difficult because lactose appears not only in milk and milk products but also as an ingredient in many nondairy foods such as breads, cereals, breakfast drinks, salad dressings, and cake mixes. People on strict lactose-free diets need to read labels and avoid foods that include milk, milk solids, whey (milk liquid), and casein (milk protein, which may contain traces of lactose). They also need to check all medications with a pharmacist because 20% of prescription drugs and 5 percent of over-the-counter drugs contain lactose as a filler. People who consume few milk products must take care to meet riboflavin, vitamin D, and calcium needs.

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 104. Discuss the roles of the mouth and the stomach in the digestion of carbohydrate. ANSWER: The salivary enzyme amylase starts to work in the mouth, hydrolyzing the starch to shorter polysaccharides and to the disaccharide maltose. Because food is in the mouth for a relatively short time, very little carbohydrate digestion takes place there. Carbohydrate digestion ceases in the stomach. The activity of salivary amylase diminishes as the stomach’s acid and protein-digesting enzymes inactivate the enzyme. The stomach’s digestive juices contain no enzymes to break down carbohydrates. Fibers are not digested, but because they linger in the stomach, they delay gastric emptying, thereby creating satiety.

105. Why is glucose homeostasis important? How is the body designed to maintain it? ANSWER: To function optimally, the body must maintain blood glucose within limits that permit the cells to nourish themselves. If blood glucose falls below normal, a person may become dizzy and weak; if it rises above normal, a person may become fatigued. Left untreated, fluctuations to the extremes—either high or low —can be fatal. Blood glucose homeostasis is regulated primarily by two hormones: Insulin, which moves glucose from the blood into the cells, and glucagon, which brings glucose out of storage when necessary. After a meal, as blood glucose rises, special cells of the pancreas respond by secreting insulin into the blood. In general, the amount of insulin secreted corresponds with the rise in glucose. As the circulating insulin contacts the body’s cells, receptors respond by ushering glucose from the blood into the cells. Most of the cells take only the glucose they can use for energy right away, but the liver and muscle cells can assemble the small glucose units into long, branching chains of glycogen for storage. The liver cells also convert extra glucose to fat. Thus, elevated blood glucose returns to normal levels as excess glucose is stored as glycogen and fat. When blood glucose falls (as occurs between meals), other special cells of the pancreas respond by secreting glucagon into the blood. Glucagon raises blood glucose by signaling the liver to break down its glycogen stores and release glucose into the blood for use by all the other body cells. Another hormone that signals the liver cells to release glucose is the “fight-or-flight” hormone, epinephrine. When a person experiences stress, epinephrine acts quickly to ensure that all the body cells have energy fuel in emergencies. Among its many roles in the body, epinephrine works to release glucose from liver glycogen to the blood.

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 106. Your mother was just diagnosed with type 2 diabetes. She wants to improve both her eating habits and her glucose control. After an Internet search, she has decided to try out a new diet that uses the glycemic index in meal planning. She asks you if you think the diet is practical and beneficial. How do you respond? ANSWER: The glycemic response refers to how quickly glucose is absorbed after a person eats, how high blood glucose rises, and how quickly it returns to normal. Slow absorption, a modest rise in blood glucose, and a smooth return to normal are desirable (a low glycemic response). Fast absorption, a surge in blood glucose, and an overreaction that plunges glucose below normal are less desirable (a high glycemic response). The glycemic response may be particularly important to people with diabetes, who may benefit from limiting foods that produce too great a rise, or too sudden a fall, in blood glucose. Different foods elicit different glycemic responses; the glycemic index classifies foods accordingly. Some studies have shown that selecting foods with a low glycemic index is a practical way to improve dietary adequacy and glucose control. Lowering the glycemic index of the diet may improve blood lipids, reduce inflammation, and lower the risk of heart disease as well. A low glycemic diet may also help with appetite regulation and weight management, although research findings are mixed. Researchers debate whether selecting foods based on the glycemic index is practical or offers any real health benefits. Those who oppose the use of the glycemic index argue that it is not sufficiently supported by scientific research. The glycemic index has been determined for relatively few foods, and when the glycemic index has been established, it is based on an average of multiple tests with wide variations in their results. Values vary because of differences in the physical and chemical characteristics of foods, testing methods of laboratories, and digestive processes of individuals. Calculating the glycemic index for meals or diets based on individual foods greatly overestimates the values. Furthermore, the practical utility of the glycemic index is limited because this information is neither provided on food labels nor intuitively apparent. Indeed, a food’s glycemic index is not always what one might expect. Ice cream, for example, is a high-sugar food but produces less of a glycemic response than baked potatoes, a highstarch food. Perhaps most relevant to real life, a food’s glycemic effect differs depending on plant variety, food processing, cooking method, and whether it is eaten alone or with other foods. Most people eat a variety of foods, cooked and raw, that provide different amounts of carbohydrate, fat, and protein—all of which influence the glycemic index of a meal. Paying attention to the glycemic index may be unnecessary because current guidelines already suggest many low and moderate glycemic index choices: Whole grains, legumes, vegetables, fruits, and milk and milk products. In addition, eating frequent, small meals spreads glucose absorption across the day and thus offers similar metabolic advantages to eating foods with a low glycemic response. People wanting to follow a low-glycemic diet should be careful not to adopt a low-carbohydrate diet as well.

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 107. List and briefly discuss ways to reduce the intake of added sugars. ANSWER: Use less table sugar on foods and in beverages. Use your sugar kcalories to sweeten nutrient-dense foods (such as oatmeal) instead of consuming empty kcalorie foods and beverages (such as candy and soda). Drink fewer regular sodas, sports drinks, energy drinks, and fruit drinks; choose water, fat -free milk, 100 percent fruit juice, or unsweetened tea or coffee instead. If you do drink sugar-sweetened beverages, have a small portion. Select fruit for dessert. Eat less cake, cookies, ice cream, other desserts, and candy. If you do eat these foods, have a small portion. Instead of adding sugar, add fresh fruit to cereal and dried fruit to oatmeal. Instead of using sugar in recipes, use unsweetened applesauce (equal amounts). Instead of using sugar, enhance the flavors of foods with spices such as cinnamon, allspice, ginger, or nutmeg and with extracts of almond, vanilla, orange, or lemon. Read the Nutrition Facts on a label to choose foods with less sugar. Compare the unsweetened version of a food (such as cornflakes) with the sweetened version (such as frosted cornflakes) to estimate the quantity of added sugars. The quantity of sugars listed in the Nutrition Facts for foods containing little or no milk or fruit are a good estimate of added sugars per serving. Read the ingredients list to identify foods with little or no added sugars. A food is likely to be high in added sugars if its ingredient list starts with any of the sugars that are typically added or if it contains several of the added sugars.

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 108. How do added sugars contribute to health problems? ANSWER: In general, the energy intake of people who drink soft drinks, fruit punches, and other sugary beverages is greater than those who choose differently. Adolescents, for example, who drink as much as 26 oz or more (about two cans) of sugar-sweetened soft drinks daily, consume 400 more kcalories a day than teens who don’t. Not too surprisingly, they also tend to weigh more. Overweight children and adolescents consume more sweet desserts and soft drinks than their normal-weight peers. Research confirms that consuming sugary beverages correlates with increases in energy intake, body weight, and associated diseases. Some research suggests that added sugars in general, and fructose in particular, favor the fat-making pathways and impair the fat-clearing pathways in the body. The resulting blood lipid profile increases the risk of heart disease. As the liver busily makes lipids, its handling of glucose becomes unbalanced and insulin resistance develops—an indicator of prediabetes. All in all, research is finding links between added sugars and the risk of diabetes, inflammation, hypertension, and heart disease. Importantly, moderate intakes of sugars do not cause these health problems. For this reason, researchers suggest replacing sugar-sweetened beverages with water, and the American Heart Association recommends limiting the intake of added sugars to no more than 100 kcal/day for women and 150 kcal/day for men. Foods such as whole grains, vegetables, legumes, and fruits that contain some natural sugars and lots of starches and fibers provide vitamins and minerals as well. By comparison, foods and beverages that contain lots of added sugars such as cakes, candies, and sodas provide the body with glucose and energy, but few, if any, other essential nutrients or fiber. The more added sugars (and solid fats) in the diet, the more difficult it is to meet recommendations for dietary fiber, vitamins, and minerals and still stay within kcalorie limits. A person spending 200 kcal of a day’s energy allowance on a 16-oz soda gets little of value for those kcalories. In contrast, a person using 200 kcal on three slices of whole-wheat bread gets 9 g of protein and 6 g of fiber plus several of the B vitamins with those kcalories. For the person who wants something sweet, a reasonable compromise might be two slices of bread with a teaspoon of jam on each. The amount of sugar a person can afford to eat depends on how many discretionary kcalories are available beyond those needed to deliver indispensable vitamins and minerals. Both naturally occurring and added sugars from foods and from the breakdown of starches in the mouth can contribute to tooth decay. Bacteria in the mouth ferment the sugars and, in the process, produce an acid that erodes tooth enamel, causing dental caries, or tooth decay. People can eat sugar without this happening, though. Much depends on how long foods stay in the mouth. Sticky foods stay on the teeth longer and continue to yield acid longer than foods that are readily cleared from the mouth. For that reason, sugar in a juice consumed quickly, for example, is less likely to cause dental caries than sugar in a pastry. By the same token, the sugar in sticky foods such as raisins can be more detrimental than the quantity alone would suggest. Another concern is how often people eat sugar. Bacteria produce acid for 20 to 30 minutes after each exposure. If a person eats three pieces of candy at one time, the teeth will be exposed to approximately 30 minutes of acid destruction. But, if the person eats three pieces at half-hour intervals, the time of exposure increases to 90 minutes. Likewise, slowly sipping a sugary sports beverage may be more harmful than drinking quickly and clearing the mouth of sugar. Nonsugary foods can help remove sugar from tooth surfaces; hence, it is better to eat sugar with meals than between meals. Foods such as milk and cheese may be particularly helpful in protecting against dental caries by neutralizing acids, stimulating salivary flow, inhibiting bacterial activity, and promoting remineralization of damaged enamel. Beverages such as soft drinks, orange juice, and sports drinks not only contain sugar but also have a low pH. These acidic drinks can erode tooth enamel and may explain why the prevalence of dental erosion is growing steadily.

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Chapter 04- The Carbohydrates: Sugars, Starches, and Fibers 109. How does dietary fiber help prevent heart disease, type 2 diabetes, and colon cancer? ANSWER: Unlike high-carbohydrate diets rich in added sugars that can alter blood lipids to favor heart disease, those rich in whole grains, legumes, vegetables, and fruits may protect against heart attack and stroke by lowering blood pressure, improving blood lipids, and reducing inflammation. Such diets are low in animal fat and cholesterol and high in dietary fibers, vegetable proteins, and phytochemicals—all factors associated with a lower risk of heart disease. High-fiber foods—especially whole grains—play a key role in managing and preventing type 2 diabetes. When soluble fibers trap nutrients and delay their transit through the GI tract, glucose absorption is slowed, which helps to prevent glucose surge and rebound. Research studies suggest that a high-fiber diet protects against colon cancer. When a large study of diet and cancer examined the diets of more than a half million people in 10 countries for several years, the researchers found an inverse association between dietary fiber and colon cancer. People who ate the most dietary fiber (35 g/day) reduced their risk of colon cancer by 40% as compared with those who ate the least fiber (15 g/day). Importantly, the study focused on dietary fiber, not fiber supplements or additives, which lack valuable nutrients and phytochemicals that also help protect against cancer. Plant foods—vegetables, fruits, and whole-grain products—reduce the risks of colon and rectal cancers. Fibers may help prevent colon cancer by diluting, binding, and rapidly removing potential cancer-causing agents from the colon. In addition, soluble fibers stimulate bacterial fermentation of resistant starch and fiber in the colon, a process that produces short-chain fatty acids that lower the pH. These small fat molecules activate cancer-killing enzymes and inhibit inflammation in the colon.

110. Your brother would like to lose 20 lb. He is debating between a new low-carbohydrate diet or a more established low-fat diet. What advice would you give him? ANSWER: For the most part, weight loss is similar for people following either a low-carbohydrate diet or a low-fat diet. This is an important point. Weight losses reflect restricted kcalories—not the proportion of energy nutrients in the diet. Any diet can produce weight loss, at least temporarily, if energy intake is restricted. And most weight-loss diets also restrict added sugars.

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 1. Which lipid is most abundant in foods and in the body? a. sterols b. glycerols c. triglycerides d. monoglycerides e. polyglycerides ANSWER: c 2. By definition, lipids that are solid at room temperature (77°F [25°C]) are called “ a. oils

.”

b. fats c. omegas d. glycerols e. phospholipids ANSWER: b 3. Which statement about fatty acids is FALSE? a. They consist of a chain of carbon and hydrogen atoms with an acid group on one end and a methyl group at

the other end. b. Fatty acids differ in the number and location of their double bonds. c. Naturally occurring fatty acids contain even numbers of carbons in their chains. d. The short-chain fatty acids of meats and seafood are most common in the diet. e. Fatty acids are organic compounds. ANSWER: d 4. Which item is a chief food source of long-chain fatty acids? a. fish b. artichokes c. dairy d. rye e. fruit ANSWER: a

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 5. Oleic acid is a monounsaturated fatty acid. Linoleic acid is a polyunsaturated fatty acid. They differ in their number

. a. amino acids b. double bonds c. saccharide units d. peptide linkages e. oxygen atoms ANSWER: b 6. What is the simplest of the 18-carbon fatty acids? a. oleic acid b. stearic acid c. linolenic acid d. arachidonic acid e. linoleic acid ANSWER: b 7. Which fatty acid is missing two hydrogen atoms and has one double bond between carbons? a. monounsaturated fatty acid b. polyunsaturated fatty acid c. long-chain saturated fatty acid d. short-chain saturated fatty acid e. triglycerides ANSWER: a 8. What is the characteristic property of an omega 3-fatty acid? a. It contains three double bonds. b. Its closest double bond is three carbons away from the acid end. c. Its closest double bond is three carbons away from the methyl end. d. Its closest double bond is three carbons away from each end. e. Its structure bends three times. ANSWER: c

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 9. Which of the following is a factor that determines the hardness of a fat at a given temperature? a. origin of the fat b. degree of saturation c. number of acid groups d. number of oxygen atoms e. number of sulfur atoms. ANSWER: b 10. Which product has the highest amount of saturated fatty acids? a. butter b. lard c. beef tallow d. coconut oil e. chicken fat ANSWER: d 11. Which of these oils provides the most omega-3 fatty acid? a. palm oil b. walnut oil c. soybean oil d. flaxseed oil e. corn oil ANSWER: d 12. Which of the following structural features of fatty acids determines their susceptibility to spoilage by oxygen and

therefore stability? a. chain length b. number of double bonds c. position of first saturated bond d. size of adjacent fatty acids on the triglyceride molecule e. temperature of the fatty acid ANSWER: b

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 13. Which of the following is the definition of the term conjugated linoleic acid? a. a type of cis-fatty acid b. a triglyceride with a phosphate group c. a fatty acid with the chemical makeup of linoleic acid but with a different configuration d. a food additive that preserves or delays rancidity of fats in foods e. a nitrogen-containing compound found in foods and made in the body from the amino acid methionine ANSWER: c 14. Which statement about trans-fatty acids is FALSE? a. In nature, most double bonds are cis. Few are trans. b. Hydrogenation converts cis-fatty acids to trans-fatty acids. c. The conversion of cis-fatty acids to trans-fatty acids is inhibited by the presence of antioxidants. d. In the body, trans-fatty acids are metabolized more like saturated fats than unsaturated fats. e. The hydrogen atoms are located on opposite sides of the double bond. ANSWER: c 15. Which of the following is a characteristic of phospholipids? a. resistant to digestion b. soluble in both water and fat c. highly susceptible to oxidation d. found naturally only in animal foods e. found in omega 3- fats. ANSWER: b 16. Which statement accurately describes lecithin? a. It is the best-known sterol. b. It is similar to triglycerides, but contains four fatty acids. c. Each attachment site is occupied by a phosphate group and a molecule of choline. d. It is soluble in fat, but not in water. e. It is used as an emulsifier by the food industry. ANSWER: e

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 17. Which food source is rich in lecithin? a. eggs b. salmon c. hard cheeses d. milk e. legumes ANSWER: a 18. Which of the following is NOT a sterol? a. estrogen b. cortisol c. cholesterol d. vitamin D e. bile ANSWER: e 19. Which of the following foods contain cholesterol? a. peas b. pasta c. baked chicken d. wheat germ e. boiled potatoes ANSWER: c 20. Cholesterol made within the body is referred to as “ a. exogenous

.”

b. atherosclerosis c. endogenous d. hydrophobic e. hydrophilic ANSWER: c

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 21. Which of the following is a fat-digesting enzyme secreted in the mouth? a. hydrophobic lipase b. gastric lipase c. lingual lipase d. proteases lipase e. ductal lipase ANSWER: c 22. Which statement about lipid digestion is FALSE? a. Gastric lipase is responsible for only a small amount of fat digestion. b. When fat enters the small intestine, it triggers the release of CCK and bile. c. Lingual lipase plays an active role in fat digestion in infants. d. Lipid digestion begins in the mouth with the help of dextrin e. Pancreatic lipase removes each of a triglyceride’s fatty acids, leaving a monoglyceride. ANSWER: d 23. The emulsification of fat by bile is often compared to a. the evaporation of alcohol when cooking

b. a detergent removing grease spots from clothes c. driving a car on the highway d. a dog wagging its tail e. flossing one’s teeth ANSWER: b 24. In which part of the GI tract does most fat digestion occur? a. mouth b. stomach c. small intestine d. large intestine e. esophagus ANSWER: c

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 25. What are chylomicrons? a. clusters of lipids and proteins used as transport vehicles from the intestines to the body b. tiny spheres of emulsified fat c. alcohols with three-carbon chains d. food additives e. nitrogen compounds found in foods and made in the body ANSWER: b 26. Which is NOT part of the enterohepatic circulation of bile? a. Bile is made from cholesterol in the liver. b. Bile is stored in the pancreas. c. Bile emulsifies fats in the small intestine. d. Bile is reabsorbed in to the blood. e. Bile that has been trapped in soluble fibers in the colon is excreted. ANSWER: b 27. Which term describes the spherical complexes of emulsified fats that arise during digestion? a. micelles b. chylomicrons c. lipoproteins d. eicosanoids e. adiponectin ANSWER: a 28. Which is NOT a group of lipoproteins? a. chylomicrons b. VLDL c. LDL d. HDL e. VHDL ANSWER: e

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 29. Which are the largest and least-dense of the lipoproteins? a. chylomicrons b. VLDL c. LDL d. HDL e. VHDL ANSWER: a 30. Which of the lipoproteins primarily transports triglycerides from the liver to other tissues? a. chylomicrons b. VLDL c. LDL d. HDL e. VHDL ANSWER: b 31. In comparison to a low-density lipoprotein, a high-density lipoprotein contains a. more chylomicrons

b. more protein c. more cholesterol d. more carbohydrate e. more triglyceride ANSWER: b 32. Which lipoprotein primarily transports cholesterol in the blood? a. chylomicron b. low-density lipoprotein c. high-density lipoprotein d. very-low-density lipoprotein e. very-high-density lipoprotein ANSWER: b

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 33. Renata eats a meal containing some fats. Within

hours after absorption, her body has removed the

chylomicrons from her blood. a. 2 b. 5 c. 14 d. 18 e. 24 ANSWER: c 34. Which of the following is representative of enterohepatic circulation? a. chylomicron conversion to LDLs and HDLs b. recycling of bile from the intestine to the liver c. hormonal control of digestive secretions d. liver secretion of eicosanoids that promote absorption of eicosanoid precursors e. hormonal control of pancreatic secretions. ANSWER: b 35. A high risk of heart disease correlates with high blood levels of a. free fatty acids. b. high-density lipoproteins. c. low-density lipoproteins. d. very high-density lipoproteins. e. high levels of omega- 3 fatty acids. ANSWER: c 36. Which of the following is NOT a function of adipose tissue? a. to store fat b. to protect vital organs from shock c. to secrete proteins that help regulate energy balance d. to regulate blood glucose levels e. to insulate the body from temperature extremes ANSWER: d

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 37. Which adipokine promotes inflammation and causes insulin resistance? a. leptin b. adiponectin c. resistin d. retinol e. chemerin ANSWER: c 38. Which of the following is an essential fatty acid? a. lecithin b. cholesterol c. stearic acid d. linolenic acid e. adiponectin ANSWER: d 39. Which of these is a member of the omega-3 family? a. stearic acid b. palmitic acid c. linoleic acid d. eicosapentaenoic acid e. arachidonic acid ANSWER: d 40. Which statement accurately describes a feature of essential fatty acids? a. Aspirin works to reduce the symptoms of infection or pain by retarding the synthesis of certain eicosanoids. b. Eicosanoids from the omega-6 family of fatty acids provide a greater health benefit than do those from the

omega-3 family. c. Research shows that reducing the number of dietary omega-3 fatty acids may be beneficial. d. Most diets in the United States meet the minimum fatty acid requirement. e. Omega-3 eicosanoids promote clot formation, inflammation, and blood vessel constriction. ANSWER: a

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 41. Fat supplies about

of the body’s ongoing energy needs during rest.

a. 10% b. 20% c. 40% d. 60% e. 80% ANSWER: d 42. When the body is deprived of food, which enzyme hydrolyzes triglycerides so that their parts enter general

circulation and are available to other cells? a. lipoprotein lipase b. adipose lipase c. lingual lipase d. hormone-sensitive lipase e. pancreatic lipase ANSWER: d 43. What is the highest blood triglyceride concentration (mg/dL) that falls within the desirable range? a. 99 b. 149 c. 199 d. 299 e. 350 ANSWER: b 44. What is the main cause of cardiovascular disease? a. endocarditis b. aneurysm c. arrhythmias d. atherosclerosis e. cardiomyopathy ANSWER: d

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 45. Which statement about the health effects of lipids is FALSE? a. Heart disease is the number one killer of adults in the United States. b. Smoking and alcohol consumption are stronger risk factors for cancer than is dietary fat. c. There is no clear relationship between dietary cholesterol and heart disease. d. Fat from milk or fish has not been implicated in cancer risk. e. Choosing fat-free foods is an effective strategy in cutting kcalories. ANSWER: e 46. The DRI suggests a diet that provides a. less than 10%

of the daily energy intake from fat.

b. 10% to 20% c. 20% to 35% d. 40% to 50% e. 50% to 60% ANSWER: c 47. According to surveys, the average daily cholesterol intake (mg/day) of U.S. women is about a. 110 b. 221 c. 360 d. 925 e. 315 ANSWER: b 48. Surveys show that most diets in the United States provide about a. 25%

of their total energy from fat.

b. 33% c. 45% d. 55% e. 75% ANSWER: b

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 49. Cholesterol intakes in the United States average

milligrams for men.

a. 112 b. 175 c. 221 d. 315 e. 355 ANSWER: d 50. Which of the following is a potentially healthful source of monounsaturated fats? a. olives b. coconut c. pumpkin seeds d. flaxseed e. eggs ANSWER: a 51. Which of the following is a potentially harmful source of lipids? a. walnuts b. yeast c. nondairy coffee creamer d. olive oil-based vinaigrette e. natural peanut butter ANSWER: c 52. Regular consumption of a. cholesterol

may help prevent blood clots.

b. saturated fats c. monounsaturated fats d. omega-3 fatty acids e. omega-6 fatty acids ANSWER: d

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 53. Which is NOT a potential side effect of high intakes of omega-3 polyunsaturated fatty acids? a. increased bleeding time b. rapid heartbeat c. interference in wound healing d. higher LDL cholesterol e. suppressed immune functions ANSWER: b 54. According to the DRI, what percentage of the daily energy intake should be provided by linoleic acid? a. 0.6 to 1.2 b. 2 to 4.7 c. 5 to 10 d. 15.5 to 18 e. 20 to 35 ANSWER: c 55. A person who regularly consumes fish such as shark, king mackerel, and swordfish is at risk for ingesting

potentially toxic amounts of a. EPA

b. DHA c. mercury d. cadmium e. dioxins ANSWER: c 56. Which of these protein foods is the leanest? a. eggs b. tofu c. flounder d. peanut butter e. pork tenderloin ANSWER: c

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 57. Which of these foods has the highest amount of omega-3 fatty acids per 3.5-oz serving? a. chilean sea bass b. farmed catfish c. monkfish d. grouper e. shrimp ANSWER: a 58. Sucrose polyester is another name for a. BHA

b. DHA c. olestra d. I fat e. omega-3 fats ANSWER: c 59. Which statement about fat replacers is FALSE? a. Olestra is a synthetic fat made from sucrose. b. Olestra is fortified with vitamins A, D, E, and K c. Carbohydrate-based fat replacers are used as thickeners in soups. d. Fat-based fat replacers are heat-stable and used in cake mixes. e. Olestra is an artificial fat that delivers a small amount of energy. ANSWER: e 60. The % Daily Value for fat on food labels is based on a. 24

grams.

b. 46 c. 63 d. 78 e. 92 ANSWER: d

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 61. Which of the following is a source of trans-fats, a potentially harmful lipid? a. mayonnaise b. bacon c. refrigerated biscuits d. milk e. peanut oil ANSWER: c 62. The Seven Countries Study found that Mediterranean countries have low rates of heart disease because they

consume more a. butter b. coconut oil c. olive oil d. chicken e. eggs

in their diet.

ANSWER: c 63. An ounce of mixed nuts provides about a. 25

kcalories.

b. 50 c. 100 d. 200 e. 300 ANSWER: d 64. Which of the following is NOT a benefit of eating almonds or walnuts? a. lower mortality b. lower blood cholesterol and blood pressure c. limiting oxidative stress d. providing satiety e. decreasing blood-clotting factors ANSWER: e

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 65. Pregnant women and young children should avoid consuming tilefish, swordfish, king mackerel, marlin, or shark

because they are sources of a. cadmium b. mercury c. chromium d. DEET e. PCBs

, an environmental contaminant.

ANSWER: b 66. Reducing saturated fat intake by 1% can be expected to produce a a. 1%

drop in heart disease risk.

b. 2% c. 3% d. 4% e. 5% ANSWER: b 67. About how much of the fat in cheese and sour cream is saturated? a. 1/4 b. 1/3 c. 1/2 d. 2/3 e. 7/8 ANSWER: c 68. According to the Mediterranean Diet Pyramid, how often should one eat fish and seafood? a. once a week b. at least twice a week c. only once a month d. no more than a few times a month e. never ANSWER: b

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 69. According to the Mediterranean Diet Pyramid, how often should one eat meat? a. once a week b. at least twice a week c. only once a month d. no more than a few times a month e. never ANSWER: d 70. Which of the following foods share the same space with meats on the Mediterranean Diet Pyramid? a. sweets b. cheese c. poultry d. legumes e. olive oil ANSWER: a 71. Which of the following statements accurately defines the U.S. intake of saturated fats? a. Zero saturated fat diets are possible with expert help. b. More than half of the fat in most meats is saturated. c. Tropical oils are frequently used by consumers. d. Tropical oils are commonly found in commercially prepared foods. e. Vegan diets and mixed diets have about the same amount of saturated fats. ANSWER: d 72. The double bond of a fatty acid, where hydrogen atoms can easily be added to the structure, is called the “ ______ _.” ANSWER: point of saturation 73. An alcohol composed of a three-carbon chain, which can serve as the backbone for a triglyceride, is called “ ______ _.” ANSWER: glycerol 74. The term that refers to a chemical configuration in which the hydrogen atoms are located on the same side of a double bond is . ANSWER: cis 75.

is a term referring to water-loving, or water-soluble, substances. ANSWER: Hydrophilic

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 76. Cholesterol from outside the body is called

cholesterol.

ANSWER: exogenous 77. A molecule of glycerol with two fatty acids attached is called a “

.”

ANSWER: diglyceride 78. Lipoproteins that derive from VLDL and transport lipids, primarily cholesterol, in the blood are called “

.”

ANSWER: low-density lipoproteins (LDLs) 79. Proteins synthesized and secreted by adipose cells are called “

.”

ANSWER: adipokines 80. A protein produced by adipose cells that inhibits inflammation and protects against insulin resistance is called “ ______ _.” ANSWER: adiponectin 81. The term that refers to the results of blood tests that reveal a person’s total cholesterol, triglycerides, and various lipoproteins is . ANSWER: blood lipid profile

a. Liver b. Trout c. Micelle d. Eicosanoids e. Choline f. Mayonnaise g. Olive oil h. Yeast i. Small intestine j. Canola oil k. Linoleic acid l. Stearic acid m. Cholesterol n. Doughnuts o. Point of saturation p. Chylomicron q. Linolenic acid r. Gastric lipase s. High-density lipoprotein t. Very low-density lipoprotein Page 19

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 82. An 18-carbon polyunsaturated fatty acid with two double bonds ANSWER: k 83. The double bond of a fatty acid, where hydrogen atoms can be added ANSWER: o 84. An 18-carbon saturated fatty acid ANSWER: l 85. A common source of oleic acid ANSWER: j 86. Part of the phospholipid lecithin ANSWER: e 87. The most well-known sterol ANSWER: m 88. Makes bile from cholesterol ANSWER: a 89. Fat-digesting enzymes secreted from the stomach ANSWER: r 90. Responsible for most of the hydrolysis of triglycerides ANSWER: i 91. Spherical complexes of emulsified fat ANSWER: c 92. Largest and least dense lipoprotein ANSWER: p 93. The lipoprotein that primarily transports triglycerides from liver to other tissues ANSWER: t 94. The lipoprotein that is half protein ANSWER: s 95. Derivatives of 20-carbon fatty acids ANSWER: d 96. An essential fatty acid with three double bonds ANSWER: q 97. Common source of trans-fatty acids ANSWER: n Page 20

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 98. Good food source of omega-3 fatty acids ANSWER: h 99. Good food source of omega-6 fatty acids ANSWER: f 100. Lean source of dietary protein ANSWER: b 101. Oil typically part of the Mediterranean diet ANSWER: g 102. Briefly describe the chemistry of fatty acids, including the number and location of double bonds. ANSWER: Like carbohydrates and proteins, lipids are composed of carbon (C), hydrogen (H), and oxygen (O). Because lipids have many more carbons and hydrogens in proportion to their oxygens, they can supply more energy per gram than carbohydrates can. All fatty acids have the same basic structure—a chain of carbon and hydrogen atoms with an acid group (COOH) at one end and a methyl group (CH3) at the other end. Fatty acids may differ from one another, however, in the length of their carbon chains and in the number and location of their double bonds. Most naturally occurring fatty acids contain even numbers of carbons in their chains—up to 24 carbons in length. The 18-carbon fatty acids are abundant in our food supply. Stearic acid is the simplest of the 18-carbon fatty acids; the bonds between its carbons are all alike. The long-chain (more than 12 carbons) fatty acids of meats, seafood, and vegetable oils are most common in the diet. Smaller amounts of medium-chain (8 to 12 carbons) and short-chain (up to 6 carbons) fatty acids also occur, primarily in dairy products. Stearic acid is a saturated fatty acid, which is fully loaded with all its hydrogen atoms and contains only single bonds between its carbon atoms. A fatty acid with hydrogens missing and at least one double bond is an unsaturated fatty acid. A polyunsaturated fatty acid has two or more carbon-to-carbon double bonds. Linoleic acid, the 18-carbon fatty acid common in vegetable oils, lacks four hydrogens and has two double bonds. A fourth 18-carbon fatty acid is linolenic acid, which has three double bonds. Fatty acids differ not only in the length of their chains and their degree of saturation, but also in the locations of their double bonds. Chemists identify polyunsaturated fatty acids by the position of the double bond closest to the methyl (CH3) end of the carbon chain, which is described by an omega number. A polyunsaturated fatty acid with its closest double bond three carbons away from the methyl end is an omega-3 fatty acid. Similarly, an omega-6 fatty acid is a polyunsaturated fatty acid with its closest double bond six carbons away from the methyl end.

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 103. What are trans-fatty acids? How do they affect one’s health? ANSWER: In nature, most double bonds are cis—meaning that the hydrogens next to the double bonds are on the same side of the carbon chain. Only a few fatty acids (notably a small percentage of those found in milk and meat products) naturally occur as trans-fatty acids—meaning that the hydrogens next to the double bonds are on opposite sides of the carbon chain. In the body, trans-fatty acids behave more like saturated fats, increasing blood cholesterol and the risk of heart disease. Some research suggests that both naturally occurring and commercially created trans fats change blood lipids similarly; other research suggests that the negative effects are specific to only the commercial trans fats. In any case, the important distinction is that a relatively small amount of trans fat in the diet comes from natural sources. At current levels of consumption, natural trans fats have little, if any, effect on blood lipids. Some naturally occurring trans-fatty acids, known as conjugated linoleic acids, may even have health benefits. Conjugated linoleic acids are not counted as trans fats on food labels. In the body, trans fats alter blood cholesterol the same way some saturated fats do: They raise LDL cholesterol and lower HDL cholesterol. Limiting the intake of trans fats can improve blood cholesterol and lower the risk of heart disease. To that end, many restaurants and manufacturers have taken steps to eliminate or greatly reduce trans fats in foods. The decrease in trans-fatty acids in the food supply is apparent in a decrease in plasma concentrations of trans-fatty acids in consumers.

104. Discuss the roles and food sources of sterols. ANSWER: Sterols are compounds containing a four-ring carbon structure with any of a variety of side chains attached. Foods derived from both plants and animals contain sterols, but only those from animals contain significant amounts of cholesterol—meats, eggs, seafood, poultry, and dairy products. Some people, confused about the distinction between dietary cholesterol and blood cholesterol, have asked which foods contain the “good” cholesterol. “Good” cholesterol is not a type of cholesterol found in foods, but it refers to the way the body transports cholesterol in the blood. Sterols other than cholesterol are naturally found in plants. Being structurally similar to cholesterol, plant sterols interfere with cholesterol absorption. By inhibiting cholesterol absorption, a diet rich in plant sterols lowers blood cholesterol levels. Food manufacturers have fortified foods such as margarine with plant sterols, creating a functional food that helps to reduce blood cholesterol. Many vitally important body compounds are sterols. Among them are bile acids, the sex hormones (such as testosterone, androgen, and estrogen), the adrenal hormones (such as cortisol, cortisone, and aldosterone), and vitamin D, as well as cholesterol itself. Cholesterol in the body can serve as the starting material for the synthesis of these compounds or as a structural component of cell membranes; more than 90% of all the body’s cholesterol is found in the cells. Despite common misconceptions, cholesterol is not a villain lurking in some evil foods—it is a compound the body makes and uses. The chemical structure is the same, but cholesterol that is made in the body is referred to as endogenous, whereas cholesterol from outside the body (from foods) is referred to as exogenous. Right now, as you read, your liver is manufacturing cholesterol from fragments of carbohydrate, protein, and fat. In fact, the liver makes about 800 to 1500 mg of cholesterol per day, thus contributing much more to the body’s total than does the diet. For perspective, the Daily Value on food labels for cholesterol is 300 mg per day. Cholesterol’s harmful effects in the body occur when it accumulates in the artery walls and contributes to the formation of plaque. These plaque deposits lead to atherosclerosis, a disease that causes heart attacks and strokes.

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 105. Briefly describe how dietary lipids are digested and absorbed. ANSWER: Fat digestion starts off slowly in the mouth, with some hard fats beginning to melt when they reach body temperature. A salivary gland at the base of the tongue releases an enzyme (lingual lipase) that plays an active role in fat digestion in infants, but a relatively minor role in adults. In infants, this enzyme efficiently digests the short- and medium-chain fatty acids found in milk. In a quiet stomach, fat would float as a layer above the watery components of swallowed food. But whenever food is present, the stomach becomes active. The strong muscle contractions of the stomach propel its contents toward the pyloric sphincter. Some chyme passes through the pyloric sphincter periodically, but the remaining partially digested food is propelled back into the body of the stomach. This churning grinds the solid pieces to finer particles, mixes the chyme, and disperses the fat into small droplets. These actions help to expose the fat for attack by the gastric lipase enzyme—an enzyme that performs best in the acidic environment of the stomach. Still, little fat digestion takes place in the stomach; most of the action occurs in the small intestine. When fat enters the small intestine, it triggers the release of the hormone cholecystokinin (CCK), which signals the gallbladder to release its stores of bile. (Remember that the liver makes bile, and the gallbladder stores bile until it is needed.) Among bile’s many ingredients are bile acids, which are made in the liver from cholesterol and have a similar structure. In addition, bile acids often pair up with an amino acid (a building block of protein). The amino acid end is hydrophilic, and the sterol end is hydrophobic. This structure enables bile to act as an emulsifier, drawing fat molecules into the surrounding watery fluids. There, the fats are fully digested as they encounter lipase enzymes from the pancreas and small intestine. Most of the hydrolysis of triglycerides occurs in the small intestine. The major fat-digesting enzymes are pancreatic lipases; some intestinal lipases are also active. These enzymes remove each of a triglyceride’s outer fatty acids one at a time, leaving a monoglyceride. Occasionally, enzymes remove all three fatty acids, leaving a free molecule of glycerol. Phospholipids are digested similarly—that is, their fatty acids are removed by hydrolysis. The two fatty acids and the remaining glycerol and phosphate fragments are then absorbed. Most sterols can be absorbed as is; if any fatty acids are attached, they are first hydrolyzed off. Most of the bile is reabsorbed from the small intestine and recycled. The other possibility is that some of the bile can be trapped by dietary fibers in the large intestine and excreted. Because cholesterol is needed to make bile, the excretion of bile effectively reduces blood cholesterol. The dietary fibers most effective at lowering blood cholesterol this way are the soluble fibers commonly found in fruits, whole grains, and legumes. Small molecules (glycerol and short- and medium-chain fatty acids) can diffuse easily into the intestinal cells; they are absorbed directly into the bloodstream. Larger molecules (monoglycerides and long-chain fatty acids) are emulsified by bile, forming spherical complexes known as micelles. The micelles diffuse into the intestinal cells, where the monoglycerides and long-chain fatty acids are reassembled into new triglycerides. Within the intestinal cells, the newly made triglycerides and other lipids (cholesterol and phospholipids) are packed with protein into transport vehicles known as chylomicrons. The intestinal cells then release the chylomicrons into the lymphatic system. The chylomicrons glide through the lymph until they reach a point of entry into the bloodstream at the thoracic duct near the heart. The blood carries these lipids to the rest of the body for immediate use or storage. A look at these lipids in the body reveals the kinds of fat the diet has been delivering. The blood, fat stores, and muscle cells of people who eat a diet rich in unsaturated fats, for example, contain more unsaturated fats than those of people who select a diet high in saturated fats.

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 106. How are dietary lipids transported? ANSWER: The chylomicrons are one of several clusters of lipids and proteins that are used as transport vehicles for fats. As a group, these vehicles are known as lipoproteins, and they solve the body’s challenge of transporting fat through the watery bloodstream. The body makes four main types of lipoproteins, distinguished by their size and density. Each type contains different kinds and amounts of lipids and proteins. The more lipids, the less dense; the more proteins, the more dense. The chylomicrons are the largest and least dense of the lipoproteins. They transport diet-derived lipids (mostly triglycerides) from the small intestine (via the lymph system) to the rest of the body. Cells all over the body remove triglycerides from the chylomicrons as they pass by, so the chylomicrons get smaller and smaller. Within 14 hours after absorption, most of the triglycerides have been depleted, and only a few remnants of protein, cholesterol, and phospholipid remain. Special protein receptors on the membranes of the liver cells recognize and remove these chylomicron remnants from the blood. Meanwhile, in the liver—the most active site of lipid synthesis—cells are making cholesterol, fatty acids, and other lipid compounds. Ultimately, the lipids made in the liver and those collected from chylomicron remnants are packaged with proteins as a VLDL (very-low-density lipoprotein) and shipped to other parts of the body. As the VLDLs travel through the body, cells remove triglycerides. As they lose triglycerides, the VLDLs shrink and the proportion of lipids shifts. Cholesterol becomes the predominant lipid, and the lipoprotein becomes smaller and denser. As this occurs, the VLDL becomes an LDL (low-density lipoprotein), loaded with cholesterol, but containing relatively few triglycerides. The LDLs circulate throughout the body, making their contents available to the cells of all tissues—muscles (including the heart muscle), fat stores, the mammary glands, and others. The cells take triglycerides, cholesterol, and phospholipids to use for energy, make hormones or other compounds, or build new membranes. Special LDL receptors on the liver cells play a crucial role in the control of blood cholesterol concentrations by removing LDL from circulation. The liver makes HDL (high-density lipoprotein) to remove cholesterol from the cells and carry it back to the liver for recycling or disposal. By efficiently clearing cholesterol, HDL lowers the risk of heart disease. In addition, HDLs have antiinflammatory properties that seem to keep artery-clogging plaque from breaking apart and causing heart attacks.

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 107. What is adipose tissue? How can it benefit the body? ANSWER: First and foremost, triglycerides—either from food or from the body’s fat stores—provide the cells with energy. When a person dances all night, her dinner’s triglycerides provide some of the fuel that keeps her moving. When a person loses his appetite, his stored triglycerides fuel much of his body’s work until he can eat again. Recall that gram for gram, fat provides more than twice as much energy (9 kcal) as carbohydrate or protein (4 kcal), making it an extremely efficient storage form of energy. Unlike the liver’s glycogen stores, the body’s fat stores have virtually unlimited capacity, thanks to the special cells of the adipose tissue. The fat cells of the adipose tissue readily take up and store triglycerides. Other body cells store only small amounts of fat for their immediate use; fat accumulation in nonadipose cells is toxic and impairs health. This scenario occurs when the diet delivers excesses and the liver increases its fat production. Fatty liver linked to obesity causes chronic inflammation, which can advance to fibrosis, cirrhosis, and cancer. Adipose tissue is more than just a storage depot for fat. Adipose tissue actively secretes several hormones known as adipokines—proteins that help regulate energy balance and influence several body functions. When body fat is markedly reduced or excessive, the type and quantity of adipokine secretions change, with consequences for the body’s health. Researchers are currently exploring how adipokines influence the links between obesity and chronic diseases such as type 2 diabetes, hypertension, and heart disease. Obesity, for example, increases the release of the adipokine resistin, which promotes inflammation and insulin resistance— factors associated with heart disease and diabetes. Similarly, obesity decreases the release of the adipokine adiponectin, which protects against inflammation, diabetes, and heart disease. Fat serves other roles in the body as well. Because fat is a poor conductor of heat, the layer of fat beneath the skin insulates the body from temperature extremes. Fat pads also serve as natural shock absorbers, providing a cushion for the bones and vital organs. Fat provides the structural material for cell membranes and participates in cell-signaling pathways.

108. Explain the relationships among dietary fats, cancer, and obesity. ANSWER: The links between dietary fats and cancer are not as evident as they are for heart disease. Dietary fat does not seem to initiate cancer development, but instead it may promote cancer once it has arisen. Stronger risk factors for cancer include smoking, alcohol, and environmental contaminants. The relationship between dietary fat and the risk of cancer differs for various types of cancers. In the case of breast cancer, evidence has been weak and inconclusive. Some studies indicate an association between dietary fat and breast cancer; more convincing evidence indicates that body fatness contributes to the risk. In the case of colon cancer, limited evidence suggests a harmful association with foods containing animal fats. The relationship between dietary fat and the risk of cancer differs for various types and combinations of fats as well. The increased risk of cancer from fat appears to be due primarily to saturated fats or dietary fat from meats (which is mostly saturated). Fat from milk or fish has not been implicated in cancer risk. Olive oil seems to have a protective effect. As for obesity, fat contributes more than twice as many kcalories per gram as either carbohydrate or protein. Consequently, people who eat high-fat diets regularly may exceed their energy needs and gain weight, especially if they are inactive. Because fat boosts energy intake, cutting fat from the diet can be an effective strategy in cutting kcalories. In some cases, though, choosing a fat-free food offers no kcalorie savings. Fat-free frozen desserts, for example, often have so much sugar added that the kcalorie count can be as high as in the regular-fat product. In this case, cutting fat and adding carbohydrate offers no kcalorie savings or weight-loss advantage. In fact, it may even raise energy intake and exacerbate weight problems. Page 25

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 109. What are the health benefits of monounsaturated and polyunsaturated fats? ANSWER: Whereas saturated fats and trans fats are implicated in chronic diseases, monounsaturated and polyunsaturated fats seem to offer health benefits. For this reason, dietary recommendations suggest replacing sources of saturated fats and trans fats with foods rich in monounsaturated and polyunsaturated fats—foods such as seafood, nuts, seeds, and vegetable oils. Replacing saturated fats with unsaturated fats reduces LDL cholesterol and lowers the risk of heart disease and related deaths. To replace saturated fats with unsaturated fats, sauté foods in olive oil instead of butter, garnish salads with sunflower seeds instead of bacon, snack on mixed nuts instead of potato chips, use avocado instead of cheese on a sandwich, and eat salmon instead of steak. Research on the different types of fats has spotlighted the many beneficial effects of the omega-3 polyunsaturated fatty acids. Regular consumption of omega-3 fatty acids may help prevent blood clots, protect against irregular heartbeats, improve blood lipids, and lower blood pressure, especially in people with hypertension or atherosclerosis. In addition, omega-3 fatty acids lower the incidence of heart disease-related deaths, support a healthy immune system, and suppress inflammation. The omega-3 fatty acids of fatty fish may protect against some cancers as well, perhaps by suppressing inflammation. Even when omega-3 fats do not protect against cancer development, there seems to be a significant reduction in cancer-related deaths. Thus, dietary advice to reduce cancer risks parallels that given to reduce heart disease risks: Reduce saturated fats and increase omega-3 fatty acids. Evidence does not support omega-3 supplementation. Limited research suggests that the omega-3 fatty acids of fish may protect against asthma, pancreatitis, and rheumatoid arthritis. Omega-3 fats also appear to play a role in improving memory and cognition.

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 110. What are fat replacers? Are they safe? ANSWER: Some foods are made with fat replacers—ingredients that provide some of the taste and texture of fats, but with fewer kcalories. Because the body may digest and absorb some of these fat replacers, they may contribute energy, although significantly less energy than fat’s 6 kcal/g. Some fat replacers are derived from carbohydrate, protein, or fat. Carbohydrate-based fat replacers are used primarily as thickeners or stabilizers in foods such as soups and salad dressings. Protein-based fat replacers provide a creamy feeling in the mouth and are often used in foods such as ice creams and yogurts. Fat-based replacers act as emulsifiers and are heat-stable, making them most versatile in shortenings used in cake mixes and cookies. Fat replacers offering the sensory and cooking qualities of fats but none of the kcalories are called “artificial fats.” A familiar example of an artificial fat that has been approved for use in snack foods such as potato chips, crackers, and tortilla chips is olestra. Olestra’s chemical structure is similar to that of a triglyceride but with important differences. A triglyceride is composed of a glycerol molecule with three fatty acids attached, whereas olestra is made of a sucrose molecule with six to eight fatty acids attached. Enzymes in the digestive tract cannot break the bonds of olestra, so unlike sucrose or fatty acids, olestra passes through the digestive system unabsorbed. The FDA’s evaluation of olestra’s safety addressed two questions. First, is olestra toxic? Research on both animals and human beings supports the safety of olestra as a partial replacement for dietary fats and oils, with no reports of cancer or birth defects. Second, does olestra affect either nutrient absorption or the health of the digestive tract? When olestra passes through the digestive tract unabsorbed, it binds with some of the fat-soluble vitamins —A, D, E, and K—and carries them out of the body, robbing the person of these valuable nutrients. To compensate for these losses, the FDA requires manufacturers to fortify olestra with vitamins A, D, E, and K. Saturating olestra with these vitamins does not make the product a good source of vitamins, but it does block olestra’s ability to bind with the vitamins from other foods. An asterisk in the ingredients list informs consumers that these added vitamins are “dietarily insignificant.” Consumers need to keep in mind that low-fat and fat-free foods still deliver kcalories. Alternatives to fat can help lower energy intake and support weight loss only when they actually replace fat and energy in the diet.

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Chapter 05- The Lipids: Triglycerides, Phospholipids, and Sterols 111. What are the basic features of the Mediterranean diet? What health benefits might it provide? ANSWER: The links between good health and traditional Mediterranean eating patterns of the mid-1900s were introduced earlier with regard to olive oil. For people who eat these diets, the incidence of heart disease, some cancers, diabetes, and other chronic inflammatory diseases is low, and life expectancy is high. Some research suggests that the health benefits of the Mediterranean eating pattern are partially due to its favorable effects on body weight. Although each of the many countries that border the Mediterranean Sea has its own culture, traditions, and dietary habits, their similarities are much greater than the use of olive oil alone. In fact, no one factor alone can be credited with reducing disease risks—the association holds true only when the overall eating pattern is present. Apparently, each of the foods contributes small benefits that harmonize to produce either a substantial cumulative or synergistic effect. The Mediterranean eating pattern features fresh, whole foods. The people select crusty breads, whole grains, potatoes, and pastas; a variety of vegetables (including wild greens) and legumes; feta and mozzarella cheeses and yogurt; nuts, and fruits (especially grapes and figs). They eat some fish, other seafood, poultry, a few eggs, and little meat. Along with olives and olive oil, their principal sources of fat are nuts and fish; they rarely use butter or encounter hydrogenated fats. They commonly use herbs and spices instead of salt. Consequently, traditional Mediterranean diets are low in saturated fat and very low in trans fat. Furthermore, they are rich in monounsaturated and polyunsaturated fat, complex carbohydrate and fiber, and nutrients and phytochemicals that support good health. As a result, lipid profiles improve, blood pressure lowers, plaque stabilizes, inflammation diminishes, and the risk of heart disease declines.

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Chapter 06- Protein: Amino Acids 1. Which of the following is the primary factor that differentiates one amino acid from another? a. the side group b. the central carbon atom c. the amino group d. the acid group e. the presence of a central hydrogen atom ANSWER: a 2. Amino means containing a. oxygen

b. sulfur c. carbon d. hydrogen e. nitrogen ANSWER: e 3. Of all the amino acids, how many must be supplied by the diet? a. 2 b. 5 c. 9 d. 13 e. 17 ANSWER: c 4. What is the simplest amino acid? a. phenylalanine b. glycine c. glutamine d. lysine e. tryptophan ANSWER: b

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Chapter 06- Protein: Amino Acids 5. Which of the following is a nonessential amino acid? a. serine b. histidine c. valine d. tryptophan e. phenylalanine ANSWER: a 6. Which of the following is an essential amino acid? a. cysteine b. valine c. glutamine d. glycine e. aspartic acid ANSWER: b 7. Which of the following terms describes an amino acid that is normally dispensable, but must be supplied by the

diet in special circumstances when the need for it exceeds the body’s ability to make it? a. conditionally nonessential amino acid b. conditionally essential amino acid c. nonessential amino acid d. essential amino acid e. circumspect amino acid ANSWER: b 8. Human insulin consists of 51 amino acids chemically bonded together, which classifies it a(an) a. unipeptide

b. dipeptide c. tripeptide d. oligopeptide e. polypeptide ANSWER: e

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Chapter 06- Protein: Amino Acids 9. What type of chemical reaction connects amino acids? a. hydrolysis b. oxidation c. denaturation d. condensation e. polymerization ANSWER: d 10. The tangled shape of a polypeptide is its a. primary

structure, which gives it maximum stability.

b. secondary c. tertiary d. quaternary e. denaturalized ANSWER: c 11. An example of a protein with quaternary polypeptide structures is a. insulin

b. tryptophan c. hemoglobin d. disulfide bridges e. valine ANSWER: c 12. Which term refers to the change in a protein’s shape due to the application of heat or acid? a. oxygenation b. condensation c. denaturation d. destabilization e. hydrolyzation ANSWER: c

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Chapter 06- Protein: Amino Acids 13. What component denatures protein structures and activates pepsinogen? a. hydrochloric acid b. pepsin c. trypsin d. enteropeptidase e. chymotrypsin ANSWER: a 14. Which digestive enzyme hydrolyzes protein in the stomach?

chymotrypsin a. elastase b. pepsin c. trypsin d. enteropeptidase e. chymotrypsin ANSWER: b 15. In what part of the GI tract is pepsin active? a. mouth b. stomach c. pancreas d. small intestine e. liver ANSWER: b 16. What is the chief function of pepsin? a. emulsifying dietary proteins b. activating hydrochloric acid c. activating pancreatic proteases d. cleaving proteins into smaller polypeptides e. emulsifying dietary fats ANSWER: d

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Chapter 06- Protein: Amino Acids 17. What percentage of dietary protein is hydrolyzed in the mouth? a. 0 b. 5 to 10 c. 15 to 20 d. 25 to 30 e. 70 to 75 ANSWER: a 18. Digestive enzymes are a. lipids

and function optimally at their specific pH.

b. carbohydrates c. sterols d. proteins e. supplements ANSWER: d 19. Which of the follow is true of amino acid supplements? a. They are whole proteins. b. They keep the digestive system from overworking. c. The digestive system handles whole proteins better than supplements. d. They save the body from having to digest proteins. e. They are rapidly excreted through the digestive system. ANSWER: c 20. What happens when pepsin enters the small intestine? a. It activates HCl. b. It is digested due to the high pH. c. It cleaves proteins into smaller peptides and some free amino acids. d. It inhibits pepsinogen synthesis. e. It denatures protein structures. ANSWER: b

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Chapter 06- Protein: Amino Acids 21. The process of messenger RNA being made from a template of DNA is

a. expression b. sequencing c. transcription d. ribosome assembly e. translation ANSWER: c 22. The process whereby messenger RNA directs the sequence of amino acids and synthesis of proteins is

. a. expression b. sequencing c. transcription d. ribosome assembly e. translation ANSWER: e 23. What is a ribosome? a. a template for protein synthesis b. a protein transportation machine c. a protein-making machine d. an immune booster e. a protein pool ANSWER: c 24. Which disease is caused by a sequencing error in the structure of hemoglobin, which changes its shape and

characteristics? a. diabetes b. marasmus c. phenylketonuria d. sickle-cell anemia e. hemolytic anemia ANSWER: d

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Chapter 06- Protein: Amino Acids 25. To build a bone or tooth, cells first lay down a

and then fill it with crystals of calcium, phosphorus,

magnesium, fluoride, and other minerals. a. matrix b. enzyme grid c. buffer d. fluid regulator e. transporter ANSWER: a 26. Scars are made from which type of protein? a. ferritin b. albumin c. collagen d. hemoglobin e. enzyme ANSWER: c 27. Which protein, acting as a hormone, regulates blood glucose? a. oxytocin b. prolactin c. thyroxine d. antidiuretic e. insulin ANSWER: e 28. How do proteins regulate fluid balance? a. Proteins are hydrophilic. b. Water attracts proteins. c. Water degrades proteins. d. Proteins form polymers of water. e. Proteins are hydrophobic. ANSWER: a

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Chapter 06- Protein: Amino Acids 29. Proteins acts as buffers because they

a. help emulsify fats b. help maintain a constant pH c. facilitate chemical reactions d. help protect against plaque buildup e. prevent degradation of proteins ANSWER: b 30. Which statement about protein transporters is FALSE? a. Hemoglobin transports oxygen from the lungs to the cells. b. Some transport proteins act as “pumps.” c. Iron is captured in an intestinal cell by a protein. d. Transport proteins within a cell membrane pick up and release sodium and potassium across the membrane. e. Active transport systems require no energy. ANSWER: e 31. Viruses, bacteria, and toxins are examples of a. antigens

b. antibodies c. buffers d. acidosis e. alkalosis ANSWER: a 32. What is fibrin? a. an antigen b. an antibody c. a light-sensitive protein d. a blood clotting protein e. a sterol ANSWER: d

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Chapter 06- Protein: Amino Acids 33. Which of the following proteins inactivates foreign bacteria and viruses? a. enzymes b. collagen c. hormones d. antibodies e. antigens ANSWER: d 34. The degradation and synthesis of protein is called “ a. protein turnover

.”

b. nitrogen balance c. amino acid pool d. immunity e. transamination ANSWER: a 35. When nitrogen losses exceed the amount of nitrogen taken into the body, the person is in a. a healthy state

b. nitrogen equilibrium c. positive nitrogen balance d. negative nitrogen balance e. nitrogen homeostasis ANSWER: d 36. For whom is nitrogen balance typically positive? a. pregnant women b. starving children c. burn victims d. febrile children e. adult men ANSWER: a

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Chapter 06- Protein: Amino Acids 37. Which amino acid is used to synthesize the neurotransmitter epinephrine and the pigment melanin? a. glycine b. tyrosine c. methionine d. tryptophan e. valine ANSWER: b 38. If a nonessential amino acid is not available, cells can make it from a keto acid if a(an)

source is

available. a. carbonyl b. nitrogen c. ammonia d. carbon e. oxygen ANSWER: b 39. Transamination produces a new nonessential amino acid and a new a. uric acid

b. keto acid c. folic acid d. gluco acid e. phyto acid ANSWER: b 40. When amino acids are deaminated, the immediate products are ammonia and often a a. uric acid

b. keto acid c. folic acid d. gluco acid e. fatty acid ANSWER: b

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Chapter 06- Protein: Amino Acids 41. The production of urea hits its maximum rate at intakes approaching

grams of protein per day.

a. 5 b. 50 c. 100 d. 250 e. 500 ANSWER: d 42. An otherwise healthy person regularly consuming a high-protein diet risks

a. liver disease b. decreased size of the liver and kidneys c. dehydration d. ulcers e. diabetes ANSWER: c 43. Which of the following are responsible for urea synthesis? a. all amino acids b. animal sources of proteins only c. essential amino acids only d. nonessential amino acids only e. vegetarian sources of protein only ANSWER: a 44. What is the most likely reason for a person to have abnormally high blood urea levels? a. liver dysfunction b. kidney dysfunction c. rapid weight gain d. protein intake one-tenth the RDA e. hyperstimulation of the immune system ANSWER: b

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Chapter 06- Protein: Amino Acids 45. Which of the following is NOT a function of proteins in the body? a. providing fuel for energy needs b. facilitating chemical reactions c. maintaining volume of body fluids d. protecting the body against diseases e. inhibiting the absorption of cholesterol ANSWER: e 46. The digestibility of most plant proteins (beside legumes) is a. 30 to 50%

b. 50 to 60% c. 60 to 70% d. 70 to 90% e. 90 to 99% ANSWER: d 47. The digestibility of most animal proteins is a. 50 to 59%

b. 60 to 69% c. 70 to 79% d. 80 to 89% e. 90 to 99% ANSWER: e 48. Which of the following foods contains all of the essential amino acids in relatively the same amounts that the human

body requires? a. turkey b. quinoa c. broccoli d. gelatin e. pumpkin seeds ANSWER: a

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Chapter 06- Protein: Amino Acids 49. Which of the following cannot support growth and health as a diet’s sole protein? a. fish b. cheese c. gelatin d. turkey e. fatty fish ANSWER: c 50. Which of the following is not a limiting amino acid? a. lysine b. methionine c. threonine d. tryptophan e. serine ANSWER: e 51. A vegetarian who plans a meal involving rice can consume all the essential amino acids by adding another plant

protein rich in a. lysine

b. tryptophan c. phenylalanine d. glutamic acid e. methionine ANSWER: a 52. A vegetarian who plans a meal involving black beans can consume all the essential amino acids by adding another

a plant protein rich in a. lysine b. tyrosine

c. methionine d. isoleucine e. phenylalanine ANSWER: c

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Chapter 06- Protein: Amino Acids 53. A reference protein is determined by comparing its amino acid composition with the essential amino acid

requirements of . a. infants b. preschool-age children c. male teenagers d. pregnant women e. adult men ANSWER: b 54. The amino acid homocysteine is elevated in a. cancer

b. kidney disease c. heart disease d. protein-energy malnutrition e. osteoporosis ANSWER: c 55. Which amino acid may protect against heart disease by lowering blood pressure and preventing blood clots? a. arginine b. cysteine c. tryptophan d. phenylalanine e. methionine ANSWER: a 56. Which of the following would NOT be classified as a carcinogen by the World Health Organization? a. bacon b. hot dogs c. beef jerky d. chicken e. ham ANSWER: d

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Chapter 06- Protein: Amino Acids 57. Which statement accurately describes the relationship between dietary protein and kidney function? a. Protein deficiency increases the risk of kidney stones. b. Restricting dietary protein helps slow the progression of kidney disease. c. Long-term, high-protein diets are a risk factor for kidney disease. d. High urea production from high-protein diets increases kidney efficiency. e. High-protein diets are recommended for childhood with genetic kidney issues. ANSWER: b 58. What is the average daily protein intake in United States? a. 50 g b. 65 g c. 80 g d. 125 g e. 175 g ANSWER: c 59. The protein RDA for adults is a. 0.08

grams per kilogram of body weight.

b. 0.36 c. 0.8 d. 3.6 e. eight ANSWER: c 60. Which of the following is NOT an assumption made in the formulation of the RDA for protein? a. People are healthy and do not have unusual metabolic needs for protein. b. Dietary protein is of mixed quality. c. Dietary carbohydrate and fat intakes are adequate. d. The body will use protein efficiently. e. Dietary protein needs are lower in infants and children. ANSWER: e

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Chapter 06- Protein: Amino Acids 61. About how much protein is provided by 1 cup of milk? a. 4 g b. 8 g c. 16 g d. 32 g e. 56 g ANSWER: b 62. Which of the following statements about whey protein is FALSE? a. It is popular among athletes hoping to build muscle. b. It is found in many affordable protein powders. c. It is a waste product of cheese production. d. It benefits body tissues in ways dietary proteins cannot. e. It has a high leucine content and is digested quickly. ANSWER: d 63. Which amino acid has been advertised in the popular media for treating insomnia and depression? a. glycine b. arginine c. tryptophan d. phenylalanine e. proline ANSWER: c 64. Which term refers to the study of how nutrients influence the activities of genes? a. nutrigenetics b. nutrigenomics c. genetic synthesis d. human nutritional economics e. bioproteomics ANSWER: b

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Chapter 06- Protein: Amino Acids 65. Which term refers to the study of how genes influence the activities of nutrients? a. nutrigenetics b. nutrigenomics c. genetic synthesis d. human nutritional economics e. bioproteomics ANSWER: a 66. Approximately how many protein-coding genes are in the human genome? a. 5000 to 7000 b. 10,000 to 15, 000 c. 20,000 to 25, 000 d. 40,000 to 45, 000 e. 80,000 to 85, 000 ANSWER: c 67. In epigenetics , methylation involves a. the addition of a methyl group

b. the removal of a methyl group c. the failure to metabolize tyrosine d. the removal of amino acids e. the addition of glucose ANSWER: a 68. Which nutrient participates in demethylation? a. folate b. a phytochemical in green tea c. lysine d. vitamin C e. iron ANSWER: d

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Chapter 06- Protein: Amino Acids 69. A diet that restricts phenylalanine and supplies tyrosine is the only current treatment for people born with the

single-gene disorder a. DNA b. ALC c. NLM d. PKU e. BHA

ANSWER: d 70. The incidence of PKU in the United States affects 1 in every a. 15,000

people.

b. 100,000 c. 500,000 d. 10,000 e. 1,000,000 ANSWER: a 71. Amino acids that the body can make are called “

.”

ANSWER: nonessential amino acids 72. A bond that connects the acid end of one amino acid with the amino end of another, forming a link in a protein chain, is called a “ .” ANSWER: peptide bond 73.

refers to the change in a protein’s shape and consequent loss of its function brought about by heat, agitation, acid, base, alcohol, heavy metals, or other agents. ANSWER: Denaturation

74. The inactive form of pepsin is called “

.”

ANSWER: pepsinogen 75.

is the process by which a cell converts the genetic code into RNA and protein. ANSWER: Gene expression

76. The swelling of body tissue caused by excessive amounts of fluid in the interstitial spaces is called “

.”

ANSWER: edema 77. A

provides a standard against which to measure the quality of other proteins.

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Chapter 06- Protein: Amino Acids 78. A measure of the amount of amino acids absorbed from a given protein take is called “

.”

ANSWER: protein digestibility 79. The term meaning “a substance that can cause cancer” is

ANSWER: carcinogen 80. The essential amino acids leucine, isoleucine, and valine, which are present in large amounts in skeletal muscle tissue are called amino acids. ANSWER: branched-chain Match the appropriate receptor to the correct description. Some choices may be used more than once. a. Soy b. Urea c. Pepsin d. Tryptophan e. Gelatin f. Serine g. Sulfur h. Keto i. Dipeptide j. Translation k. Denaturation l. Transcription m. Sickle-cell anemia n. Marasmus o. Serotonin p. Gene expression q. Hemoglobin r. Conditionally essential amino acid s. Arginine t. Protein turnover 81. A dietary nonessential amino acid ANSWER: f 82. Term for two or more amino acids bonded together ANSWER: i 83. Element found in some amino acids ANSWER: g

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Chapter 06- Protein: Amino Acids 84. Globular protein that accounts for 80% of the body’s iron ANSWER: q 85. Nonessential amino acid supplied by diet in special circumstances ANSWER: n 86. Change in protein when agitated ANSWER: k 87. Enzyme active in the stomach ANSWER: c 88. When messenger RNA is made from DNA ANSWER: l 89. When messenger RNA sequences amino acids ANSWER: j 90. Disease caused by sequencing errors ANSWER: m 91. When a cell converts genetic code into RNA and protein ANSWER: p 92. Degradation and synthesis of protein ANSWER: t 93. Neurotransmitter that regulates sleep ANSWER: o 94. Organic acid with a carbon group ANSWER: h 95. Combination of ammonia and carbon dioxide ANSWER: b 96. Low-quality animal protein ANSWER: e 97. High-quality plant protein ANSWER: a 98. A typical limiting amino acid ANSWER: d 99. A condition of protein malnutrition ANSWER: n Page 20

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Chapter 06- Protein: Amino Acids 100. An amino acid that may lower blood pressure ANSWER: s 101. Briefly explain the chemical structure of amino acids. ANSWER: All amino acids have the same basic structure—a central carbon (C) atom with a hydrogen atom (H), an amino group (NH2), and an acid group (COOH) attached to it. Remember, however, that carbon atoms must have four bonds, so a fourth attachment is necessary. This fourth site distinguishes each amino acid from the others. Attached to the central carbon at the fourth bond is a distinct atom, or group of atoms, known as the “side group” or “side chain.” The side groups on the central carbon vary from one amino acid to the next, making proteins more complex than either carbohydrates or lipids. A polysaccharide (starch, for example) may be several thousand units long, but each unit is a glucose molecule just like all the others. A protein, on the other hand, is made up of about 20 different amino acids, each with a different side group. The simplest amino acid, glycine, has a hydrogen atom as its side group. A slightly more complex amino acid, alanine, has an extra carbon with three hydrogen atoms. Other amino acids have more complex side groups. Thus, although all amino acids share a common structure, they differ in size, shape, electrical charge, and other characteristics because of differences in these side groups.

102. Compare and contrast essential, nonessential, and conditionally essential amino acids. Include examples of each ANSWER: More than half of the amino acids are nonessential, meaning that the body can synthesize them for itself. Proteins in foods usually deliver these amino acids, but it is not essential that they do so. The body can make all nonessential amino acids, given nitrogen to form the amino group and fragments from carbohydrate or fat to form the rest of the structure. Examples include alanine, arginine, asparagine, aspartic acid, cysteine, glutamic acid, glutamine, glycine, proline, serine, and tyrosine. There are nine amino acids that the human body either cannot make at all or cannot make in sufficient quantity to meet its needs. These nine amino acids must be supplied by the diet; they are essential. These include histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. Sometimes a nonessential amino acid becomes essential under special circumstances. For example, the body normally uses the essential amino acid phenylalanine to make tyrosine (a nonessential amino acid). But if the diet fails to supply enough phenylalanine, or if the body cannot make the conversion for some reason, then tyrosine becomes a conditionally essential amino acid.

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Chapter 06- Protein: Amino Acids 103. How are proteins digested and absorbed? ANSWER: Proteins are crushed and moistened in the mouth, but the real action begins in the stomach. The major event in the stomach is the partial breakdown (hydrolysis) of proteins. Hydrochloric acid uncoils (denatures) each protein’s tangled strands so that digestive enzymes can attack the peptide bonds. The hydrochloric acid also converts the inactive form of the enzyme pepsinogen to its active form, pepsin. Pepsin cleaves proteins—large polypeptides—into smaller polypeptides and some amino acids. When polypeptides enter the small intestine, several pancreatic and intestinal proteases hydrolyze them further into short peptide chains, tripeptides, dipeptides, and amino acids. Then peptidase enzymes on the membrane surfaces of the intestinal cells split most of the dipeptides and tripeptides into single amino acids. Only a few peptides escape digestion and enter the blood intact. A number of specific carriers transport amino acids (and some dipeptides and tripeptides) into the intestinal cells. Once inside the intestinal cells, amino acids may be used for energy or to synthesize needed compounds. Amino acids that are not used by the intestinal cells are transported across the cell membrane into the surrounding fluid, where they enter the capillaries on their way to the liver.

104. Describe the process of protein synthesis. ANSWER: Each human being is unique because of small differences in the body’s proteins. These differences are determined by the amino acid sequences of proteins, which, in turn, are determined by genes. Protein synthesis depends on a diet that provides adequate protein and all the essential amino acids. The instructions for making every protein in a person’s body are transmitted by way of the genetic information received at conception. This body of knowledge, which is filed in the DNA (deoxyribonucleic acid) within the nucleus of every cell, never leaves the nucleus. Transforming the information in DNA into the appropriate sequence of amino acids needed to make a specific protein requires two major steps. In the first step, known as transcription, a stretch of DNA is used as a template to make messenger RNA (mRNA); in other words, the genetic code is transcribed. mRNA then carries the code across the nuclear membrane into the body of the cell, where it seeks out and attaches itself to one of the ribosomes (a protein-making machine, which is itself composed of RNA and protein). There the second step, known as translation, takes place. Situated on a ribosome, messenger RNA specifies the sequence in which the amino acids line up for the synthesis of a protein. In other words, mRNA translates the genetic code to make the new protein. Other forms of RNA, called transfer RNA (tRNA), collect amino acids from the cell fluid and take them to messenger RNA. Each of the 20 amino acids has a specific tRNA. Thousands of tRNAs, each carrying its amino acid, cluster around the ribosomes, awaiting their turn to unload. When the mRNA calls for a specific amino acid, the tRNA carrying that amino acid moves into position. Then the next loaded tRNA moves into place and then the next and the next. In this way, the amino acids line up in the sequence that is genetically determined, and enzymes bind them together. Finally, the completed protein strand is released, and the tRNAs are freed to return for another load of amino acids.

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Chapter 06- Protein: Amino Acids 105. Discuss three of the many roles of proteins in the body. ANSWER: From the moment of conception, proteins form the building blocks of muscles, blood, and skin—in fact, protein is the major structural component of all the body’s cells. To build a bone or a tooth, for example, cells first lay down a matrix of the protein collagen and then fill it with crystals of calcium, phosphorus, magnesium, fluoride, and other minerals. Some proteins act as enzymes. Enzymes not only break down substances, but they also build substances (such as bone) and transform one substance into another (amino acids into glucose, for example). Breaking down reactions are catabolic, whereas building up reactions are anabolic. The body’s many hormones are messenger molecules, and some hormones are proteins. Various endocrine glands in the body release hormones in response to changes that challenge the body. The blood carries the hormones from these glands to their target tissues, where they elicit the appropriate responses to restore and maintain normal conditions. Proteins help to maintain the body’s fluid balance. Normally, proteins are found primarily within the cells and in the plasma (essentially blood without its red blood cells). Being large, proteins do not normally cross the walls of the blood vessels. During times of critical illness or protein malnutrition, however, plasma proteins leak out of the blood vessels into the spaces between the cells. Because proteins attract water, fluid accumulates and causes swelling. Proteins also help to maintain the balance between acids and bases within the body fluids. Normal body processes continuously produce acids and bases, which the blood carries to the kidneys and lungs for excretion. The challenge is to maintain acid–base balance as conditions continually change. Some proteins move about in the body fluids, carrying nutrients and other molecules. The protein hemoglobin carries oxygen from the lungs to the cells. The lipoproteins transport lipids around the body. Special transport proteins carry vitamins and minerals. Proteins also defend the body against disease. A virus—whether it is one that causes flu, smallpox, measles, or the common cold—enters the cells and multiplies there. One virus may produce 100 replicas of itself within an hour or so. Each replica can then burst out and invade 100 different cells, soon yielding 10,000 viruses, which invade 10,000 cells. Left free to do their worst, they will soon overwhelm the body with disease. Fortunately, when the body detects these invading antigens, it manufactures antibodies, giant protein molecules designed specifically to combat them. The antibodies work so swiftly and efficiently that in a healthy individual, most diseases never get started. Without sufficient protein, though, the body cannot maintain its army of antibodies to resist infectious diseases. Without energy, cells die; without glucose, the brain and nervous system falter. Even though proteins are needed to do the work that only they can perform, they will be sacrificed to provide energy and glucose during times of starvation or insufficient carbohydrate intake. The body will break down its tissue proteins to make amino acids available for energy or glucose production (a process known as gluconeogenesis). In this way, protein can maintain blood glucose levels, but at the expense of losing lean body tissue. As mentioned earlier, proteins form integral parts of most body structures such as skin, muscles, and bones. They also participate in some of the body’s most amazing activities such as blood clotting and vision. When a tissue is injured, a rapid chain of events leads to the production of fibrin, a stringy, insoluble mass of protein fibers that forms a solid clot from liquid blood. Later, more slowly, the protein collagen forms a scar to replace the clot and permanently heal the wound. The light-sensitive pigments in the cells of the eye’s retina are molecules of the protein opsin. Opsin responds to light by changing its shape, thus initiating the nerve impulses that convey the sense of sight to the brain. The amino acids are as versatile as the proteins. In addition to serving as building blocks for proteins in the body, amino acids have multiple roles in regulating pathways that support growth, reproduction, metabolism, and immunity.

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Chapter 06- Protein: Amino Acids 106. Describe the relationship between protein turnover and nitrogen balance. How does nitrogen balance differ among infants, adults, and those who are injured or on weight-loss diets? ANSWER: Protein turnover and nitrogen balance go hand in hand. In healthy adults, protein synthesis balances with degradation, and protein intake from food balances with nitrogen excretion in the urine, feces, and sweat. When nitrogen intake equals nitrogen output, the person is in nitrogen equilibrium, or zero nitrogen balance. Researchers use nitrogen-balance studies to estimate protein requirements. If the body synthesizes more than it degrades, then protein is added and nitrogen status becomes positive. Nitrogen status is positive in growing infants, children, adolescents, pregnant women, and people recovering from protein deficiency or illness; their nitrogen intake exceeds their nitrogen excretion. They are retaining protein in new tissues as they add blood, bone, skin, and muscle cells to their bodies. If the body degrades more than it synthesizes, then protein is being lost and nitrogen status becomes negative. Nitrogen status is negative in people who are starving or suffering other severe stresses such as burns, injuries, infections, and fever; their nitrogen excretion exceeds their nitrogen intake. During these times, the body loses nitrogen as it breaks down muscle and other body proteins for energy.

107. What are high-quality proteins and how are they derived? ANSWER: A high-quality protein contains all the essential amino acids in relatively the same amounts and proportions that human beings require; it may or may not contain all the nonessential amino acids. Proteins that are low in an essential amino acid cannot, by themselves, support protein synthesis. Generally, foods derived from animals (meat, seafood, poultry, eggs, and milk and milk products) provide high-quality proteins, although gelatin is an exception. Gelatin lacks tryptophan and cannot support growth and health as a diet’s sole protein. Proteins from plants (vegetables, nuts, seeds, grains, and legumes) have more diverse amino acid patterns and tend to be limited in one or more essential amino acids. Some plant proteins are notoriously low quality (for example, corn protein). A few others are high quality (for example, soy protein). 108. How might protein consumption affect heart disease? ANSWER: In the United States and other developed countries, protein is so abundant that problems of excess are more common than deficiency. Depending on the food source, a high-protein diet may contribute to the progression of heart disease. Foods rich in animal protein also tend to be rich in saturated fats. Consequently, it is not surprising to find a correlation between animal-protein intake (red meats and milk products) and heart disease. On the other hand, substituting vegetable protein (legumes and nuts) for animal protein and using low-fat milk, poultry, and fish may improve blood pressure and blood lipids and decrease heart disease mortality. The amino acid homocysteine is elevated in heart disease, but its role as a risk factor is unclear. Some research suggests that elevated homocysteine is a marker, describing gene activity or free radical oxidation. Lowering homocysteine by using supplements of the B vitamins (particularly folate), however, do not seem to lower the risks of heart attacks, strokes, or sudden death. In contrast to homocysteine, the amino acid arginine may help protect against heart disease by lowering blood pressure and preventing blood clots. Additional research is needed to confirm the benefits of arginine or the use of supplements.

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Chapter 06- Protein: Amino Acids 109. You and a friend have been doing some strength training to gain muscle mass. Your friend suggests you reduce your gym time and add protein powders to your diets. How do you respond? ANSWER: Because the body builds muscle protein from amino acids, many athletes take protein powders soon after exercising, especially when resistance training, to promote protein synthesis and muscle strength. Whether this enhanced protein synthesis actually builds muscle or improves performance is less clear, but because protein supplements are relatively safe and inexpensive, they remain popular. Athletes may prefer the convenience of protein powders and the assurance of measured quantities, but food sources of protein—lean meats, milk, eggs, and legumes—also provide an array of amino acids as well as valuable vitamins and minerals. Whey protein appears to be particularly popular among athletes hoping to achieve greater muscle gains. A by-product of cheese manufacturing, whey protein is a high-quality protein that is commonly found in many protein powders. With a full array of essential amino acids, high leucine content, and rapid digestibility, whey supplements consumed soon after strength training exercises stimulate muscle protein synthesis. Of course, muscles are also repaired and rebuilt when athletes eat balanced meals providing adequate energy and protein to support their physical activity.

110. Describe phenylketonuria, including its symptoms, causes, and treatments. ANSWER: Some disorders are caused by mutations in single genes that are inherited at birth. The consequences of a missing or malfunctioning protein can seriously disrupt metabolism and may require significant dietary or medical intervention. A classic example of a diet-related, single-gene disorder is phenylketonuria, or PKU. Approximately 1 in every 15,000 infants in the United States is born with PKU. PKU arises from mutations in the gene that codes for the enzyme that converts the essential amino acid phenylalanine to the amino acid tyrosine. Without this enzyme, phenylalanine and its metabolites accumulate and damage the nervous system, resulting in mental retardation, seizures, and behavior abnormalities. At the same time, the body cannot make tyrosine or compounds made from it (such as the neurotransmitter epinephrine). Consequently, tyrosine becomes a conditionally essential amino acid: Because the body cannot make it, the diet must supply it. Although the most debilitating effect is on brain development, other symptoms of PKU become evident if the condition is left untreated. Infants with PKU may have poor appetites and grow slowly. They may be irritable or have tremors or seizures. Their bodies and urine may have a musty odor. Their skin coloring may be unusually pale, and they may develop skin rashes. The effect of nutrition intervention in PKU is remarkable. In fact, the only current treatment for PKU is a diet that restricts phenylalanine and supplies tyrosine to maintain blood levels of these amino acids within safe ranges. Because all foods containing protein provide phenylalanine, the diet must depend on a special formula to supply a phenylalanine-free source of energy, amino acids, vitamins, and minerals. If the restricted diet is conscientiously followed, the symptoms can be prevented. Because phenylalanine is an essential amino acid, the diet cannot exclude it completely. Children with PKU need phenylalanine to grow, but they cannot handle excesses without detrimental effects. Therefore, their diets must provide enough phenylalanine to support normal growth and health but not enough to cause harm. The diet must also provide tyrosine. To ensure that blood concentrations of phenylalanine and tyrosine are close to normal, children and adults who have PKU must have blood tests periodically and adjust their diets as necessary.

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Chapter 07- Energy Metabolism 1. The formation of glycogen by the liver cell from glucose molecules is an example of a. oxidation b. glycolysis

c. anabolism d. catabolism e. photosynthesis ANSWER: c 2. In photosynthesis, a plant uses energy from the sun plus water and carbon dioxide; the end product comprises a. carbohydrates only. b. fats and carbohydrates only. c. protein and carbohydrates only. d. fats, proteins, and carbohydrates. ANSWER: a 3. What are the “powerhouses” of the cell? a. DNAs b. ribosomes c. RNAs d. electron transport chains e. mitochondria ANSWER: e 4. A feature of catabolic reactions is that they a. involve release of energy. b. occur only in mitochondria. c. involve consumption of energy. d. occur only during loss of body weight. e. involve storage of energy. ANSWER: a 5. During anabolism, what is occurring? a. Energy is released. b. Energy is required. c. Compounds are broken down. d. ADP is created. e. ATP is broken down. ANSWER: b

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Chapter 07- Energy Metabolism 6. In which process is the cytoplasm involved? a. lipid synthesis b. protein synthesis c. electron transport chain d. glycolysis e. oxidation ANSWER: d 7. In which process are the mitochondria of the cells involved? a. conversion of pyruvate to ATP b. lipid synthesis c. vitamin and mineral synthesis d. cholesterol synthesis e. hydrolysis of glycogen to glucose ANSWER: a 8. Which of these is an anabolic reaction? a. glycogen to glucose b. amino acids to protein c. energy release d. protein to amino acids e. triglycerides to fatty acids and glycerol ANSWER: b 9. The conversion of energy from food to ATP energy occurs with an efficiency rate of about a. 50% b. 65% c. 75% d. 90% e. 100%

ANSWER: a 10. What does the body do with the chemical energy of food that is not converted to the chemical energy of ATP? a. removes it through the kidneys b. radiates it as heat c. converts it to carbon dioxide that is then expelled through the lungs d. converts it to electromagnetic radiation e. stores it in the body’s fat cells ANSWER: b Page 2

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Chapter 07- Energy Metabolism 11. Which of the following is NOT among the primary functions of the liver? a. synthesis of urea b. synthesis of glycogen c. production of red blood cells d. conversion of fructose to fatty acids e. detoxification of alcohol and drugs. ANSWER: c 12. Which metabolic reaction occurs when a cell releases energy? a. ATP gains a phosphate group and becomes ADP. b. ADP gains a phosphate group and becomes ATP. c. ATP releases a phosphate group and becomes ADP. d. ADP releases a phosphate group and becomes ATP. e. ADP and ATP cycle back and forth repeatedly. ANSWER: c 13. What is the sugar that helps make up ATP? a. sucrose b. glucose c. dextrose d. phosphate e. ribose ANSWER: e 14. Which one of these compounds is not the result of the breakdown of the energy-releasing nutrients? a. glucose b. glycerol c. fatty acids d. disaccharides e. amino acids ANSWER: d 15. The metabolic breakdown of glucose to pyruvate is known as a. hydrolysis b. synthesis

c. glycolysis d. activation e. energy release ANSWER: c Page 3

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Chapter 07- Energy Metabolism 16. From which B vitamin is CoA, or coenzyme A, derived, making it central to energy metabolism? a. folate b. pantothenic acid c. niacin d. thiamin e. vitamin B12 ANSWER: b 17. Which of the following is a feature of aerobic metabolism? a. It does not require oxygen. b. Lactate is created. c. Energy is produced more slowly than in anaerobic metabolism. d. Pyruvate is converted to glucose. e. The energy created can be sustained for only a couple of minutes. ANSWER: c 18. For short, intense exercise, which energy-producing pathway does the body rely on most? a. pyruvate to acetyl CoA b. lactate to pyruvate c. glucose to pyruvate to lactate d. pyruvate to chylomicrons e. Acetyl CoA to glucose ANSWER: c 19. Which of the following is NOT a 3-carbon compound? a. lactate b. glycerol c. pyruvate d. acetyl CoA e. none of these are correct ANSWER: d 20. In the Cori cycle, lactate is converted to glucose in the a. liver b. muscles c. bloodstream

d. pancreas e. gallbladder ANSWER: a Page 4

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Chapter 07- Energy Metabolism 21. When a person performing intense physical exercise begins to feel fatigue and a burning pain in the muscles, the muscles respond by synthesizing more . a. lactate b. glucose c. citric acid d. fatty acids e. galactate ANSWER: a 22. Which of the following statements is NOT true of pyruvate? a. It plays a key role in energy metabolism. b. It is involved in glycolysis. c. The pathway of pyruvate to acetyl CoA is reversible. d. The pathway of pyruvate to acetyl CoA is irreversible. e. It is involved in the Cori cycle. ANSWER: c 23. In energy metabolism, glycerol can convert to –––––. a. vitamin A b. fructose c. glucose or pyruvate. d. fatty acids e. triglycerides ANSWER: c 24. Once acetyl CoA is formed, it has two main options: to generate ATP or to a. convert to urea b. make glucose c. make fats d. convert to ammonia e. turn to carbon dioxide

ANSWER: c 25. Fatty acid oxidation produces a. ketones b. fructose c. pyruvate d. acetyl CoA e. lactate

ANSWER: d Page 5

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Chapter 07- Energy Metabolism 26. With regard to energy metabolism, which of the following statements is true about fatty acids? a. They cannot make glucose. b. They can make glucose. c. They enter the same energy pathway as glucose. d. They can convert to lactate. e. They are metabolized via the Cori cycle. ANSWER: a 27. What percentage (by weight) of a triglyceride molecule can be converted to glucose? a. 5% b. 10% c. 25% d. 50% e. 75% ANSWER: a 28. What is the final yield of acetyl CoA molecules from the oxidation of a 16-carbon fatty acid? a. 4 b. 8 c. 10 d. 12 e. 16 ANSWER: b 29. In the tricarboxylic acid (TCA) cycle, which compound is involved in both the first and the last step? a. glucose b. oxaloacetate c. lactate d. ketones e. carbon dioxide ANSWER: b 30. Where do the TCA cycle reactions occur? a. nucleus b. smooth endoplasmic reticulum c. inner sections of the mitochondria d. rough endoplasmic reticulum e. ribosomes ANSWER: c Page 6

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Chapter 07- Energy Metabolism 31. Before entering the metabolic pathways, amino acids first face a. removal of their nitrogen-containing amino group b. removal of their nitrogen

c. conversion to protein d. condensation of their bonds e. removal of their acetyl group ANSWER: a 32. Urea is produced as a result of a. deamination b. protein synthesis c. detoxification d. anabolism e. the Cori cycle

ANSWER: a 33. When energy-yielding nutrients are consumed in excess, which one(s) are stored in body fat? a. fat only b. carbohydrate only c. fat and carbohydrate only d. fat, carbohydrate, and protein e. protein and fat only ANSWER: d 34. When the carbohydrate content of the diet is insufficient to meet the body’s needs for glucose, which of these compounds can be converted to glucose? a. fatty acids b. acetyl CoA c. amino acids d. carbon dioxide e. urea ANSWER: c 35. How many electrons are released in each turn of the TCA cycle? a. 6 b. 8 c. 10 d. 16 e. 32 ANSWER: b Page 7

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Chapter 07- Energy Metabolism 36. Which of these statements about the electron transport chain is true? a. It occurs simultaneously with the TCA cycle. b. It also is known as the Krebs cycle. c. It captures energy in the ATP bonds. d. It releases energy into the ATP bonds. e. It helps make acetyl CoA ANSWER: c 37. Amino acids that enter the TCA cycle directly are considered a. glycogenic b. gluconeogenic c. glucogenic d. ketogenic e. oxalates

ANSWER: c 38. One way that all the energy-yielding nutrients are alike is that a. they produce energy through entirely different pathways. b. they all go through the Cori cycle. c. they have the same number of hydrogen bonds. d. they share the same final metabolic pathway, the TCA cycle. e. they have the same number of carbon–hydrogen bonds.

ANSWER: d 39. What is the reason that fat yields more calories than carbohydrate or protein? a. Fat has few carbon–hydrogen bonds. b. Fat contains many carbon–hydrogen bonds that can be readily oxidized. c. Fat is not easily oxidized. d. Fat undergoes many energy-requiring metabolic reactions, thereby increasing its energy yield. e. Fat has a low ratio of carbon to hydrogen bonds. ANSWER: b 40. The number of ATP molecules that can be produced from a molecule of protein, fat, or carbohydrate is generally related to the number of atoms of _______ _. a. carbon b. oxygen c. nitrogen d. hydrogen e. potassium ANSWER: d Page 8

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Chapter 07- Energy Metabolism 41. Which of the following can be synthesized from all three energy-yielding nutrients? a. lactate b. glycogen c. acetyl CoA d. oxaloacetate e. glucose ANSWER: c 42. Why is it easier for the body to convert dietary fat to stored fat than dietary carbohydrate to stored fat? a. The conversion of dietary fat to stored fat requires fewer steps. b. The conversion of dietary fat to stored fat allows for use of more energy. c. Fat enters the bloodstream more quickly. d. Fat is easier to digest. e. Fat takes less time to digest. ANSWER: a 43. What percentage of a person’s ingested energy intake is required to store excess dietary fat as body fat? a. 5 b. 15 c. 25 d. 35 e. 45 ANSWER: a 44. What occurs when a person eats in excess ? a. Fat cells multiply. b. Fat cells enlarge. c. Metabolism favors carbohydrate. d. Metabolism favors protein. e. Their energy needs increase temporarily. ANSWER: b 45. Which of the following is true about excess protein intake? a. The extra protein is used to grow muscle. b. The extra protein is stored in the liver. c. The extra protein is converted to lactate. d. Protein oxidation is increased. e. The excess protein is stored in several larger muscle groups. ANSWER: d Page 9

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Chapter 07- Energy Metabolism 46. Which of the following occurs with excess carbohydrate intake? a. The carbohydrate is efficiently converted to body fat. b. It spares oxidation of body fat and dietary fat. c. Oxidation is decreased. d. It causes the release of glycogen. e. It causes the release of lactate. ANSWER: b 47. Of the total amount of carbohydrate energy consumed, approximately what percentage is used by the brain and nerve cells? a. 10% b. 30% c. 50% d. 90% e. 100% ANSWER: c 48. During the first few days of a fast, what energy source provides maximum amounts of the glucose needed to fuel the body? a. protein b. ketones c. glycogen d. triglycerides e. vitamins and minerals. ANSWER: a 49. During the first few days of a fast, amino acids provide about what percentage of the glucose the body needs to fuel itself? a. 15% b. 25% c. 35% d. 75% e. 90% ANSWER: e

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Chapter 07- Energy Metabolism 50. Which of the following statements is true of low-carbohydrate diets? a. They often lead to diarrhea. b. They elevate blood pressure. c. They induce ketosis. d. They’re effective at reducing body fat. e. They’re a sound means of weight loss. ANSWER: c 51. How soon would death occur from starvation if the body was unable to shift to a state of ketosis? a. within 3 weeks b. 1 month c. 2 months d. 3 to 4 months e. About 6 months ANSWER: a 52. After about 10 days of fasting, which one of these compounds will be the nervous system’s main fuel provider? a. ketone bodies b. glycerol c. fatty acids d. amino acids e. protein ANSWER: a 53. Which of the following is a feature of ketosis? a. higher blood pH b. acetone breath c. increased appetite d. increased glycolysis e. synthesis of body protein ANSWER: b 54. What is the major site for gluconeogenesis? a. liver b. brain c. muscle d. small intestine e. pancreas ANSWER: a Page 11

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Chapter 07- Energy Metabolism 55. Which one of these statements is true of binge drinking? a. It is most common among 35-to-60-year-olds. b. It is most common among 18-to-34-year-olds. c. It is a pattern of drinking in which the blood alcohol level rises to no more than 0.08%. d. In women, it corresponds to six or more drinks within several hours. e. Is most common in adults over 65 years old. ANSWER: b 56. Alcohol is the leading risk factor for premature death and disability in which group? a. those under 18 years old b. 18-to-22-year-olds c. 15-to-49-year-olds d. 30-to-65-year-olds e. those over 65 years old ANSWER: c 57. The amount of pure ethanol in a typical “drink” is a. 0.5 ounce b. 1 ounce c. 1.5 ounces d. 2 ounces e. 4 ounces

ANSWER: a 58. About how many kcalories are in a 6.8-ounce serving of canned piña colada? a. 150 kcal b. 185 kcal c. 205 kcal d. 235 kcal e. 526kcal ANSWER: e 59. What is one explanation for why women have generally lower tolerance for alcohol than men? a. Women fast more often. b. Women are less likely to eat food with their alcohol. c. Women tend to have smaller stomachs. d. Women produce less of the enzyme dehydrogenase. e. Women have more fat tissue. ANSWER: d Page 12

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Chapter 07- Energy Metabolism 60. What is the primary site of alcohol metabolism? a. the brain b. the stomach c. the pancreas d. the liver e. the gallbladder ANSWER: d 61. When health experts say to consume alcohol “in moderation,” what do they mean? a. Men should have no more than two drinks per day; women, no more than one drink per day. b. Men and women should have no more than two drinks per day. c. Men should have no more than four drinks per week; women, no more than two drinks per week d. Men and women should have no more than one drink per day. e. Men and women should have no more than two drinks in a 4-hour period. ANSWER: a 62. The metabolism of alcohol begins in the a. liver b. brain c. stomach d. intestines e. mouth

ANSWER: c 63. What is acetaldehyde? a. a toxic compound created in alcohol metabolism b. an enzyme used in alcohol metabolism c. a substance in liver that helps detoxify alcohol d. a ketone body e. the final product of alcohol metabolism. ANSWER: a 64. In general, how long does it take the liver to process the alcohol in a typical drink? a. 15 minutes b. 30 minutes c. 1 hour d. 2 hours e. 4 hours ANSWER: c Page 13

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Chapter 07- Energy Metabolism 65. One way that alcohol metabolism affects the energy pathways is that a. it gives priority to the metabolism of the energy-producing nutrients b. it speeds up the TCA cycle

c. it increases synthesis of proteins d. it shifts the body’s acid–base balance to make it more alkaline e. it promotes the making of lactate from pyruvate ANSWER: e 66. Which functions are most sensitive to alcohol? a. speech and vision b. judgment and reasoning c. voluntary muscle control d. respiration and heart function e. balance and coordination ANSWER: b 67. The Wernicke–Korsakoff syndrome in people with chronic alcohol abuse stems primarily from a deficiency of ________. a. folate b. thiamin c. antidiuretic hormone d. alcohol dehydrogenase e. protein ANSWER: b 68. Which one of the following statements is a myth about alcohol? a. The damage alcohol causes depends on the amount consumed, not the type. b. Alcohol is a depressant. c. Alcoholism is related to the quantity and frequency of alcohol consumption, not the type of alcohol consumed. d. A shot of alcohol will warm you up. e. Alcohol is considered a drug. ANSWER: d 69. Alcoholic beverage labels are required to provide a variety of information except for a. alcohol content b. name and address of bottler or importer c. calorie content d. a health warning e. net contents

ANSWER: c Page 14

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Chapter 07- Energy Metabolism 70. Chronic alcohol abuse has the most dramatic effect on the B vitamin a. folate b. riboflavin

c. B12 d. B6 e. biotin ANSWER: a 71. The simultaneous hydrolysis of ATP with reactions that will use energy is known as

ANSWER: coupled reactions 72. Some of the energy released during the breakdown of glucose, glycerol, fatty acids, and amino acids is captured in the high-energy compound with three phosphate groups called . ANSWER: adenosine triphosphate, or ATP 73. When the body needs energy quickly, pyruvate is converted to

ANSWER: lactate 74. The process in which fatty acids are taken apart two carbons at a time is known as

ANSWER: fatty acid oxidation 75. The process of converting lactate from muscles to glucose in the liver that can be returned to the muscles is known as the ____________________ _. ANSWER: Cori cycle 76. The process of making glucose from noncarbohydrate sources is called “ ......................................... ” ANSWER: gluconeogenesis 77. The acidic compounds produced by the liver during incomplete breakdown of fat when carbohydrate is not available are known as “ ____________________ _.” ANSWER: ketone bodies

a. Ethanol b. Urea c. MEOS d. Water e. Glucose f. Enzyme g. Glycogen h. Glycerol Page 15

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Chapter 07- Energy Metabolism i. Ammonia j. Coenzyme k. TCA cycle l. Lactate m. ketonemia n. Acetyl CoA o. Pyruvate p. Triglyceride q. Starvation r. Breakdown of glycogen to glucose s. Synthesis of protein from amino acids t. Synthesis of glucose from acetyl 78. Example of an anabolic reaction ANSWER: s 79. Example of a catabolic reaction ANSWER: r 80. A protein that accelerates a chemical reaction ANSWER: f 81. A small nonprotein organic substance that promotes optimal activity of an enzyme ANSWER: j 82. A product of glycolysis ANSWER: o 83. A product of pyruvate metabolism when oxygen is limited ANSWER: l 84. The oxidation product of pyruvate ANSWER: n 85. A series of metabolic reactions once known as the Krebs cycle ANSWER: k 86. An irreversible reaction ANSWER: t 87. The part of a triglyceride that is convertible to glucose ANSWER: h 88. A product of deamination ANSWER: i Page 16

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Chapter 07- Energy Metabolism 89. Its glycerol part can be converted to pyruvate or glucose ANSWER: p 90. The principal nitrogen-containing waste product ANSWER: b 91. A nonenergy product of the electron transport chain ANSWER: d 92. A storage form of carbohydrate ANSWER: g 93. The major energy fuel for the central nervous system ANSWER: e 94. A condition of elevated blood ketones ANSWER: m 95. A condition in which cells degrade their components for fuel ANSWER: q 96. The type of alcohol in distilled spirits, wine, and beer ANSWER: a 97. A system of enzymes for metabolizing drugs and alcohol ANSWER: c 98. Briefly describe these parts of a typical cell and their role in energy metabolism: nucleus, mitochondria, smooth endoplasmic reticulum, rough endoplasmic reticulum, and cytoplasm. ANSWER: The nucleus contains the chromosomes, which contain the genetic material DNA. The mitochondria are known as the “powerhouses” of the cells. The mitochondria are intricately folded membranes that house all the enzymes involved in conversion of pyruvate to acetyl CoA, fatty acid oxidation, the TCA cycle, and the electron transport chain. Smooth endoplasmic reticulum is a network of membranes that serve as the site of lipid synthesis. Rough endoplasmic reticulum is dotted with ribosomes—the site of protein synthesis. The cytoplasm lies inside the cell membrane. It is a lattice-type structure that supports and controls the movement of the cell’s structure. A protein-rich jelly-like fluid called the cytosol fills the spaces within the lattice. The cytosol contains the enzymes involved in glucose breakdown (glycolysis).

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Chapter 07- Energy Metabolism 99. Describe the Cori cycle in three steps. ANSWER: Step 1: Working muscles break down most of their glucose molecules to pyruvate, releasing energy (ATP). Step 2: If the cells lack sufficient mitochondria, or in the absence of sufficient oxygen, pyruvate can accept the hydrogens from glucose breakdown and become lactate. This conversion frees the coenzymes so that glycolysis can continue. Step 3: Lactate travels to the liver, where it can be converted to glucose, although this reaction requires energy. The glucose is then returned to the muscles. 100. How does the electron transport chain function in the synthesis of ATP? ANSWER: The electron transport chain captures energy in the high-energy bonds of ATP. The electron transport chain consists of a series of proteins that serve as electron “carriers.” These carriers are mounted in sequence on the inner membrane of the mitochondria. As the coenzymes deliver their electrons from the TCA cycle, glycolysis, and fatty acid oxidation to the electron transport chain, each carrier receives the electrons and passes them on to the next carrier. These electron carriers continue passing the electrons along until they reach oxygen. Oxygen accepts the electrons and combines with hydrogen atoms to form water. Oxygen must be available for energy metabolism, which explains why it is essential to life. As electrons are passed from carrier to carrier, hydrogen ions are pumped across the membrane to the outer compartment of the mitochondria. The rush of hydrogen ions back into the inner compartment powers the synthesis of ATP. In this way, energy is captured in the bonds of ATP. The ATP leaves the mitochondria and enters the cytoplasm, where it can be used for energy. 101. Explain gluconeogenesis. ANSWER: Gluconeogenesis is the making of glucose from noncarbohydrate sources. The liver is the major site of gluconeogenesis, but the kidneys become increasingly involved under certain circumstances, such as starvation. The glycerol portion of a triglyceride and most amino acids can be used to make glucose. To obtain the amino acids, body proteins must be broken down. For this reason, protein tissues such as muscle and liver always break down to some extent during fasting. The amino acids that cannot be used to make glucose are used as an energy source for other body cells. The breakdown of body protein is an expensive way to obtain glucose. In the first few days of a fast, body protein provides about 90% of the needed glucose; glycerol, about 10%. If body protein losses were to continue at this rate, death would follow within 3 weeks, regardless of the quantity of fat a person had stored. Fortunately, fat breakdown also increases with fasting—in fact, fat breakdown almost doubles, providing energy for other body cells and glycerol for glucose production.

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Chapter 07- Energy Metabolism 102. Describe how the body’s metabolism adapts to the conditions of fasting and starvation. ANSWER: During fasting, carbohydrate, fat, and protein are all eventually used for energy—fuel must be delivered to every cell. As the fast begins, glucose from the liver’s stored glycogen and fatty acids from the adipose tissue’s stored fat travel to the cells. These molecules are broken down to acetyl CoA, which enters the energy pathways that power the cells’ work. Several hours later, however, liver glycogen is depleted and blood glucose begins to fall. The body must adjust its normal metabolism to survive without food. Starvation demands cells to degrade their components for fuel. At this point, most cells are using fatty acids for their fuel. But red blood cells and the cells of the nervous system need glucose. Glucose is their primary energy fuel. Normally, the brain and nerve cells —which weigh only about 3 pounds—consume about half of the total glucose used each day (about 500 kcalories’ worth). About one fourth of the energy the adult body uses when it is at rest is spent by the brain. During a fast, the need for glucose poses a major problem. The body can use its stores of fat, which may be quite generous, to furnish most of its cells with energy, but the red blood cells are completely dependent on glucose, and the brain and nerves prefer energy in the form of glucose. Amino acids that yield pyruvate can be used for gluconeogenesis—the making of glucose from noncarbohydrate sources. The liver is the major site of gluconeogenesis, but the kidneys become increasingly involved under certain circumstances, such as starvation. As the fast continues, the body finds a way to use its fat to fuel the brain. It adapts by combining acetyl CoA fragments derived from fatty acids to produce an alternative energy source, ketone bodies. Normally produced and used only in small quantities, ketone bodies can efficiently provide fuel for brain cells. Ketone body production rises until, after about 10 days of fasting, it is meeting much of the nervous system’s energy needs. Still, many areas of the brain rely exclusively on glucose, and to produce it, the body continues to sacrifice protein—albeit at a slower rate than in the early days of fasting. In an effort to conserve body tissues for as long as possible, the hormones of fasting slow metabolism. As the body shifts to the use of ketone bodies, it simultaneously reduces its energy output and conserves both its fat and its lean tissue. Still the lean protein tissues shrink and perform less metabolic work, reducing energy expenditures. As the muscles waste, they can do less work and so demand less energy, reducing expenditures further.

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Chapter 07- Energy Metabolism 103. How does the body respond to a low-carbohydrate diet? ANSWER: When a person consumes a low-carbohydrate diet, a metabolism similar to that of fasting prevails. With little dietary carbohydrate coming in, the body uses its glycogen stores to provide glucose for the cells of the brain, nerves, and blood. Once the body depletes its glycogen reserves, it begins making glucose from the amino acids of protein (gluconeogenesis). A low carbohydrate diet may provide abundant protein from food, but the body still uses some protein from body tissues. Dieters can know glycogen depletion has occurred and gluconeogenesis has begun by monitoring their urine. Whenever glycogen or protein is broken down, water is released and urine production increases. Low-carbohydrate diets also induce ketosis, and ketones can be detected in the urine. Ketones form whenever glucose is lacking and fat breakdown is incomplete. Many fad diets regard ketosis as the key to losing weight, but studies comparing weight-loss diets find no relation between ketosis and weight loss. People in ketosis may experience a loss of appetite and a dramatic weight loss within the first few days. They should know that much of this weight loss reflects the loss of glycogen and protein together with large quantities of body fluids and important minerals. They need to appreciate the difference between loss of fat and loss of weight. Fat losses on ketogenic diets are no greater than on other diets providing the same number of kcalories. Once the dieter returns to well-balanced meals that provide adequate energy, carbohydrate, fat, protein, vitamins, and minerals, the body avidly retains these needed nutrients. The weight will return, quite often to a level higher than the starting point. 104. Explain what happens to protein, carbohydrate, and fat when consumed in excess. ANSWER: When a person eats excess carbohydrate, the body will first store the excess as glycogen, but glycogen storage areas are limited and fill quickly. Because maintaining glucose balance is critical, the body uses glucose frugally when the diet provides only small amounts and freely when supplies are abundant. In other words, glucose oxidation rapidly adjusts to the dietary intake of carbohydrate. Excess glucose can also be converted to fat. This pathway is relatively minor, however. Still, new body fat is made whenever carbohydrate intake is excessive. Excess dietary carbohydrate also can displace fat in the fuel mix. When this occurs, carbohydrate spares both dietary fat and body fat from oxidation. So the excess carbohydrate contributes to obesity or at least to the maintenance of an overweight body. When a person overeats protein, the body uses the surplus first by replacing normal daily losses and then by increasing protein oxidation. If excess protein is still available, the amino acids are deaminated and the remaining carbons are converted to ketone bodies, which are stored as fat in adipose tissues. Thus, a person can grow fat by eating too much protein. Unlike with excess carbohydrate and protein intake, excess fat intake does not promote oxidation. Instead, excess dietary fat moves efficiently into the body’s fat sores. Almost all the excess fat is stored.

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Chapter 07- Energy Metabolism 105. Describe the two major pathways for metabolism of alcohol in the liver. How does the liver adapt when forced to metabolize high quantities of alcohol on a daily basis? ANSWER: The liver is the primary site of alcohol metabolism. It can process about ½ ounce of ethanol per hour (the amount defined as a drink), depending on the person’s body size, previous drinking experience, food intake, and general health. This maximum rate of alcohol breakdown is determined by the amount of alcohol dehydrogenase available. If more alcohol arrives at the liver than the enzymes can handle, the extra alcohol travels around the body, circulating again and again until liver enzymes are finally available to process it. The amount of alcohol dehydrogenase enzyme present in the liver varies from one individual to another, depending on the genes they have inherited and on how recently they have eaten. Fasting for as little as a day prompts the body to degrade its proteins, including the alcohol-processing enzymes, and this can slow the rate of alcohol metabolism by half. Drinking after not eating all day thus causes the drinker to feel the effects more promptly for two reasons: rapid absorption and slowed breakdown. The alcohol dehydrogenase enzyme breaks down alcohol by removing hydrogens in two steps. In the first step, alcohol dehydrogenase oxidizes alcohol to acetaldehyde—a highly reactive and toxic compound. High concentrations of acetaldehyde in the brain and other tissues are responsible for many of the damaging effects of alcohol abuse. In the second step, a related enzyme, acetaldehyde dehydrogenase, converts acetaldehyde to acetate, which is then converted to either carbon dioxide (CO2) or acetyl CoA—the compound that plays a central role in energy metabolism. The reactions from alcohol to acetaldehyde to acetate produce hydrogens and electrons. The B vitamin niacin, in its role as a coenzyme, helpfully picks up these hydrogens and electrons and escorts them to the electron transport chain. 106. Explain how chronic alcohol abuse can lead to malnutrition. ANSWER: Heavy drinkers usually substitute alcohol for their normal food intake. Diet quality declines as alcohol consumption increases. Consequently, many heavy drinkers suffer malnutrition. Alcohol is rich in energy (7 kcal per gram), but the calories are empty of nutrients. The more alcohol people drink, the less likely they are to eat enough food to obtain adequate nutrients. The more kcalories used for alcohol, the fewer kcalories available to use from nutritious foods. Chronic alcohol abuse not only displaces nutrients from the diet, but it also interferes with the body’s metabolism of nutrients. Most dramatic is alcohol’s effect on the B vitamin folate. The liver loses its ability to retain folate, and the kidneys increase their excretion of it. Alcohol abuse creates a folate deficiency that devastates digestive system function. The small intestine normally releases and retrieves folate continuously, but it becomes damaged by folate deficiency and alcohol toxicity, so it fails to retrieve its own folate and misses any that may trickle in from food as well. The inadequate intake and impaired nutrient absorption that accompany chronic alcohol abuse often lead to a deficiency in thiamin. Acetaldehyde, an intermediate in alcohol metabolism, interferes with nutrient use, too. For example, acetaldehyde dislodges vitamin B6 from its protective binding protein so that it is destroyed, causing a vitamin B6 deficiency. Malnutrition occurs not only because of lack of intake and altered metabolism but also because of direct toxic effects. Alcohol causes stomach cells to oversecrete both gastric acid and histamine, an immune system agent that produces inflammation.

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Chapter 07- Energy Metabolism 107. Discuss the consequences of caffeinated alcoholic beverages. ANSWER: Caffeinated alcoholic beverages can amplify the dangers of binge drinking. The caffeine seems to mask the sensory cues that an individual normally relies on to determine intoxication. Consequently, individuals drinking these beverages typically consume more alcohol and become more intoxicated than they realize. The Food and Drug Administration has warned manufacturers of packaged caffeinated alcoholic beverages to stop sales. The combination of alcohol and added caffeine has not been approved because these products are associated with risky behaviors that may lead to hazardous and life-threatening situations.

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Chapter 08- Energy Balance and Body Composition 1. Though it has limitations, a basic rule of energy balance states that 1 pound of fat is stored for each kcalories eaten in excess. a. 500 b. 1500 c. 2500 d. 3500 e. 5000 ANSWER: d 2. Imagine that an adult consumes 500 excess kcalories each day for 2 weeks. About how much weight would that person gain? a. 0.5 lb b. 2 lb c. 3 lb d. 4 lb e. 8 lb ANSWER: b 3. Imagine that, over time, an adult gains an extra 20 pounds of body weight. About how much of this weight gain is fat? a. 5 lb b. 10 lb c. 12.5 lb d. 15 lb e. 18.5 lb ANSWER: d 4. Over time, the composition of weight gained or lost typically is a. 10%, 90% b. 20%, 80% c. 35%, 65%

fat and

lean.

d. 50%, 50% e. 75%, 25% ANSWER: e

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Chapter 08- Energy Balance and Body Composition 5. Imagine an adult who loses 20 pounds of excess body weight through a starvation diet. About how much of this weight loss is lean tissue? a. 2 lb b. 4 lb c. 5 lb d. 10 lb e. 15 lb ANSWER: d 6. The amount of energy that the human body derives from foods is known as the a. basal metabolism b. food combustion c. bomb calorimetry value d. physiological fuel value e. psychological fuel value

ANSWER: d 7. Which statement accurately describes the energy measurement of foods? a. The amount of carbon dioxide consumed gives an indirect measure of energy released. b. A bomb calorimeter measures the amount of oxygen released when a food is oxidized. c. Bomb calorimetry provides precise amounts of energy a person derives from the foods consumed. d. Bomb calorimetry typically overstates the physiological fuel value. e. In general, the fuel value of protein foods will exceed their energy value as measured by bomb calorimetry. ANSWER: d 8. What is the physiological fuel value? a. the scientific measure of kcalories a food provides b. the amount of oxygen consumed as energy is released c. the feeling of satisfaction during or after a mean d. the number of kcalories the body derives from a food e. the energy needed to maintain life when the body is at complete rest ANSWER: d 9. Which part of the brain is the primary center for appetite control? a. cerebellum b. cerebral cortex c. medulla d. hypothalamus e. hippocampus ANSWER: d Page 2

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Chapter 08- Energy Balance and Body Composition 10. You have just consumed a very large Thanksgiving meal, but still want a slice of pumpkin pie for dessert. What term best describes this state? a. satiety b. hunger c. appetite d. depression e. bulimia ANSWER: c 11. What hormone becomes active in the stomach and causes satiation? a. gastrin b. adipokines c. neuropeptide Y d. cholecystokinin e. pepsin ANSWER: d 12. Satiety determines . a. what kinds of foods are consumed at meals b. how much food is consumed during a meal c. how much time passes between meals d. how long it takes digestion to begin e. protein versus carbohydrate intake ANSWER: c 13. Among the following, which has the greatest power to suppress hunger? a. carrots b. french fries c. biscuits d. potato chips e. chocolate ANSWER: a 14. Which energy-yielding nutrient is the most satiating? a. fat b. water c. protein d. carbohydrate e. alcohol ANSWER: c Page 3

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Chapter 08- Energy Balance and Body Composition 15. The brain chemical, neuropeptide Y, causes cravings for a. fat b. salt c. protein d. carbohydrate e. water

ANSWER: d 16. Which of the following describes the process of thermogenesis? a. a fat-metabolizing enzyme b. a fat-synthesizing hormone c. the generation of heat d. the generation of water e. a release of oxygen, similar to oxygenation ANSWER: c 17. Quiet metabolic activities account for about a. 10% b. 25% c. 30% d. 40% e. 50% or more

of the average person’s daily energy expenditures.

ANSWER: e 18. Which of the following is not a metabolic activity? a. inhaling and exhaling air b. making new red blood cells via bone marrow c. chewing food d. filtering wastes through the kidneys e. the heart beating 100,000 times each day ANSWER: c 19. Which of the following statements about the resting metabolic rate is FALSE? a. It measures energy use for a person at rest in a comfortable setting. b. It is less stringent than the BMR in regard to physical activity. c. It is less stringent than the BMR in regard to recent food intake. d. It is easier to determine than the BMR. e. It typically is slightly lower than the BMR. ANSWER: e Page 4

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Chapter 08- Energy Balance and Body Composition 20. The thermic effect of food accounts for a. 10% b. 25% c. 30% d. 40% e. 50% or more

of the average person’s energy expenditure each day.

ANSWER: a 21. Which of the following factors raises the BMR? a. sleep b. a growing body c. fasting d. obesity e. aging ANSWER: b 22. Which of the following has the most significant influence on the body’s metabolic rate? a. age b. environmental temperature c. amount of fat tissue d. amount of lean body tissue e. height ANSWER: d 23. Which of the following factors lowers the BMR? a. aging b. fever c. smoking d. caffeine e. cold temperatures ANSWER: a 24. Which of the following activities expends the fewest kcalories per pound (or kilogram) per minute? a. vacuuming b. golfing c. studying d. Wii boxing e. gardening ANSWER: c Page 5

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Chapter 08- Energy Balance and Body Composition 25. Running at 9 mph expends 0.103 kcalories per pound per minute. About how many kcalories will a 120-pound woman expend during a 30-minute run? a. 13 b. 309 c. 370 d. 730 e. 903 ANSWER: c 26. Which of the following statements describes the thermic effect of foods (TEF)? a. TEF is estimated at 25% of energy intake. b. TEF plus an increase in the metabolic rate due to overeating is called diet-induced thermogenesis (DIT). c. A meal eaten all at once has a lower TEF than one spread out over hours. d. TEF is higher for high-fat foods than for high-carbohydrate foods. e. TEF must be considered when estimating energy expenditure because its contribution to total energy output is substantial. ANSWER: b 27. Which of the following parameters are essential to compute a woman’s BMR? a. body fat, height, and age b. body weight, height, and age c. physical activity level, body weight, and height d. energy intake, physical activity level, and body weight e. physical activity and age ANSWER: b 28. Which food component has the lowest thermic effect? a. alcohol b. fat c. protein d. carbohydrate e. minerals ANSWER: b

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Chapter 08- Energy Balance and Body Composition 29. Imagine that Tom, a 51-year-old man, breaks his foot and is nonambulatory for 8 weeks. What term describes the increase in Tom’s energy expenditures? a. febrile hyperthermia b. physical hyperthermia c. specific thermogenesis d. adaptive thermogenesis e. stress hyperthermia ANSWER: d 30. What is the reason for excluding the value for adaptive thermogenesis when calculating energy requirements? a. It is expensive to measure. b. It is too variable to measure. c. The value is too low to be utilized in calculations. d. The value is highly influenced by the dietary ratio of protein, fat, and carbohydrate. e. All of these are correct ANSWER: b 31. Which term reflects the proportions of muscle, bone, fat, and other tissue that make up a person’s total body weight? a. metabolic syndrome b. body weight distribution c. body mass index d. body composition e. relative energy index ANSWER: d 32. Which of the following would NOT be considered a valid recommendation for accepting a healthy body weight? a. Seek the advice of friends and the fashion industry for criteria regarding appearance and body size. b. Use positive, nonjudgmental descriptions of your body. c. Accept positive comments from others. d. Seek professional counseling to make gains in self-esteem beyond a focus on weight. e. Never restrict food intake below the minimum levels that meet nutrient needs. ANSWER: a 33. An index of a person’s weight in relation to height is called a. body mass index b. height-to-weight index c. ideal body weight index d. desirable body weight index e. BMR

ANSWER: a Page 7

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Chapter 08- Energy Balance and Body Composition 34. Signs of illness, diminished work capacity, and poor reproductive function become apparent when the BMI is below ________. a. 12 b. 14 c. 17 d. 18.5 e. 20 ANSWER: c 35. Which of the following represents the BMI of a person classified as overweight? a. 15 b. 18.5 c. 22 d. 27 e. 34 ANSWER: d 36. Which of the following represents the BMI of a person classified as obese? a. 15 b. 18.5 c. 22 d. 27 e. 34 ANSWER: e 37. Which of these is a feature of the body mass index? a. It correlates with disease risks. b. It decreases by 1 unit for every 20 years of life. c. It provides an estimate of the total amount fat level of the body. d. It is defined as the person’s height divided by the square of the weight. e. It is defined as the estimates amounts and percentage of muscle mass in the body. ANSWER: a 38. Which of the following can be used to gauge the amount of a person’s abdominal fat or central obesity? a. BMI b. height c. age d. waist circumference e. Cholesterol Levels. ANSWER: d Page 8

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Chapter 08- Energy Balance and Body Composition 39. A high risk of weight-related health problems is seen in women whose waist circumference begins to exceed ________inches. a. 26 b. 29 c. 35 d. 42 e. 55 inches ANSWER: c 40. Body fat content for normal-weight men 20–39 years of age should be a. 5–10% b. 18–21% c. 22–30% d. 32–40% e. 41–47%

ANSWER: b 41. What is the range of body fat content for normal-weight women 20–39 years of age? a. 5–10% b. 18–22% c. 23–26% d. 28–32% e. 31–34% ANSWER: c 42. What is the approximate body mass index of a woman who is 5 ft 5 in. and 215 lb? a. 21 b. 26 c. 31 d. 36 e. 40 ANSWER: d 43. Which person would need more body fat than the others? a. a professional ballet dancer b. a pregnant woman c. a high school basketball player d. A ranch hand in Phoenix, Arizona e. A bodybuilder ANSWER: b Page 9

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Chapter 08- Energy Balance and Body Composition 44. Which term refers to fat stored within the abdominal cavity in association with the internal abdominal organs? a. visceral fat b. subcutaneous fat c. waist fat d. dual fat e. ectopic fat ANSWER: a 45. Which statement accurately describes fat distribution? a. Subcutaneous fat is called “central obesity.” b. Central obesity does not contribute to heart disease, cancers, and diabetes. c. Subcutaneous fat contributes to heart disease, cancers, and diabetes. d. Visceral fat is most common in women. e. Body fat around the hips and thighs is most common in women during their reproductive years. ANSWER: e 46. In general, woman with a waist circumference greater than inches and men with a waist circumference of greater than inches have a high risk of central-obesity-related health problems. a. 24, 32 b. 27, 38 c. 35, 40 d. 38, 27 e. 40, 35 ANSWER: c 47. Research shows less susceptibility to health problems when excess body fat is distributed around the a. stomach b. arms and chest c. hips and thighs d. face and neck e. shoulders

ANSWER: c

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Chapter 08- Energy Balance and Body Composition 48. To assess body composition and central obesity, health-care professionals most often use BMI and a. age and height b. essential body fat c. hydrodensitometry d. waist circumference e. adaptive thermogenesis efficiency ANSWER: d 49. Research shows high susceptibility to health problems when excess body fat is distributed around the a. neck b. abdomen c. hips and thighs d. arms and shoulders e. lower legs and feet

ANSWER: b 50. Research shows that excess body fat distributed primarily around the abdomen a. is related directly to exercise b. lowers the risk for diabetes c. is less common in women past menopause d. is associated with increased mortality for both sexes e. is related to heart disease risk but not cancer

ANSWER: d 51. Which method to assess body fat weighs a person on land and then again while submerged in water? a. hydrodensitometry b. skinfold measures c. bioelectrical impedance d. air-displacement plethysmography e. DXA scan ANSWER: a 52. Which method to assess body fat involves a chamber of computerized sensors, which is commonly called the “bod pod”? a. hydrodensitometry b. skinfold measures c. bioelectrical impedance d. air-displacement plethysmography e. DXA scan ANSWER: d Page 11

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Chapter 08- Energy Balance and Body Composition 53. A graph showing the relationship between mortality and body mass index is shaped like the a/n a. J b. S c. backslash d. inverted U e. forward slash

ANSWER: a 54. Obesity is second only to a. motor vehicle accidents b. tobacco c. underweight d. suicide e. alcohol

in causing premature deaths.

ANSWER: b 55. Which of the following is a health result of losing excess body weight? a. It begins atherosclerosis. b. It lowers HDL cholesterol. c. It increases insulin resistance. d. It raises the number of immune cells in adipose tissue. e. It lowers blood pressure. ANSWER: e 56. Which of the following is a metabolic consequence of obesity that precedes type 2 diabetes? a. subcutaneous fat b. insulin resistance c. thyroid insufficiency d. hypothalamic impedance e. islet cell pathology ANSWER: b 57. Fat that accumulates outside of adipose tissue is called “ a. visceral fat b. subcutaneous fat c. waist fat

.”

d. dual fat e. ectopic fat ANSWER: e Page 12

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Chapter 08- Energy Balance and Body Composition 58. What term refers to the combination of risk factors—elevated fasting blood glucose, hypertension, abnormal blood lipids, and abdominal obesity—that greatly increase a person’s risk of developing heart disease? a. metabolic syndrome b. progressive inflammatory disease c. ectopic cluster syndrome d. normal-weight obesity syndrome e. immunological disease ANSWER: a 59. Why are overweight or obese women at higher risk for cancer of the female reproductive system? a. Obese women are more sedentary, which promotes cancer development. b. Adipose tissue stores carcinogens in the body. c. Excess body fat produces more estrogen, which may promote the development of cancer. d. Obese women eat more food; therefore, they are exposed to more naturally occurring carcinogens. e. Obese women have impaired immune function, so their ability to deal with cancer-causing viruses is diminished. ANSWER: c 60. Research shows that a. less than 1% b. 2% c. 3.5% d. 5% e. 10%

of women have suffered from anorexia nervosa at some point in their lives.

ANSWER: a 61. Which term describes the combination of disordered eating, amenorrhea, and osteoporosis? a. female athlete triad b. triathlete medical disorder c. high stress tertiary disorder d. nonadaptable training syndrome e. athletic hormonal disruption ANSWER: a

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Chapter 08- Energy Balance and Body Composition 62. Which of the following represents the most common eating disorder among men and women of any age? a. athlete triad b. bulimia nervosa c. anorexia nervosa d. binge-eating disorder e. carbohydrate addiction ANSWER: d 63. Which term refers to a psychiatric disorder characterized by a preoccupation with building body mass? a. amenorrhea b. bulimia c. cathartic disordered eating d. muscle dysmorphia e. orthorexia nervosa ANSWER: d 64. Which term refers to a relatively new food practice that uses restrictive diets, ritualized eating patterns, and rigid food avoidance? a. amenorrhea b. bulimia c. cathartic disordered eating d. muscle dysmorphia e. orthorexia nervosa ANSWER: e 65. An agent that causes vomiting is a/n a. dysmorphia b. RED-S c. emetic d. cathartic e. laxative ANSWER: c 66. Which of the following describes a cathartic? a. strong laxative b. drug that induces vomiting c. device to measure skinfold thickness d. device to measure the energy of foods e. drug that reduces nausea ANSWER: a Page 14

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Chapter 08- Energy Balance and Body Composition 67. What is the first treatment objective when treating a patient with anorexia nervosa? a. stop weight loss b. eat foods with a lower energy density at first c. decrease physical activity d. eat foods with higher fiber content e. decrease fat intake ANSWER: a 68. What characterizes the eating pattern of people with bulimia nervosa? a. Binge eating usually occurs during the daytime as a reward for something done well. b. Binge eating often involves nutritious foods in overabundance. c. Binge eating typically occurs after a period of strict dieting. d. A binge-eating episode is usually completed within 20 minutes. e. Young women are particularly likely to have “binge buddies” with whom they binge. ANSWER: c 69. How is binge eating different from bulimia nervosa? a. Binge-eaters are depressed; bulimics enjoy good mental health. b. Binge-eaters rarely purge. Bulimics almost always purge. c. Binge-eaters eat more during a binge session than do bulimics. d. Binge-eaters follow stricter diets than do bulimics. e. Binge-eaters are more normal weight than are bulimics. ANSWER: b 70. The integrated response to the sight, smell, thought, or taste of food that initiates or delays eating is called “ ______ _.” ANSWER: appetite 71.

is the painful sensation caused by a lack of food that initiates food-seeking behavior. ANSWER: Hunger

72. A chemical produced in the brain that stimulates appetite is called “ ......................................... ” ANSWER: neuropeptide Y 73. The generation of heat is ____________________ _. ANSWER: thermogenesis 74. The energy needed to maintain life when a body is at complete digestive, physical, and emotional rest is called “ ______ _.” ANSWER: basal metabolism Page 15

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Chapter 08- Energy Balance and Body Composition 75. The body minus its fat is called “

.”

ANSWER: lean body mass 76. A person with a body mass index less than 18.5 is

ANSWER: underweight 77. The proportions of muscle, bone, fat, and other tissue that make up a person’s total body weight is the

ANSWER: body composition 78.

is an immunological response to cellular injury characterized by an increase in white blood cells. ANSWER: Inflammation

79. Excess fat in locations other than adipose tissue is

ANSWER: ectopic fat MATCHING a. 22 b. 30 c. 50 d. 75 e. 3500 f. Visceral fat g. Subcutaneous fat h. Sleep i. Satiety j. Hunger k. Malnutrition l. Appetite m. Ectopic fat n. Satiation o. Thermic effect p. Basal metabolism q. Bomb calorimeter r. Indirect calorimetry s. Metabolic syndrome t. Adaptive thermogenesis 80. Approximate number of kcalories in 1 pound of body fat ANSWER: e

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Chapter 08- Energy Balance and Body Composition 81. Percentage of fat per pound of weight gained over time ANSWER: d 82. Percentage of fat per pound of weight lost via starvation ANSWER: c 83. Instrument used to measure food’s energy value ANSWER: q 84. Technique used to measure the amount of oxygen consumed when a food burns ANSWER: r 85. Response to the thought of a favorite food ANSWER: l 86. Painful sensation that initiates food-seeking behavior ANSWER: j 87. A feeling that says “do not start eating again” ANSWER: i 88. A feeling that says “stop eating” ANSWER: n 89. Energy expended while resting quietly ANSWER: p 90. A factor that lowers basal metabolism ANSWER: h 91. A factor that raises basal metabolism ANSWER: k 92. Percentage of energy expended during digestion and absorption of protein ANSWER: b 93. Estimate of energy needed to process food ANSWER: o 94. Changes in energy expenditure due to physiological events ANSWER: t 95. The BMI of a healthy weight person ANSWER: a 96. Intra-abdominal fat ANSWER: f Page 17

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Chapter 08- Energy Balance and Body Composition 97. Fat stored directly under the skin ANSWER: g 98. Fat in locations other than adipose tissue ANSWER: m 99. Risk factor combination that increases heart disease risk ANSWER: s 100. Why is energy balance important for healthy living? ANSWER: People expend energy continuously and eat periodically to refuel. Ideally, their energy intakes cover their energy expenditures with little, or no, excess. Excess energy is stored as fat, and stored fat is used for energy between meals. The fat stores of even a healthy-weight adult represent an ample reserve of energy—50,000 to 200,000 kcalories. The amount of body fat a person deposits in, or withdraws from, storage on any given day depends on the energy balance for that day—the amount consumed (energy in) versus the amount expended (energy out). When a person is maintaining weight, “energy in” equals “energy out.” When the balance shifts, weight changes. Quick changes in body weight are not simple changes in fat stores. Weight gained or lost rapidly includes some fat, large amounts of fluid, and some lean tissues such as muscle proteins and bone minerals. Because water constitutes about 60% of an adult’s body weight, retention or loss of water can greatly influence body weight. Even over the long term, the composition of weight gained or lost is normally about 75% fat and 25% lean. During starvation, losses of fat and lean are about equal. Invariably, though, fat gains and losses are gradual. 101. Explain why a person might override feelings of hunger and satiety. ANSWER: Eating can be triggered by signals other than hunger, even when the body does not need food. Some people experience food cravings when they are bored or anxious. In fact, they may eat in response to any kind of stress, negative or positive. (“What do I do when I’m grieving? Eat. What do I do when I’m celebrating? Eat!”) Eating to relieve stress can easily lead to overeating (making especially poor food choices) and weight gain. Many people respond to external cues such as the time of day (“It’s time to eat”) or the availability, sight, and taste of food (“I’d love a piece of chocolate even though I’m full”). Environmental influences such as large portion sizes, favorite foods, or an abundance or variety of foods stimulate eating and increase energy intake. Cognitive influences—such as perceptions, memories, intellect, and social interactions—can easily lead to weight gain. Those who are overweight or obese may be especially susceptible to external cues that trigger hunger and the desire to eat. Eating can also be suppressed by signals other than satiety, even when a person is hungry. People with the eating disorder anorexia nervosa, for example, use tremendous discipline to ignore the pangs of hunger. Some people simply cannot eat during times of stress, negative or positive. (“I’m too sad to eat.” “I’m too excited to eat!”) Why some people overeat in response to stress and others cannot eat at all remains a bit of a mystery, although researchers are beginning to understand the connections between hormones, brain activity, mood, and “comfort foods.”

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Chapter 08- Energy Balance and Body Composition 102. Describe basal metabolism. Then, compare and contrast the basal metabolic rate with the resting metabolic rate. ANSWER: People expend energy when they are physically active, of course, but they also expend energy when they are resting quietly. In fact, quiet metabolic activities account for the largest share of most people’s energy expenditures. About two thirds of the energy the average person expends in a day supports the body’s basal metabolism. Metabolic activities include the lungs inhaling and exhaling air, the bone marrow making new red blood cells, the heart beating 100,000 times a day, and the kidneys filtering wastes—in short, they support all the basic processes of life. The basal metabolic rate (BMR) is the rate at which the body expends energy for these life-sustaining activities. The rate may vary from person to person and may vary for the same individual with a change in circumstance or physical condition. The rate is slowest when a person is sleeping undisturbed, but it is usually measured in a room with a comfortable temperature when the person is awake, but lying still, after a restful sleep and an overnight (12 to 14 hours) fast. A similar measure of energy output—called the “resting metabolic rate” (RMR)—is slightly higher than the BMR because its criteria for recent food intake and physical activity are not as strict. 103. List and briefly discuss three factors that increase the basal metabolic rate. Then list and briefly discuss three factors that decrease the metabolic rate. ANSWER:

The following factors increase the metabolic rate: Growth: In children, adolescents, and pregnant women, the BMR is higher. Height: In tall, thin people, the BMR is higher. Body composition (sex): The more lean tissue, the higher the BMR (which is why males usually have a higher BMR than females). Fever: Fever raises the BMR. Environmental temperature: Both heat and cold raise the BMR. Hormones (sex): The thyroid hormone thyroxine, for example, can speed up or slow down the BMR. Premenstrual hormones slightly raise the BMR. Smoking: Nicotine increases energy expenditure. Caffeine: Caffeine increases energy expenditure. The following factors decrease the metabolic rate: Age: Lean body mass diminishes with age, slowing the BMR. Body composition (sex): The more fat tissue, the lower the BMR (typically women). Stresses: Stresses (including many diseases and certain drugs) raise the BMR. Fasting/starvation: Fasting/starvation lowers the BMR. Malnutrition: Malnutrition lowers the BMR. Hormones (sex): The thyroid hormone thyroxine, for example, can speed up or slow down the BMR. Sleep: BMR is lowest when sleeping.

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Chapter 08- Energy Balance and Body Composition 104. Why is the body mass index a good method for assessing healthy weight? What two valuable pieces of information for assessing disease risk does it overlook? ANSWER: A range of healthy body weights has been identified using a common measure of weight and height— the body mass index. The body mass index (BMI) describes relative weight for height. Healthy weight falls between a BMI of 18.5 and 24.9, with underweight below 18.5, overweight above 25, and obese above 30. The prevalence of obesity in the United States has increased steadily in recent decades. More than two thirds of adults in the United States have a BMI greater than 25. Obesity-related diseases become evident beyond a BMI of 25. For this reason, a BMI of 25 for adults represents a healthy goal for overweight people and an upper limit for others. The lower end of the healthy range may be a reasonable target for severely underweight people. BMI values slightly below the healthy range may be compatible with good health if food intake is adequate, but signs of illness, reduced work capacity, and poor reproductive function become apparent when the BMI is below 17. Although weight measures are inexpensive, easy to take, and highly accurate, they fail to reveal two valuable pieces of information in assessing disease risk: how much of the weight is fat and where the fat is located. 105. How does the type of body fat and the distribution of that fat affect the risk of degenerative diseases? ANSWER: The location of fat on the body may influence health as much as, or more than, total fat alone. Visceral fat that is stored around the organs of the abdomen is referred to as “central obesity” or “upper-body fat.” Much research supports the widely held belief that central obesity—significantly and independently of BMI—contributes to heart disease cancers, diabetes, and related deaths. Visceral fat is most common in men and to a lesser extent in women past menopause. Even when total body fat is similar, men have more visceral fat than women. Subcutaneous fat around the hips and thighs, sometimes referred to as “lower-body fat,” is most common in women during their reproductive years, and is associated with lower heart disease risks. Central obesity may raise the risk of heart attack and stroke as much as the three leading risk factors (high LDL cholesterol, hypertension, and smoking) do. In addition to body fat, weight gain also increases the risk of cardiovascular disease. Weight loss, on the other hand, can effectively reverse atherosclerosis and lower both blood cholesterol and blood pressure in overweight and obese people. Of course, lean and normal-weight people may also have high blood cholesterol and blood pressure, and these factors are just as dangerous in lean people as in obese people. Obese people who do not have high blood cholesterol, high blood pressure, or other indicators of heart disease tend to have more a favorable fat distribution and may be described as “metabolically healthy,” with lower risks for heart disease. Type 2 diabetes is three times more likely to develop in an obese person than in a nonobese person. Furthermore, the person with type 2 diabetes often has central obesity. Central-body fat cells appear to be larger and more insulin-resistant than lower-body fat cells. The association between insulin resistance and obesity is strong, and both are major risk factors for the development of type 2 diabetes.

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Chapter 08- Energy Balance and Body Composition 106. What are some health risks for those who are underweight? ANSWER: An underweight person, especially an older adult, may be unable to preserve lean tissue during the fight against a wasting disease such as cancer or a digestive disorder, especially when the disease is accompanied by malnutrition. Without adequate nutrient and energy reserves, an underweight person will have a particularly tough battle against such medical stresses and face increased risks of mortality following surgeries. Underweight women develop menstrual irregularities and become infertile. Those who do conceive may give birth to unhealthy infants. An underweight woman can improve her chances of having a healthy infant by gaining weight prior to conception, during pregnancy, or both. Underweight and significant weight loss are also associated with osteoporosis and bone fractures. For all these reasons, underweight people may benefit from enough of a weight gain to provide an energy reserve and protective amounts of all the nutrients. 107. How is chronic inflammation linked to metabolic syndrome? ANSWER: Chronic inflammation accompanies obesity, and inflammation contributes to chronic diseases. As a person grows fatter, lipids first fill the adipose tissue and then migrate into other tissues such as the muscles and liver. Fatty liver is a major contributor to the many diseases associated with obesity. This accumulation of fat, especially in the abdominal region, changes the body’s metabolism, resulting in insulin resistance (and high blood glucose), low HDL cholesterol, high triglycerides, and high blood pressure. This cluster of symptoms—collectively known as the “metabolic syndrome”—increases risks for diabetes, hypertension, and atherosclerosis. Fat accumulation, especially in the abdominal region, activates genes that code for proteins (adipokines) involved in inflammation. Furthermore, although relatively few immune cells are commonly found in adipose tissue, weight gain significantly increases their number and their role in inflammation. Elevated blood lipids—whether due to obesity or to a highfat diet—also promote inflammation. Together, these factors help to explain why chronic inflammation accompanies obesity and how obesity contributes to the metabolic syndrome and the progression of chronic diseases. Even in healthy youngsters, body fat correlates positively with chronic inflammation. As might be expected, weight loss improves insulin resistance, reduces the number of immune cells in adipose tissue, and changes gene expression to reduce inflammation. 108. Harper is a teenaged competitive gymnast who has spent years restricting her eating habits to appear lean in her team leotard. What adverse consequences of Harper’s disordered eating habits are likely? ANSWER: A prolonged, inadequate energy intake has numerous adverse consequences. It leads to nutrient deficiencies (including anemia), chronic fatigue, and increased risk of infections and illnesses. Protein synthesis decreases and blood lipids increase, favoring heart disease. All of these consequences harm health and impair performance. Females commonly develop amenorrhea. The prevalence of amenorrhea among premenopausal women in the United States is about 2 to 5% overall, but among female athletes, it may be as high as 65 to 70%. Body fat stores and hormone levels are too inadequate to support normal menstruation. Amenorrhea is often accompanied by bone losses. In general, physical activity increases bone density, but for women with amenorrhea, physical activity increases bone losses and stress fractures. To grow strong bones, athletes should be encouraged to consume 1300 milligrams of calcium each day, to eat nutrient-dense foods, and to obtain enough energy to support both a healthy body weight and the energy expended in physical activity. Nutrition is critical to bone recovery.

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Chapter 08- Energy Balance and Body Composition 109. What is binge-eating disorder and how is it treated? ANSWER: People with binge-eating disorder typically consume less during a binge than do bulimics, rarely purge, and exert less restraint during times of dieting. Similarities also exist, including feeling out of control, disgusted, depressed, embarrassed, guilty, or distressed because of their self-perceived gluttony. There are also differences between obese binge eaters and obese people who do not binge. Those with bingeeating disorder report higher rates of self-loathing, disgust about body size, depression, and anxiety. Their eating habits differ as well. Obese binge eaters tend to consume more kcalories and more dessert and snack-type foods during regular meals and binges than obese people who do not binge. Binge eating may incur health risks greater than those of obesity alone. Some of the characteristics seen in people with binge-eating disorder are similar to those seen in people with substance-use disorders: strong cravings, poor self-control, a diminished sensitivity to pleasure, and patterns of compulsive use. These resemblances have given rise to the concept of food addictions and may reflect the same biological and psychological systems that are involved in rewards and selfcontrol. When the reward of delicious foods tempts a person, the ability to resist depends on selfcontrol. Neural images show that certain foods (especially those with added sugars and solid fats) have effects on the brain similar to those seen with addictive drugs. Dopamine activity—which helps to regulate emotional and motivational behavior—is also similarly altered in both drug addicts and those with compulsive eating behaviors. Binge eating can be resolved with treatment. Reducing binge eating makes participation in weightcontrol programs easier. It also improves physical health, mental health, and the chances of success in breaking the cycle of rapid weight losses and gains.

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 1. Over the past five decades, what proportion of the U.S. adult population is considered overweight or obese? a. 50% b. 60% c. 70% d. 80% e. 90% ANSWER: c 2. Which of the following statements accurately describes fat cell development? a. While fat cells grow and shrink in size, their number is fixed. b. An obese person has more and larger fat cells than does a healthy-weight person. c. The number of fat cells grows substantially during early adulthood, as energy expenditure begins to decline. d. Researchers have concluded there is no way to induce fat cell death. e. When energy out exceeds energy in, the number and size of fat cells decrease. ANSWER: b 3. Which of the following removes triglycerides from the blood for storage in fat and muscle cells? a. Glucagon b. Lipoprotein lipase c. Cellulite synthetase d. Lipoprotein synthetase e. Adipose lipase ANSWER: b 4. Women readily develop lower body fat around the hips and thighs and men readily develop central body fat around the abdomen. This primarily is due to gender differences in a. blood insulin levels. b. the activity of lipoprotein lipase. c. set points. d. the activity of lipoprotein synthetase. e. patterns of physical activity. ANSWER: b 5. Which of the following defines the body’s set point? a. a person’s minimum healthy weight b. a person’s maximum healthy weight c. point at which a person’s weight plateaus before dropping again quickly d. point above which the body tends to lose weight and below which it tends to gain weight e. point at which all LPL activity ceases ANSWER: d Page 1

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 6. What is Prader–Willi syndrome? a. altered receptor activity for ghrelin b. a genetic disorder resulting in obesity c. fat accumulation in the liver of leptin-resistant patients d. a failure to adapt to alternating periods of excess and inadequate energy intake e. a genetic disorder characterized by loss of appetite ANSWER: b 7. About how many sites in the human genome are associated with obesity and fat? a. 10 b. 50 c. 100 d. 500 e. 1000 ANSWER: c 8. Which of the following statements accurately describes weight gain and genetics? a. Obese people can change their genome and influence their epigenome. b. Exercise has little, if any, effect on the genetic influence on weight gain. c. Fraternal twins are more likely to weigh the same than are identical twins. d. Adopted children tend to have body weights more like their biological parents than like their adoptive parents. e. Most cases of obesity stem from a single gene. ANSWER: d 9. Which of the following is a protein produced by fat cells under the direction of the ob gene that decreases appetite and increases energy expenditure? a. leptin b. ghrelin c. elastin d. brite e. collagen ANSWER: a 10. Leptin acts as a hormone, primarily in the a. pancreas b. intestines c. liver d. hypothalamus e. hippocampus

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 11. Which of the following is a protein that stimulates appetite and decreases energy expenditure? a. leptin b. ghrelin c. elastin d. brite e. collagen ANSWER: b 12. Ghrelin is secreted by cells in the a. pancreas b. stomach c. liver d. hypothalamus e. hippocampus

ANSWER: b 13. What happens to leptin and ghrelin levels when someone is sleep-deprived? a. Both leptin and ghrelin increase. b. Both leptin and ghrelin decrease. c. Leptin decreases while ghrelin increases. d. Leptin increases while ghrelin decreases. e. No significant effects are observed. ANSWER: c 14. The uncoupling proteins in adipose tissue a. increase the amount of energy released as heat b. reduce the number of fat cells c. lower basal metabolism d. increase the number of fat cells e. increase the size of fat cells

ANSWER: a

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 15. Newborn babies are poorly insulated and cannot shiver when exposed to cold temperatures. What type of adipose tissue helps infants generate heat when it is cold? a. black b. white c. brown d. yellow e. red ANSWER: c 16. Which of the following statements accurately describes the “browning” of white fat cells? a. White fat cells undergo browning when they take on the activity of coupled proteins. b. White fat cells with brown fat cell characteristics are sometimes called “beige adipocytes.” c. Brown fat cells are more abundant than brite fat cells in adults. d. Interestingly, physical activity stops the browning process. e. After much study, researchers have found little connection between GI microbiota and the browning process. ANSWER: b 17. Some white fat cells can undergo a process known as browning as they take on characteristics of brown fat, most notably the activity of uncoupled proteins. What are these fat cells called? a. leptin b. ghrelin c. WAT d. BAT e. brite ANSWER: e 18. Of the following, which provides an example of an obesogenic environment? a. Airlines have increased the length of all seatbelts. b. Many companies provide employees with free memberships to local exercise facilities. c. Celebrations often involve cake and alcoholic drinks. d. Some high-end designers refuse to sell clothing in plus sizes. e. Advertisements for weight-loss products and gyms frequently run in January. ANSWER: c

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 19. What is a potential problem with using diet histories to gauge energy intake? a. They focus primarily on past energy intakes and ignore current activity. b. They do not factor into the energy balance equation. c. Obese people tend to overestimate energy intakes, while normal-weight people tend to underestimate energy intakes. d. Both normal-weight and obese people commonly misreport actual energy intakes. e. Past diet histories are less useful given today’s abundance of fast-food options. ANSWER: d 20. Studies report that the differences in the time obese and lean people spend lying, sitting, standing, and moving account for about kcalories per day. a. 150 b. 350 c. 550 d. 750 e. 1500 ANSWER: b 21. Which statement about perceptions of obesity is FALSE? a. Many people assume that every obese person can and should achieve slenderness. b. People are born and raised with various weight tendencies. c. Obese people often are judged more on their appearance than on their character. d. In parts of society, overweight is embraced as a sign of health and beauty. e. Most weight-loss programs focus on willpower, hard work, and tending the psychological issues associated with obesity. ANSWER: e 22. A reputable weight-loss program will provide customers with honest predictions of success and a. with testimonials from previous, successful users b. with testimonials from medical professionals

c. with statistics on weight cycling d. will list the psychological benefits of weight loss e. will explain the associated risks ANSWER: e

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 23. Weight loss is recommended for people who are obese (BMI 30) and for those who are overweight (BMI 25 to 29.9) with which of the following obesity-related risk factors? a. hypertension, sleep apnea, fatty liver b. poor eyesight, poor hearing, IBS c. Alzheimer’s alcoholism, anorexia d. hair loss, constipation, type 1 diabetes e. none of these are correct. ANSWER: a 24. Of the following, which would be considered a fad diet? a. eating only cold, green foods for one month b. joining WW (formerly, Weight Watchers) and a gym c. eating mostly a plant-rich diet d. adding time and new activities to a current workout plan e. limiting sweets to once per month ANSWER: a 25. Which is true of nonprescription weight-loss products? a. They must be approved by the FDA. b. They must be tested for safety and effectiveness by the manufacturer. c. They must list all active and nonactive ingredients on the label. d. Most have proved to be effective. e. Many have proved to be harmful. ANSWER: e 26. Last year, an overweight woman was classified as “obese” based on her BMI. Since then, she has gained more weight and developed type 2 diabetes. She will be categorized as having “critically severe obesity” as soon as her BMI reaches ________ _. a. 25 b. 30 c. 33 d. 35 e. 40 ANSWER: d

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 27. A less-preferred term for clinically severe obesity is a. morbid obesity b. metabolic syndrome

c. leptin-resistant obesity d. psychological-resistant syndrome e. Prader–Willi syndrome ANSWER: a 28. Which of the following statements accurately describes the use of prescription drugs to treat obesity? a. Drug therapies should be considered for both cosmetic and health reasons. b. Most experts believe obesity is not a disease, so drugs should not be prescribed. c. Most currently available drugs are proven effective in both the short and long term. d. Physicians may prescribe “off-label” drugs to take advantage of their modest weight-loss effects. e. Although initially effective, most drugs have eventually raised the risk of cardiovascular disease to unacceptable levels. ANSWER: d 29. The prescription drug orlistat acts by a. inhibiting pancreatic lipase b. regulating the utilization of norepinephrine c. increasing metabolism

d. regulating brain serotonin receptors e. releasing ghrelin and leptin ANSWER: a 30. Your patient, Mr. Sinclair, has a BMI of 43 and wants to begin taking drugs to lose weight. He has glaucoma, but is otherwise healthy. Which of the following should NOT be prescribed for Mr. Sinclair? a. olestra b. orlistat c. serotonin d. phentermine e. Belviq ANSWER: d

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 31. The prescription drug phentermine acts by regulating a. blood insulin b. norepinephrine

c. hormone-sensitive lipase d. adipocyte lipoprotein lipase e. leptin and insulin ANSWER: b 32. In which procedure is 70 to 85% of the stomach removed and the rest stapled to create a vertical tube-shaped stomach with limited capacity? a. gastric bypass b. gastric banding c. sleeve gastrectomy d. liposuction e. gastric aspiration ANSWER: c 33. Which of the following procedures is more cosmetic and has little effect on body weight? a. gastric bypass b. gastric banding c. sleeve gastrectomy d. liposuction e. gastric aspiration ANSWER: d 34. For overweight adults, a reasonable weight loss is a. ½ pound per day b. ½ to 2 pounds per week c. ½ to 2 pounds per month d. 1 pound per day

e. 10% of body weight per month ANSWER: b 35. To maintain weight loss, one should aim to lose 5 to 10% of initial body weight in a. 6 weeks b. 3 months

c. 6 months d. 9 months e. 1 year ANSWER: c Page 8

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 36. Improvements in physical capabilities and quality of life begin with a a. 5% b. 10% c. 15% d. 25% e. 30%

weight loss.

ANSWER: a 37. Those on a weight-loss regimen should aim to create an energy intake deficit of a. 100 b. 250 c. 500 d. 1000 e. 1500

kcalories per day.

ANSWER: c 38. In general, weight-loss diets need to provide a minimum of a. 500 b. 800

kcalories per day for women.

c. 1200 d. 1600 e. 1800 ANSWER: c 39. In general, weight-loss diets need to provide at least of a. 800 b. 1000 c. 1200 d. 1600 e. 2000

kcalories per day for men.

ANSWER: d 40. Which of the following reflects the importance of eating breakfast? a. Skipping breakfast reduces energy intake and causes weight loss. b. Eating breakfast just once each week has the same benefits as eating breakfast every day. c. People who eat breakfast frequently have a lower BMI than those who avoid breakfast. d. People who skip breakfast have lower daily energy intakes than breakfast eaters. e. The “dinner diet” has proven more effective than the “breakfast diet.” ANSWER: c Page 9

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 41. Which statement accurately reflects the relationship between the speed at which one eats and weight management? a. People who eat slowly have greater energy intake. b. Faster eating correlates with higher BMI. c. Eating quickly stimulates the pleasure centers of the brain faster and leads to faster satiety. d. Satiety hormones are blunted when meals are eaten more slowly. e. Faster eating correlates with higher diet-induced thermogenesis. ANSWER: b 42. Savoring each bite also activates? a. pleasure centers of the brain b. ghrelin c. white adipose tissue d. brown adipose tissue e. Prader–Willi syndrome ANSWER: a 43. Using large quantities of low-energy-density foods in a diet is sometimes referred to as “ a. calometrics b. minimetrics c. densification d. volumetrics e. substitution

.”

ANSWER: d 44. Plant-based foods such as fresh fruits, vegetables, legumes, and whole grains and vegetarian eating patterns may help with weight management in addition to . a. improving symptoms of IBS b. improving symptoms of gastrointestinal diseases c. improving leptin and ghrelin d. improving inflammation that accompanies obesity e. all of these are correct ANSWER: d

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 45. To prevent weight gain and support weight loss, one should add activity each week. a. 30–60 b. 60–90 c. 90–120 d. 120–200 e. 200–300

minutes of moderately intense physical

ANSWER: e 46. Which of the following statements about physical activity is true? a. The number of kcalories spent in an activity depends on body weight, intensity, and duration. b. Physical activity increases the energy required to meet nutrient needs. c. Physical activity cannot reduce abdominal fat without weight loss. d. Being active increases hunger. e. Physical activity does not affect metabolism. ANSWER: a 47. The postexercise effect on one’s metabolism may raise energy expenditure to a maximum of a. 5% b. 10% c. 15%

d. 20% e. 25% ANSWER: c 48. Jules burns 100 kcalories during her morning walk. How many additional kcalories is she likely to burn in the postexercise period? a. 10 b. 15 c. 30 d. 45 e. 60 ANSWER: b

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 49. Which of the following statements about physical activity and weight loss is FALSE? a. Strength and balance improve when exercise is part of a weight-loss program. b. The greater the energy deficit created by exercise, the greater the fat loss. c. Using discretionary kcalories will maximize weight loss. d. Daily vigorous activities gradually develop more lean tissue. e. Even with the same BMI, physically active people have less body fat than sedentary people. ANSWER: c 50. Why is appetite suppressed after intense exercise? a. Thirst overpowers the desire for food and water is satiating. b. The elevated blood lactate level antagonizes ghrelin. c. Glucose and fatty acids are abundant in the blood. d. Exercise causes smell and taste to be suppressed for at least an hour. e. Leptin secretion increases during workouts. ANSWER: c 51. Meeting an activity goal of a. 2,500 b. 5000 c. 7500

steps a day is an excellent way to support a healthy BMI.

d. 10,000 e. 15,000 ANSWER: d 52. Which of the following is related to “spot reducing” to exercise? a. No exercise can target fat removal from any specific area of the body. b. Upper body fat is mostly unaffected by exercising lower body. c. Lower body fat in women is depleted at a faster rate. d. Abdominal fat is released more readily with anaerobic exercise. e. Muscles own fat cells that surround them. . ANSWER: a 53. Of the following, which is an example of a behavior-modification technique for weight loss?Of the following, which is an example of a behavior-modification technique for weight loss? a. Create a blog about your overeating habits to create a like-minded community. b. Download an app to keep a record of your eating and exercise habits. c. Create the “Clean Plate Club” at home and reward family members appropriately. d. Eat with a buddy who will monitor your food intake. e. Cook your own meals and eat alone to focus on your own habits. ANSWER: b Page 12

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 54. Health care professionals suggest setting SMART goals to change one’s eating behaviors. What does SMART stand for? a. specific, measurable, attainable, relevant, time-based b. specific, meaningful, analytic, relevant, technological c. sensitive, minimal, accessible, reliable, time-bound d. supportive, media-based, attainable, repeatable, tertiary e. supportive, minimal, analytic, reliable, technological ANSWER: a 55. Which of the following reflects a SMART goal? a. I want to live to see my grandchildren grow up. b. I want to be at my healthiest weight by my next doctor’s appointment. c. I will eat only healthy foods. d. I will eat a healthy breakfast and run 3 miles every day. e. I will start running 2 miles every morning and then run a marathon next month. ANSWER: d 56. To maximize the long-term success of a weight-reduction program, a person should a. strongly believe that he can successfully lose weight b. realize that being “the overweight one” is an unchangeable part of his identity

c. consider a short-term smoking program d. accept that little exercise is a part of his lifestyle and act accordingly e. keep weight loss plans private matter to avoid embarrassment if they fail ANSWER: a 57. When people give up cigarettes, they gain an average of a. 5 b. 10 c. 15

pounds in the first year.

d. 25 e. 30 ANSWER: b 58. Successful behavior changes depend in part on two cognitive skills. What are they? a. problem solving and cognitive restructuring. b. using apps to support behavioral changes c. including a plant-based diet d. thermogenesis e. effects of leptin on the hypothalamus. ANSWER: a Page 13

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 59. Weight maintenance may require a person to expend a minimum of week. a. 500 b. 1250 c. 1500 d. 2500 e. 3500

kcalories in physical activity per

ANSWER: d 60. The National Weight Control Registry tracks over 10,000 individuals who have maintained a significant weight loss over time. Strategies of those who have been successful may differ in the details, but in general, most do the following: a. Limit television to less than 10 hours a week b. Join a gym or a fitness center c. Consume a very-low-caloric diet d. Get pharmacological support e. Follow a diet that is energy-dense ANSWER: a 61. Obesity has many causes and is a risk factor for many diseases; therefore, the best approach seems to be ________. a. fasting b. medicines c. prevention d. epigenetic counseling e. a holistic one ANSWER: c 62. About how many U.S. adults are underweight? a. .2% b. 2% c. 5% d. 10% e. 15% ANSWER: b

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 63. Trevor is an underweight long-distance runner. To achieve a healthy body weight to improve his performance, he must _______ _. a. eat a high-kcalorie diet and exercise regularly b. eat a high-kcalorie diet and reduce his exercise to minimal amounts c. eat a high-protein diet plus exercise regularly d. eliminate alcohol and exercise from his life e. eat a high-protein, high-kcalorie diet and reduce his exercise to minimal amounts ANSWER: a 64. A person is considered underweight until his BMI reaches a. 18.5 b. 20 c. 22.5 d. 25 e. 30

ANSWER: a 65. Which of the following would NOT be part of a successful program of weight gain in an underweight individual? a. eat energy-dense foods b. drink energy-dense beverages c. eat a large number of meals all day d. engage in regular physical exercise e. consume extra snacks. ANSWER: c 66. Underweight people expend so much energy adapting to a higher food intake at first that about kcalories may be needed to gain a pound a week. a. 350 b. 500 c. 750 d. 900

extra

e. 1200 ANSWER: c

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 67. Why do fad diets appeal to so many Americans? a. They are based on years of credible, but previously unpublished, research. b. They ignore dietary recommendations and allow people to eat favorite foods freely. c. They offer inexpensive, proven results. d. They are paired with sophisticated testimonials from knowledgeable nutritionists. e. They provide long-lasting results. ANSWER: b 68. Why do fad diets typically produce weight loss, at least for a short time? a. They suggest the correct amount macronutrients needed in the diet. b. They prevent rapid rises and falls in blood glucose level. c. They do not require kcalorie counting, so compliance is better. d. They limit energy intake to about 1200 kcal/day. e. They are enthusiastically followed by those trying to lose some weight. ANSWER: d 69. Most fad diets . a. produce long-lasting results b. limit food choices, which reduces energy intake c. are balanced and do not require a dietary supplement d. support good health over the long term e. embrace a variety of foods by proposing how to proportion energy nutrients ANSWER: b 70. Your friend Jody considers following a popular diet plan. She shows you the description of the plan in a magazine. Which of the following statements in the magazine would suggest that this plan is an unsound, fad diet? a. “Lose up to 2 pounds per week!” b. “This fat-busting plan jump starts your metabolism and allows you to target problem areas like hips and thighs.” c. “Keep fresh fruit or carrot sticks in the fridge at work so you won’t be tempted to raid the vending machine for a snack.” d. “Starting an aerobic exercise plan may seem daunting, but you can start out with shorter, easier sessions and then build up to 3 or more hours a week.” e. “Improve your health with well-balanced meals and increased physical activity.” ANSWER: b 71.

involves maintaining body mass in a healthy range by preventing gradual weight gains over time and losing weight if overweight. ANSWER: Weight management

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 72. The theory relates to body weight and proposes that the body tends to maintain a certain weight by means of its own internal controls. ANSWER: set point 73. The study of the influence of environmental factors, such as diet and physical activity, on gene expression is called “ ______ _.” ANSWER: epigenetics 74. A condition in which leptin levels are increased and leptin sensitivity is decreased is

ANSWER: leptin resistance 75. White fat cells with brown fat cell characteristics are called

ANSWER: brite adipocytes, or beige adipocytes 76. All the genetic information of a population at a given time is called a “................. ” ANSWER: gene pool 77. An eating plan that promises quick weight loss if an individual never eats any dairy products would be called a “ ______ _.” ANSWER: fad diet 78. The term

means pertaining to the field of medicine that specializes in treating obesity.

ANSWER: bariatric 79.

is a technique that uses a tube to empty the contents of the stomach after every meal. ANSWER: Gastric aspiration

80.

involves the changing of antecedents, behaviors, and consequences. ANSWER: Behavior modification Match the appropriate receptor to the correct description. Some choices may be used more than once. a. 2 b. 40 c. 70 d. 200–300 e. Intragastric balloon f. Yo-yo dieting g. Leptin h. Phentermine i. Ghrelin j. Orlistat Page 17

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight k. Set point l. White fat m. Stomach n. Brown fat o. Brite adipocytes p. Liposuction q. Underweight r. Lipoprotein lipase s. Spot reducing t. Obesogenic environment 81. Percentage of overweight or obese adults in the United States ANSWER: c 82. An enzyme that participates in the development of obesity ANSWER: r 83. Daily circumstances that push people toward fatness ANSWER: t 84. A theory that the body tends to maintain a certain weight by internal controls ANSWER: k 85. Weight cycling resulting from sporadic restrictive dieting ANSWER: f 86. Nicknamed the satiety hormone ANSWER: g 87. Nicknamed the hunger hormone ANSWER: i 88. Cells that secret ghrelin ANSWER: m 89. Adipose tissue that primarily stores fat for other cells to use as energy ANSWER: l 90. Adipose tissue that primarily releases stored energy as heat ANSWER: n 91. White fat cells with brown fat cell characteristics ANSWER: o 92. Attempt to lose weight in “problem areas” of the body ANSWER: s Page 18

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 93. Classification for body weight below what is considered healthy ANSWER: q 94. FDA-approved drug that inhibits pancreatic lipase ANSWER: j 95. FDA-approved drug with no known GI side effects ANSWER: h 96. Minimum BMI of a person classified as clinically severe obese ANSWER: b 97. A cosmetic weight-loss procedure ANSWER: p 98. A saline-filled silicone device in the stomach to limit food intake ANSWER: e 99. Minimum number of minutes per week of moderately intense physical activity to prevent weight gain ANSWER: d 100. Percentage of underweight U.S. adults ANSWER: a 101. Discuss how fat cells develop in number and size and how this may lead to obesity and other health risks. ANSWER: When “energy in” exceeds “energy out,” much of the excess energy is stored in the fat cells of adipose tissue. The amount of fat in adipose tissue reflects both the number and the size of the fat cells. The number of fat cells increases most rapidly during the growing years of late childhood and early puberty. After growth ceases, fat cell numbers may continue to increase whenever energy balance is positive. Obese people have more fat cells—as well as larger fat cells—than healthy-weight people. As fat cells accumulate triglycerides, they expand in size. When the cells enlarge, they stimulate cell proliferation so that their numbers increase again. Thus, obesity develops when a person’s fat cells increase in number, in size, or quite often both. When “energy out” exceeds “energy in,” the size of fat cells dwindles, but not their number. People with extra fat cells tend to regain lost weight rapidly; with weight gain, their many fat cells readily fill. In contrast, people with an average number of enlarged fat cells may be more successful in maintaining weight losses; when their cells shrink, both cell size and number are normal. Prevention of obesity is most critical, then, during the growing years of childhood and adolescence, when fat cells increase in number. Researchers are exploring ways to induce fat cell death—which would decrease the number. As mentioned earlier, excess fat first fills the body’s natural storage site—adipose tissue. If fat is still abundant, the excess is deposited in organs such as the heart and liver. Fat that accumulates outside of adipose tissue—called “ectopic fat”—disrupts normal metabolism and contributes to the development of diseases such as heart failure and fatty liver. As ectopic fat accumulates, metabolic changes that indicate disease risk—such as insulin resistance—become apparent and chronic inflammation develops.

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 102. How do leptin and ghrelin work to control food intake? What role does leptin play in genetic causes of obesity? ANSWER: Researchers have identified an obesity gene, called ob, which is expressed primarily in the adipose tissue and codes for the protein leptin. Leptin acts as a hormone, primarily in the hypothalamus. Leptin maintains homeostasis by regulating food intake and energy expenditure in response to adipose tissue. When body fat increases, leptin increases—which suppresses appetite. When body fat decreases, leptin decreases—which stimulates appetite and suppresses energy expenditure. Although extremely rare, a genetic deficiency of leptin or genetic mutation of its receptor has been identified in human beings as well. Extremely obese children with barely detectable blood levels of leptin have little appetite control; they are constantly hungry and eat considerably more than their siblings or peers. Given daily injecti ons of leptin, these children lose a substantial amount of weight, confirming leptin’s role in regulating appetite and body weight. Very few obese people have a leptin deficiency, however. In fact, leptin levels increase as BMI increases. Leptin rises but fails to suppress appetite or enhance energy expenditure—a condition researchers describe as “leptin resistance.” With weight loss, leptin levels decline, which reduces satiation and challenges weight loss maintenance; leptin injections effectively increase satiation after weight loss. Another protein—ghrelin—also acts as a hormone primarily in the hypothalamus. In contrast to leptin, ghrelin is secreted primarily by the stomach cells and promotes eating and weight gain by increasing smell sensitivity, stimulating appetite, and promoting efficient energy storage. Ghrelin triggers the desire to eat. Blood levels of ghrelin typically rise before and fall after a meal—reflecting the hunger and satiety that precede and follow eating. On average, ghrelin levels are high whenever the body is in negative energy balance, as occurs during low-kcalorie diets, for example. This response may help explain why weight loss is so difficult to maintain. Weight loss is more successful with exercise and after gastric bypass surgery, in part because ghrelin levels are relatively low. Ghrelin levels decline again whenever the body is in positive energy balance, as occurs with weight gains. Some research indicates that ghrelin also promotes sleep. Interestingly, a lack of sleep increases the hunger hormone ghrelin and decreases the satiety hormone leptin—which may help to explain the association between inadequate sleep and overweight.

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 103. How do white fat cells differ from brown fat cells and from brite fat cells? ANSWER: The body has different types of adipose tissue and the quantities of each is determined by genes. White adipose tissue stores fat for other cells to use for energy; brown adipose tissue releases stored energy as heat, thus defending against cold and preventing obesity. In coupled reactions, the energy released from the breakdown of one compound is used to create a bond in the formation of another compound. For example, when fat is oxidized, some of the energy is released in heat and some is captured in the formation of ATP. Metabolism in brown adipose tissue differs; oxidation is uncoupled from ATP formation. In uncoupled reactions, all of the energy is released as heat. By radiating energy away as heat, the body expends, rather than stores, energy. In contrast, efficient coupling facilitates synthesis reactions, including the making of fat for storage. In other words, weight gains or losses may depend on whether the body dissipates the energy from an ice cream sundae as heat or stores it in body fat. Brown fat and heat production is particularly important in newborn infants and in animals exposed to cold weather, especially those that hibernate. They have plenty of brown adipose tissue. In contrast, human adults have little brown fat, stored primarily around the neck and clavicle. Brown fat is most metabolically active during exposure to cold. Importantly, brown fat activity declines with age and with obesity; overweight and obese individuals have less brown fat activity than others. The role of brown fat in body weight regulation is not yet fully understood, but such an understanding may prove most useful in developing obesity treatments. Some white fat cells can undergo a process known as “browning” as they take on characteristics of brown fat, most notably the activity of uncoupled proteins; these fat cells are called “brite adipocytes.” Brite fat cells are far more abundant than brown fat cells in adults. By learning how browning is regulated, researchers hope to tilt energy balance from storage to expenditure in the effort to fight obesity. Interestingly, among the factors that trigger browning is physical activity. During exercise, muscle cells release a protein (the myokine irisin) that triggers the transformation of white fat cells into brite fat cells. Such findings help explain one of the many ways physical activity expends energy and supports weight management. Another factor gaining attention for its influence on the browning of white fat cells is the GI microbiota; the GI microbiota in people who are obese tend to be more limited in diversity and in activity than those in people who are not overweight.

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 104. What perceptions and prejudices do overweight and obese people face? ANSWER: Many people assume that every obese person can achieve slenderness and should pursue that goal. First, consider that most obese people do not—for whatever reason—successfully lose weight and maintain their losses. Then consider the prejudice involved in that assumption. People come with varying weight tendencies, just as they come with varying potentials for height and physical talents. Large segments of our society place such enormous value on thinness that obese people face prejudice and discrimination on the job, at school, and in social situations: they are judged on their appearance more than on their character. Socially, obese people are negatively stereotyped as lazy and lacking in self-control. Such a critical view of overweight is not prevalent in many other cultures, including segments of our own society. Instead, overweight is simply accepted or even embraced as a sign of robust health and beauty. To free society of its obsession with body weight and prejudice against obesity, people must first learn to judge others—and themselves—for who they are and not for what they weigh. Psychologically, obese people may suffer embarrassment when others treat them with hostility and contempt, and many have come to view their own bodies as flawed. Feelings of rejection, shame, and depression are common among obese people. Anxiety and depression, in turn, may contribute to the development of obesity, which perpetuates the problem. Most weight-loss programs assume that the problem can be solved simply by applying willpower and hard work. If determination were the only factor involved, though, the success rate would be far greater than it is. Overweight people may readily assume blame for failure to lose weight and maintain the losses when, in fact, it is the programs that have failed. Ineffective treatment and its associated sense of failure add to a person’s psychological burden.

105. Describe three bariatric surgical procedures, including the overall benefits and adverse side effects. ANSWER: In gastric bypass, the surgeon constructs a small gastric pouch and connects it directly to the jejunum so that the flow of food bypasses a substantial portion of the small intestine. In gastric banding, the surgeon creates a small gastric pouch using an inflatable band placed near the top of the stomach. The band is tightened or loosened by adding or removing fluid via an access port placed under the skin. Finally, in sleeve gastrectomy, the surgeon removes 70 to 85% of the stomach and staples the remaining portions together to create a vertical tube-shaped stomach with limited capacity. Almost 200,000 such surgeries are performed in the United States annually. Bariatric surgery suppresses hunger and alters metabolism by changing the production of hormones. Changes in appetite, food preferences, and GI microbiota may also influence weight losses. The results are significant: depending on the type of surgery, 20 to 30% of excess weight remains lost after 10 years. Importantly, most people experience dramatic and lasting improvements in their diabetes, blood lipids, and blood pressure; the risk of heart attacks, strokes, and cancer is also reduced. Some evidence suggests improvements in depression and anxiety as well. Overall, bariatric surgery provides clear advantages for greater weight loss and long-term survival over nonsurgical options for obese adults. The long-term safety and effectiveness of surgery depend, in large part, on compliance with dietary instructions, making nutrition care plans essential in follow-up treatment. With limited food intake and reduced absorptive surfaces, vitamin and mineral deficiencies are common, and have been linked to problems such as periodontal disease. Care plans include instructions to improve food selections as well as prescriptions for dietary supplements. Weight regain may occur and psychological problems —such as disordered eating behaviors—may also develop. Lifelong medical supervision is necessary, but the possible health benefits of weight loss—improved blood lipids, blood pressure, and insulin sensitivity— may outweigh the risks. Overall risk of death and heart disease is lower for obese people after successful surgery than for obese people who do not undergo surgery. Page 22

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 106. Your best friend is obese. She tells you she wants to lose weight, but feels defeated just by how much she has to lose. She says she wishes she could drop 50 pounds in a month, so she could be motivated by the health benefits that kind of weight loss will bring. What advice can you give her regarding healthy weight-loss goals and when she might begin to experience health benefits? ANSWER: Depending on initial body weight, a reasonable rate of loss for overweight adults is ½ to 2 pounds a week, or 5 to 10% of body weight over 6 months. For a person weighing 250 pounds, a 10% loss is 25 pounds, or about 1 pound a week for 6 months. Such gradual weight losses are more likely to be maintained than rapid losses. Keep in mind that pursuing good health is a lifelong journey. Those who are most successful at weight management seem to have fully incorporated healthful eating and physical activity into their daily lives. Even modest weight loss can improve blood glucose and reduce the risks of heart disease by lowering blood pressure and blood lipids, especially for those with central obesity. Improvements in physical capabilities and quality of life become evident with even a 5% weight loss. For these reasons, parameters such as blood pressure, blood lipids, or even vitality are more useful than body weight in marking success. People less concerned with disease risks may prefer to set goals for personal fitness, such as being able to play with children or climb stairs without becoming short of breath. Importantly, they can focus on healthy eating and activity habits instead of weight loss.

107. There are many recommendations for designing healthy eating patterns for a weight-management program. List and describe the three you think are the most important. ANSWER: Be realistic about energy intake: The main characteristic of a weight-loss diet is that it provides less energy than the person needs to maintain present body weight. If food energy is restricted too severely, dieters may not receive sufficient nutrients. Rapid weight loss usually means excessive loss of lean tissue, a lower BMR, and rapid weight regains to follow. The composition of regained weight is more fat and less lean than the composition of the originally lost weight. In addition, restrictive eating may create stress or foster unhealthy behaviors of eating disorders. Emphasize nutritional adequacy: Healthy diet plans make nutritional adequacy a priority. Nutritional adequacy is difficult to achieve on fewer than 1200 kcalories a day, and most healthy adults need never consume any less. A plan that provides an adequate intake supports a healthier and more successful weight loss than a restrictive plan that creates feelings of starvation and deprivation, which can lead to an irresistible urge to binge. Eat small portions: Portion sizes at markets, at restaurants, and even at home have increased dramatically over the years, contributing significantly to energy intake and weight gains. We have come to expect large portions, and we have learned to clean our plates. Many of us pay more attention to these external cues defining how much to eat than to our internal cues of hunger and satiety. For health’s sake, we may need to learn to eat less food at each meal—one piece of chicken for dinner instead of two, a teaspoon of butter on vegetables instead of a tablespoon, and one cookie for dessert instead of six. The goal is to eat enough food for adequate energy, abundant vitamins and minerals, and some pleasure, but not more. This amount should leave a person feeling satisfied—not stuffed. The Japanese have a saying that captures this concept—hara hachi bu—which translates to “eat until you are 80 percent full.” Slow down: Eating can be a pleasurable experience, and taking the time to savor the flavors can help with weight management. Eating slowly, taking small bites, and chewing thoroughly all help to decrease food intake. A person who slows down and savors each bite eats less before hormones signal satiety and the end of a meal. Consequently, energy intake is lower when meals are eaten slowly. Savoring each bite also activates the pleasure centers of the brain. Some research suggests that people may overeat when the brain doesn’t sense enough gratification from food. Faster eating correlates with higher BMI. Lower energy density: Most people take their cues about how much to eat based on portion sizes, and the larger Page 23

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight the portion size, the more they eat. To lower energy intake, a person can either reduce the portion size or reduce the energy density. Reducing energy density while maintaining or even increasing food quantity, especially by reducing fat and including fruits and vegetables, seems to be a successful strategy to control hunger and manage weight. This concept of using large quantities of low-energy-density foods is sometimes referred to as volumetrics. Remember water: In addition to lowering the energy density of foods, water seems to help those who are trying to lose or maintain weight. For one, foods with high water content (such as broth-based soups) increase fullness, reduce hunger, and consequently reduce energy intake. For another, drinking a large glass of water before a meal eases hunger, fills the stomach, and consequently reduces energy intake. Importantly, water adds no kcalories. The average U.S. diet delivers an estimated 75 to 150 kcal a day from sweetened beverages. Simply replacing nutrient-poor, energy-dense beverages with water can help a person achieve a 5% weight loss in 6 months. Water also helps the GI tract adapt to a high-fiber diet. Focus on plant-based foods: Plant-based foods, such as fresh fruits, vegetables, legumes, and whole grains, and vegetarian eating patterns may help with weight management and improve the inflammation that accompanies obesity. These foods offer abundant vitamins, minerals, and fiber. Eating high-fiber foods also takes time, which eases hunger and promotes satiety. Choose fats sensibly: One way to lower energy intake is to lower fat intake. Lowering the fat content of a food lowers its energy density—for example, selecting fat-free milk instead of whole milk. That way, a person can consume the usual amount (say, a cup of milk) at a lower energy intake (85 instead of 150 kcalories). Select carbohydrates carefully: Another popular way to lower energy intake is to lower carbohydrate intake. Limiting consumption of foods with added sugars can help with weight management. One way people try to control weight is to use foods and beverages sweetened with artificial sweeteners. Using artificial sweeteners instead of sugars can lower energy intake and may support modest weight loss, or at least prevent weight gain, although evidence is inconsistent; in fact, some research indicates that artificial sweeteners may stimulate appetite and lead to weight gain. One study offers a possible explanation. People who regularly drink diet sodas have decreased activity in the brain center that signals reward and controls food intake. Such an alteration makes it more likely that these people would eat more later in the day. Watch for other empty kcalories: A person trying to achieve or maintain a healthy weight needs to pay attention not only to fat and sugar, but to alcohol, too. Not only does alcohol add kcalories, but accompanying mixers can also add both kcalories and fat, especially in creamy drinks such as piña coladas. Furthermore, drinking alcohol reduces a person’s inhibitions, which can lead to excessive eating.

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 108. Your best friend is overweight. She has begun adopting new eating patterns and now wants to add physical activity to her weight-management program. She asks you for recommendations as to what kind of physical activity is best. Based on what you know about physical activity and weight management, what advice do you give? ANSWER: Clearly, physical activity is a plus in a weight-management program. What kind of physical activity is best? Any number of physical activity programs may be equally effective at reducing body weight and improving body composition when combined with a low-kcalorie eating pattern. People should choose activities that they enjoy and are willing to do regularly. What schedule of physical activity is best? It doesn’t matter; a person can benefit from either several short bouts of exercise or one continuous workout. Any activity is better than being sedentary. For an active life, limit sedentary activities, engage in strength and flexibility activities, enjoy leisure activities often, engage in vigorous activities regularly, and be as active as possible every day. Health care professionals frequently advise people to engage in activities of low-to-moderate intensity for a long duration, such as an hour-long, fast-paced walk. The reasoning behind such advice is that walking offers the health benefits of aerobic physical activity with low risk of injury. It can be done almost anywhere at any time. A person who stays with an activity routine long enough to enjoy the rewards will be less inclined to give it up and will, over the long term, reap many health benefits. A regular walking program can prevent or slow the weight gain that commonly occurs in most adults. An average of 60 minutes a day of moderate-intensity activity or an expenditure of at least 2000 kcal per week is especially helpful for weight management. Higher levels of duration, frequency, or intensity produce greater losses. In addition to exercise, a person can incorporate hundreds of energy-expending activities into daily routines: take the stairs instead of the elevator, walk to the neighbor’s apartment instead of making a phone call, and rake the leaves instead of using a blower. Remember that sitting uses more kcalories than lying down, standing uses more kcalories than sitting, and moving uses more kcalories than standing. A 175-pound person who replaces a 30-minute television program with a 2-mile walk a day can expend enough energy to lose (or at least not gain) 18 pounds in a year. Even walking in place during the commercials of a one-hour program can increase activity time by 25 minutes, steps taken by 2100, and kcalories expended by 150. Meeting an activity goal of 10,000 steps a day is an excellent way to support a healthy BMI. The point is to be active. Walk. Run. Swim. Dance. Cycle. Climb. Skip. Do whatever you enjoy doing—and do it often.

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 109. List three weight-gain strategies for those who are underweight. ANSWER: Eat energy-dense foods: Energy-dense foods (the very ones eliminated from a successful weightloss diet) hold the key to weight gain. Pick the highest kcalorie items from each food group—that is, milk shakes instead of fat-free milk, salmon instead of snapper, avocados instead of cucumbers, a cup of grape juice instead of a small apple, and whole-wheat muffins instead of whole-wheat bread. Because fat provides more than twice as many kcalories per teaspoon as sugar does, fat adds kcalories without adding much bulk. Although eating high-kcalorie, high-fat foods is not healthy for most people, it may be essential for an underweight individual who needs to gain weight. An underweight person who is physically active and eating a nutritionally adequate diet can afford a few extra kcalories from fat. For health’s sake, it is wise to select foods with monounsaturated and polyunsaturated fats instead of those with saturated or trans fats: for example, sautéing vegetables in olive oil instead of butter or hydrogenated margarine. Eat regular meals daily: People who are underweight need to make meals a priority and take the time to plan, prepare, and eat each meal. They should eat at least three healthy meals every day. Another suggestion is to eat meaty appetizers or the main course first and leave the soup or salad until later. Eat large portions: Underweight people need to learn to eat more food at each meal. For example, they can add extra slices of ham and cheese on a sandwich for lunch, drink a larger glass of milk, and eat a larger bowl of cereal. The person should expect to feel full. Most underweight individuals are accustomed to small quantities of food. When they begin eating significantly more, they feel uncomfortable. This is normal and passes with time. Eat extra snacks: Because a substantially higher energy intake is needed each day, in addition to eating more food at each meal, it is necessary to eat more frequently. Between-meal snacks can readily add to weight gains. For example, a student might make three sandwiches in the morning and eat them between classes in addition to the day’s three regular meals. Snacking on dried fruit, nuts, and seeds is also an easy way to add kcalories. Drink juice and milk: Beverages provide an easy way to increase energy intake. Consider that 6 cups of cranberry juice add almost 1000 kcalories to the day’s intake. kCalories can be added to milk by mixing in powdered milk or packets of instant breakfast. For people who are underweight because of illness, liquid dietary supplements are often recommended because a weak person can swallow them easily. Used in addition to regular meals, these high-protein, high-kcalorie formulas can help an underweight person maintain or gain weight easily. Exercise to build muscles: To gain weight, use strength training primarily, and increase energy intake to support that exercise. Eating extra food to provide an additional 500 to 1000 kcal a day above normal energy needs can support the exercise as well as build muscle.

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Chapter 09- Weight Management: Overweight, Obesity, and Underweight 110. What do Americans find appealing about fad diets? ANSWER: With more than half of our nation’s adults overweight and many more concerned about their weight, the market for a weight-loss book, product, or program is huge (no pun intended). Americans spend an estimated $60 billion a year on weight-loss services and products. Even a plan that offers only minimal weight-loss success easily attracts a following. Perhaps the greatest appeal of fad diets is that they tend to ignore dietary recommendations. Foods such as meats and milk products that need to be selected carefully to limit saturated fat can be eaten with abandon. Whole grains, legumes, vegetables, and fruits that should be eaten in abundance can now be bypassed. For some people, this is a dream come true: steaks without the potatoes, ribs without the coleslaw, and meatballs without the pasta. Who can resist the promise of weight loss while eating freely from a list of favorite foods? Dieters are also lured into fad diets by sophisticated—yet often erroneous—explanations of the metabolic consequences of eating certain foods. Terms such as eicosanoids and de novo lipogenesis are scattered about, often intimidating readers into believing that the authors must be right given their brilliance in understanding the body. If fad diets were as successful as some people claim, then consumers who tried them would lose weight, and their obesity problems would be solved. But this is not the case. Similarly, if fad diets were as worthless as others claim, then consumers would eventually stop pursuing them. Clearly, this is not happening either. Most fad diets have enough going for them that they work for some people at least for a short time, but they fail to produce long-lasting results for most people.

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 1. Which of the following functions is true of vitamins in general? a. Some yield energy. b. They help enzymes participate in the release of energy from carbohydrates, proteins, and fats. c. They are considered macronutrients. d. Structurally, they are linked together. e. They are not as readily available in food as carbohydrates, fats, and proteins. ANSWER: b 2.

Which statement is true of precursors? a. They are secreted by the pancreas. b. They are a source of energy. c. They help break down vitamins during digestion. d. They are stored in bile. e. They describe vitamins that are inactive in food but become active once inside the body. ANSWER: e 3. The bioavailability of vitamins in food . a. depends on many factors, such as how the food was prepared b. is easy to determine c. refers to a vitamin’s molecular structure d. refers to the number of neutrons in the cells of vitamins e. is the ratio of vitamin intake to calorie intake ANSWER: a 4. One difference between water-soluble vitamins and fat-soluble vitamins is that . a. fat-soluble vitamins outnumber water-soluble vitamins. b. in large amounts, water-soluble vitamins can be more toxic than fat-soluble vitamins. c. fat-soluble vitamins are easier for the body to excrete. d. water-soluble vitamins need to be consumed more frequently than fat-soluble vitamins e. fat-soluble vitamins need to be consumed more frequently than water-soluble vitamins. ANSWER: d 5. Vitamins can readily be destroyed during processing because a. they are precursors

b. they contain nitrogen c. they are organic d. they support growth e. they support digestion. ANSWER: c Page 1

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 6. B vitamins have a major role in a. antioxidation b. anticoagulation

c. antibody stabilization d. collagen formation e. energy metabolism ANSWER: e 7. Which of the following is NOT a role of thiamin? a. DNA synthesis b. conversion of pyruvate to acetyl CoA c. ATP production d. energy metabolism e. participation in the TCA cycle ANSWER: a 8. What is the name of the coenzyme form of thiamin? a. thiaminacide b. thiamin pyrophosphate c. thiamin adenine dinucleotide d. thiamin mononucleotide e. thiamin flavin ANSWER: b 9. What disease can result from prolonged thiamin deficiency? a. scurvy b. pernicious anemia c. pellagra d. beriberi e. cheilosis ANSWER: d 10. What is the richest source of thiamin? a. white rice b. whole grain products c. pork d. potatoes e. corn ANSWER: c Page 2

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 11. The risk of thiamin deficiency is doubled in a. alcoholics b. cigarette smokers

c. adults over 65 years old d. pregnant women e. infants ANSWER: a 12. The RDA for thiamin is . a. higher for women than for men b. the same for men and women c. measured in micrograms d. sometimes hard to meet because thiamin is not found in many foods e. only slightly higher for men than for women ANSWER: e 13. Of these foods, which is an unusual but best source of thiamin? a. sunflower seeds b. tuna c. eggs d. soy milk e. cheddar cheese ANSWER: d 14. Which of the following is true of thiamin? a. It is easily destroyed by heat. b. The average thiamin intake in the United States is inadequate. c. It is sometimes referred to as vitamin B2. d. Boiling is a good cooking method for conserving a food’s thiamin content. e. It works hand in hand with vitamin C. ANSWER: a 15. Riboflavin is similar to thiamin in that . a. both are found in abundant amounts in pork b. both serve as coenzymes in energy metabolism c. both are easily destroyed by heat d. both are easily destroyed by ultraviolet light e. though rare, both can be toxic when consumed in high amounts ANSWER: b Page 3

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 16. Which of the following is a symptom of riboflavin deficiency? a. edema b. diarrhea c. constipation d. anemia e. purplish tongue ANSWER: e 17. Of these foods, which is the best source of riboflavin per kcalorie? a. eggs b. tofu (soybean curd) c. potatoes d. clams e. strawberries ANSWER: a 18. A deficiency of riboflavin can cause a disease known as a. riboflavinosis b. ariboflavinosis c. pernicious anemia d. pellagra e. beriberi

ANSWER: b 19. Which of these is the greatest contributor of riboflavin in most people’s diet? a. milk and milk products b. meat, poultry and fish c. dark green, leafy vegetables d. eggs e. fruit ANSWER: a 20. Why is milk sold in cardboard or opaque plastic containers, instead of clear glass bottles? a. to prevent the amino acid content from being destroyed by UV light b. to prevent vitamin A from being destroyed by UV light c. to prevent thiamin from being destroyed by UV light d. to prevent riboflavin from being destroyed by UV light e. to prevent vitamin C from being destroyed by UV light ANSWER: d Page 4

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 21. Of these foods, which is the best source of riboflavin? a. carrots b. oranges c. tofu d. potatoes e. liver ANSWER: e 22. A deficiency of which vitamin causes cheilosis, a condition in which the corners of the mouth become cracked and red? a. vitamin C b. riboflavin c. niacin d. vitamin B12 e. vitamin B6 ANSWER: b 23. Which of the following is true of riboflavin? a. It is also known as vitamin B1. b. It is easily destroyed by heat. c. People who follow a strict vegetarian diet can’t get adequate amounts from food alone. d. Significant sources are citrus products. e. It remains stable when exposed to heat. ANSWER: e 24. The coenzyme form of niacin is central to the metabolism of a. amino acids b. glucose c. vitamin E d. vitamin C

e. lactose ANSWER: b

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 25. Which amino acid is the precursor to niacin? a. lysine b. valine c. phenylalanine d. tryptophan e. glycine ANSWER: d 26. The RDA for niacin is . a. expressed in milligrams of niacin equivalents b. expressed in milligrams of niacin estimates c. higher for women than for men d. the same for men and women e. difficult to meet unless the diet includes meat and other sources of the amino acid tryptophan ANSWER: a 27. Niacin was involved in a groundbreaking discovery that showed that a. diet inadequacies could cause disease b. the B vitamins were involved in energy metabolism c. tryptophan was a precursor of niacin d. niacin was a water-soluble vitamin e. dermatitis was a symptom of niacin deficiency

ANSWER: a 28. What is “niacin flush”? a. a condition that develops with niacin deficiency b. a condition that develops with nicotinic deficiency c. a condition of low levels of niacin in the blood d. a pharmacological effect that occurs from taking large doses of supplemental or prescription niacin e. a physiological effect that occurs from consuming large doses of the nicotinamide form of niacin ANSWER: d 29. Which of the following is true of niacin? a. Large doses of the nicotinic acid form can raise HDL cholesterol. b. Large doses of the nicotinic acid form can raise LDL cholesterol. c. Treatment for the deficiency disease, pellagra, often includes supplements of the amino acid leucine. d. Toxicity is unknown. e. High doses can treat liver diseases. ANSWER: a Page 6

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 30. Which of the following vitamins is known to be toxic in large doses? a. niacin b. biotin c. riboflavin d. vitamin B12 e. thiamin ANSWER: a 31. Of these foods, which is the best source of niacin? a. carrots b. broccoli c. chicken breast d. strawberries e. oranges ANSWER: c 32. Which of the following is true of pantothenic acid? a. It is the only B vitamin not involved in energy metabolism. b. It is relatively stable in most food-preparation methods. c. It is known to be toxic in large doses. d. It is involved in more than 100 steps in the synthesis of certain compounds. e. It is found in a few select foods. ANSWER: d 33. Which of the following is NOT true of biotin? a. It is involved in gluconeogenesis. b. Deficiencies are rare. c. It acts as a co-enzyme in the TCA cycle. d. Some is produced by GI bacteria. e. A good source is egg whites. ANSWER: e 34. There is no RDA for biotin because . a. biotin can be synthesized in the body b. it is not a true essential nutrient c. there is insufficient research on biotin requirements d. biotin is widespread in foods so requirements are not a concern e. its role in energy metabolism can be met by another vitamin ANSWER: c Page 7

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 35. Which of these vitamins is easily destroyed by food processing? a. biotin b. niacin c. thiamin d. pantothenic acid e. riboflavin ANSWER: d 36. Which B vitamin is stored extensively in muscle tissue? a. biotin b. folate c. thiamin d. pantothenic acid e. vitamin B6 ANSWER: e 37. The first major report of vitamin B6 toxicity appeared in the

a. early 1800s b. early 1970s c. early 1980s d. early 1990s e. early 2000s ANSWER: c 38. Of these foods, which is the best source of vitamin B6? a. milk b. carrots c. tofu d. cheddar cheese e. banana ANSWER: e

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 39. Which of the following is true of vitamin B6? a. Toxicity is unknown. b. Deficiency is unknown. c. It occurs in three forms. d. It is stable in heat. e. Larger doses can enhance muscle strength. ANSWER: c 40. Which of the following substances contributes to the destruction of vitamin B6 in the body? a. vitamin A b. fats c. tryptophan d. alcohol e. nicotine ANSWER: d 41. Vitamin B6 deficiency is characterized by

a. depression and confusion in the early stages b. numbness and muscle damage c. macrocytic anemia d. convulsions in the early stages e. purplish tongue ANSWER: a 42. Another name for folate is a. pyridoxamine b. glutamic acid c. pteroylglutamic acid d. foliage e. DFE

ANSWER: c 43. Because of the way in which the body handles folate, a folate deficiency can occur if a. the GI tract is injured b. intrinsic factor is lacking c. the pancreas is injured

d. part of the stomach has been removed e. anemia exists. ANSWER: a Page 9

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 44. With which B vitamin does folate have a close relationship? a. biotin b. thiamin c. vitamin B6 d. ascorbic acid e. vitamin B12 ANSWER: e 45. How much more available to the body is synthetic folate than naturally occurring folate? a. 0.7 times b. 1.2 times c. 1.5 times d. 1.7 times e. 2.5 times ANSWER: d 46. Why is folate supplementation recommended for women 1 month before conception and during the first trimester of pregnancy? a. to reduce the risk of gestational diabetes b. to prevent severe morning sickness c. to prevent neural tube defects, such as spina bifida, which may occur during the early weeks of pregnancy. d. to help reduce the risk of iron-deficient anemia. e. to help ensure a healthy maternal weight gain during pregnancy. ANSWER: c 47. High intakes of folate can mask a deficiency of which nutrient? a. iron b. vitamin A c. thiamin d. potassium e. vitamin B12 ANSWER: e

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 48. Fortification of grain products with folate has helped reduce the prevalence rate of neural tube defects, as well as the prevalence of . a. heart attacks b. macrocytic anemia c. strokes d. some cancers e. blood clots ANSWER: b 49. Of these foods, which one is the best source of folate per kcalorie? a. strawberries b. asparagus c. fortified cornflakes d. eggs e. peanut butter ANSWER: b 50. Which of the following is NOT true of folate? a. It comes in two forms. b. It is involved in DNA synthesis. c. Its bioavailability is the same whatever the source. d. It is involved in converting vitamin B12 to one of its coenzyme forms. e. It regenerates the amino acid methionine from homocysteine. ANSWER: c 51. Which group is more prone to vitamin B12 deficiency? a. older adults b. teenagers c. infants d. cigarette smokers e. athletes ANSWER: a

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 52. Of these foods, which is NOT a good source of folate? a. milk b. legumes c. breakfast cereals d. green, leafy vegetables e. fruits ANSWER: a 53. What is the main cause of vitamin B12 deficiency? a. inadequate intake b. poor absorption c. impaired folate metabolism d. excessive intrinsic factor e. weight loss ANSWER: b 54. Which of the following is NOT true of vitamin B12 a. It is found almost exclusively in animal-derived foods. b. It converts folate to its active form. c. It helps maintain nerve cells. d. It depends on intrinsic factor for absorption. e. It works closely with thiamin. ANSWER: e 55. Atrophic gastritis is a chronic condition in which a. the stomach muscles shrink b. the stomach becomes inflamed

c. the small intestine becomes inflamed d. various stretches of the GI tract become inflamed e. the gallbladder excretes too much bile into the small intestine ANSWER: b

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 56. How long can it take for the symptoms of vitamin B12 symptoms to develop, if a person, say a new vegetarian, was to suddenly stop eating animal products? a. 1 week b. 1 month c. several months d. 1 year e. several years ANSWER: e 57. Of these foods, which has the greatest vitamin B12 bioavailability? a. milk b. eggs c. meat d. poultry e. spirulina (sea algae) ANSWER: a 58. From which amino acid can choline be made? a. leucine b. tryptophan c. hydroxyproline d. methionine e. hydroxylysine ANSWER: d 59. Which of the following statements is true of choline? a. It is sometimes referred to as vitamin H. b. It is not a B vitamin but is grouped with the B vitamins anyway. c. In most cases, the body can make enough choline to meet its needs. d. Choline’s only function is to make the phospholipid lecithin. e. It is defined as a nonvitamin. ANSWER: b

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 60. Scurvy, the deficiency disease of vitamin C, is . a. a condition that was first recognized in mountain climbers b. a condition whose treatment wasn’t discovered until the early 1900s c. a condition whose symptoms start to appear within 3 days of the deficiency in the diet d. usually cured within 5 days of beginning treatment with 100 milligrams of vitamin C daily e. a particular problem for alcoholics ANSWER: d 61. Which of the following is a function of vitamin C? a. It helps form collagen. b. It is involved in energy metabolism. c. It helps rid the body of antioxidants. d. It helps rid the body of excess iron. e. It aids in the digestion of fat. ANSWER: a 62. The synthesis of collagen requires vitamin C to work with what other nutrient? a. vitamin K b. zinc c. iron d. magnesium e. vitamin A ANSWER: c 63. What organ in the body contains more vitamin C than any other organ? a. lungs b. spleen c. adrenal glands d. pituitary gland e. kidneys ANSWER: c 64. Which of the following is NOT known to increase vitamin C needs? a. chronic use of oral contraceptives b. infections c. burns d. physical activity e. cigarette smoking ANSWER: d Page 14

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 65. Which of the following is symptom of scurvy? a. purplish tongue b. poor wound healing c. edema d. hair loss e. oily skin ANSWER: b 66. From what does vitamin C protects tissues? a. lean body mass loss b. aches and pains c. water loss from tissues d. oxidative stress of free radicals e. neurological stress ANSWER: d 67. The RDA for vitamin C . a. is the same for men and women b. can be met in one serving of many fruits and vegetables c. is 60 milligrams a day for women d. is based on iron requirements e. is slightly lower for cigarette smokers ANSWER: b 68. About what percentage of U.S. adults take a multivitamin–mineral supplement regularly? a. 20 b. 30 c. 50 d. 60 e. 65 ANSWER: b 69. Which type of supplement is particularly toxic and has caused deaths in children? a. iron supplements b. calcium supplements c. vitamin E supplements d. vitamin D supplements e. folate supplements ANSWER: a Page 15

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 70. Which federal agency regulates dietary supplements? a. U.S. Department of Agriculture b. U.S. Public Health Service c. Centers for Disease Control d. Food and Drug Administration e. Federal Trade Commission ANSWER: d Match the correct answer with the appropriate term. a. Pork b. Corn c. Milk and milk products d. Folate e. Biotin f. Nicotinic acid (Niacin) g. Choline h. Anemia i. Collagen j. Thiamin k. Antioxidants l. Cheilosis m. Vitamin B6 n. Vitamin B12 o. Tryptophan p. Citrus fruits q. Vitamin C r. Intrinsic factor s. Riboflavin t. Pantothenic acid 71. Nutrient whose deficiency causes beriberi ANSWER: j 72. Richest food source of thiamin ANSWER: a 73. Also known as vitamin B2 ANSWER: s 74. Greatest contributor of riboflavin for most people ANSWER: c Page 16

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 75. Caused by riboflavin deficiency and characterized by cracks and redness at corners of mouth ANSWER: l 76. Precursor of niacin ANSWER: o 77. A low-protein diet centered on this food that once caused widespread pellagra in the U.S. South ANSWER: b 78. Large doses can raise HDL cholesterol ANSWER: f 79. Deficiency of this vitamin is induced by feeding raw egg whites ANSWER: e 80. Vitamin whose principal active form is part of coenzyme A (CoA) ANSWER: t 81. Toxicity from this vitamin is known to cause nerve damage and inability to walk ANSWER: m 82. Prevention of neural tube defects is related to increased intake of this substance by pregnant women ANSWER: d 83. One of the first two symptoms of folate deficiency ANSWER: h 84. Required to maintain nerve fiber sheath ANSWER: n 85. Required for absorption of vitamin B12 ANSWER: r 86. Vitamin made in the body from methionine ANSWER: g 87. The antiscorbutic factor ANSWER: q 88. Vitamin C is required for the synthesis of this substance ANSWER: i 89. Justly famous as a source of vitamin C ANSWER: p 90. Substances that neutralize free radicals and may play role in disease prevention ANSWER: k Page 17

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C

91.

are the nutrients that regulate body processes that support growth and maintain life. ANSWER: Vitamins

92. The term for the amount of niacin present in food—including the niacin that can theoretically be made from its precursor, tryptophan, present in the food—is . ANSWER: niacin equivalents 93. The amount of folate available to the body from naturally occurring sources, fortified foods, and supplements, accounting for differences in the bioavailability from each source is known as . ANSWER: dietary folate equivalents 94. The type of anemia characterized by large, immature red blood cells and caused by deficiencies of folate and vitamin B12 is known as ____________________ _. ANSWER: macrocytic anemia, megaloblastic anemia 95. The two substances needed for vitamin B12 absorption are _______ and____________________ _. ANSWER: hydrochloric acid, intrinsic factor 96. Substances like vitamin C that significantly decrease the adverse effects of free radicals on normal physiological functions are known as ____________________ _. ANSWER: antioxidants 97. The B vitamin that is needed in very small amounts in the diet but whose role as a coenzyme in the TCA cycle is critical in helping to replenish oxaloacetate is . ANSWER: biotin 98. Discuss the overall role of the B vitamins. ANSWER: The B vitamins help the body to use the fuel provided by carbohydrates, fats, and proteins. Some B vitamins—thiamin, riboflavin, niacin, pantothenic acid, and biotin—form part of the coenzymes that assist enzymes in the release of energy from carbohydrate, fat, and protein. Other B vitamins play other indispensable roles in metabolism. For example, vitamin B6 assists enzymes that metabolize amino acids. Folate and vitamin B12 help cells to multiply. Among these cells are the red blood cells and the cells lining the GI tract—cells that deliver energy to all the others. The vitamin portion of a coenzyme allows a chemical reaction to occur; the remaining portion of the coenzyme binds to the enzyme. Without its coenzyme, an enzyme cannot function. Thus, symptoms of B vitamin deficiencies directly reflect the disturbances of metabolism caused by a lack of coenzymes.

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 99. Discuss the solubility of vitamins. ANSWER: There are two types of vitamins: the hydrophilic, water-soluble ones (the B vitamins and vitamin C) and the hydrophobic, fat-soluble ones (vitamins A, D, E, and K). Solubility is apparent in the food sources of the different vitamins, and it affects their absorption, transport, storage, and excretion by the body. The water-soluble vitamins are found in the watery compartments of foods; the fat-soluble vitamins usually occur together in the fats and oils of foods. On being absorbed, the water-soluble vitamins move directly into the blood. Like fats, the fat-soluble vitamins must first enter the lymph, then the blood. Once in the blood, many of the water-soluble vitamins travel freely, whereas many of the fat-soluble vitamins require transport proteins. On reaching the cells, water-soluble vitamins freely circulate in the water-filled compartments, whereas fat-soluble vitamins are held in fatty tissues and the liver until needed. The kidneys, monitoring the blood that flows through them, detect and remove small excesses of water-soluble vitamins; large excesses, however, may overwhelm the system, creating adverse effects. Fat-soluble vitamins tend to remain in fat-storage sites in the body rather than being excreted, and so are more likely to reach toxic levels when consumed in excess. 100. What is meant by the bioavailability of a vitamin? How is it determined? ANSWER: Some water-soluble vitamins are synthesized by GI tract bacteria and absorbed by the large intestine, but not in quantities great enough to meet the body’s needs; foods must supply these essential nutrients. The amount of vitamins available from foods depends not only on the quantity provided by a food but also on the amount absorbed and used by the body—referred to as the vitamins’ bioavailability. The quantity of vitamins in a food can be determined relatively easily. Researchers analyze foods to determine the vitamin contents and publish the results in tables of food composition. Determining the bioavailability of a vitamin is a more complex task because it depends on many factors, including: Efficiency of digestion and time of transit through the GI tract Previous nutrient intake and nutrition status Method of food preparation (raw, cooked, or processed) Source of the nutrient (synthetic, fortified, or naturally occurring) Other foods consumed at the same time Experts consider these factors when estimating recommended intakes. 101. Explain what dietary folate equivalents are. ANSWER: The bioavailability of folate differs depending on the source, and these differences must be considered when establishing folate recommendations. The DRI committee gives naturally occurring folate from foods full credit. Synthetic folate from fortified foods and supplements is given extra credit because, on average, it is 1.7 times more available than naturally occurring folate in foods. Thus, a person consuming 100 µg of folate from foods and 100 µg from a supplement (multiplied by 1.7) receives 270 dietary folate equivalents (DFEs). So, DFEs are the amount of folate available to the body from naturally occurring sources, fortified foods, and supplements, accounting for differences in the bioavailability from each source. The formula is DFE = µg food folate + (µg synthetic folate).

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 102. Discuss the groups of people most at risk for vitamin B12 deficiency and why they are at risk. ANSWER: Most vitamin B12 deficiencies reflect inadequate absorption, not poor intake. Inadequate absorption typically occurs for one of two reasons: a lack of hydrochloric acid or a lack of intrinsic factor. Without hydrochloric acid, the vitamin is not released from the dietary proteins and so is not available for binding with the intrinsic factor. Without the intrinsic factor, the vitamin cannot be absorbed. So, those most at risk include those who are unable to absorb vitamin B12 because they lack hydrochloric acid or intrinsic factor. They include: • adults who use heartburn medicines because the medicine suppresses gastric acid products. • people who have atrophic gastritis, a condition that damages the cells of the stomach. Older people often develop this condition. It also may develop in response to iron deficiency or infection with Helicobacter pylori, the bacterium implicated in ulcer formation. Without healthy stomach cells, production of hydrochloric acid and intrinsic factor diminishes. Even with an adequate intake from foods, vitamin B12 status suffers. The vitamin B12 deficiency caused by atrophic gastritis and a lack of intrinsic factor is known as “pernicious anemia.” • people who have inherited a defective gene for the intrinsic factor. (In such cases, or when the stomach has been injured and cannot produce enough of the intrinsic factor, vitamin B12 must be given by injection to bypass the need for intestinal absorption. It also can be delivered by nasal spray.) Because vitamin B12 is found primarily in foods derived from animals, vegetarians, and especially vegans, are especially likely to develop a vitamin B12 deficiency (although it may take several years for people who stop eating animal-derived foods to develop deficiency symptoms because the body recycles much of its supply). 103. Explain folate’s importance to pregnancy. ANSWER: The brain and spinal cord develop from the neural tube, and defects in its orderly formation during the early weeks of pregnancy may result in various central nervous system disorders and death. Folate supplements taken 1 month before conception and continued throughout the first trimester of pregnancy can help prevent neural tube defects. For this reason, all women of childbearing age who are capable of becoming pregnant should consume 0.4 milligram (400 micrograms) of folate daily, which is easily accomplished by eating folate-rich foods, folate-fortified foods, and a multivitamin supplement daily. Because half of the pregnancies each year are unplanned and because neural tube defects occur early in development, before most women realize they are pregnant, the Food and Drug Administration (FDA) has mandated that grain products be fortified to deliver folate to the U.S. population. Labels on fortified products may claim that “adequate intake of folate has been shown to reduce the risk of neural tube defects.” Fortification has improved folate status in women of childbearing age and lowered the prevalence of neural tube defects. Some research suggests that folate taken before and during pregnancy may also prevent congenital birth defects, such as cleft lip and cleft palate, and neurodevelopmental disorders, such as autism. Such findings strengthen recommendations for women to pay attention to their folate needs.

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 104. Describe the roles that vitamin C performs—or may perform—in the body. ANSWER: As an antioxidant: Vitamin C loses electrons easily, a characteristic that allows it to perform as an antioxidant. In the body, antioxidants defend against free radicals. A free radical is a molecule with one or more unpaired electrons, which makes it unstable and highly reactive. Antioxidants can neutralize free radicals by donating an electron or two. In doing so, antioxidants protect other substances from free radical damage. As a cofactor in collagen formation: Vitamin C helps to form the fibrous structural protein of connective tissues known as collagen. Collagen serves as the matrix on which bones and teeth are formed. When a person is wounded, collagen glues the separated tissues together, forming scars. Cells are held together largely by collagen; this is especially important in the walls of the blood vessels, which must withstand the pressure of blood surging with each beat of the heart. As a cofactor in other reactions: Vitamin C also serves as a cofactor in the synthesis of several other compounds. As in collagen formation, vitamin C helps in the hydroxylation of carnitine, a compound that transports fatty acids, especially long-chain fatty acids, across the inner membrane of mitochondria in cells. It also participates in the conversions of the amino acids tryptophan and tyrosine to the neurotransmitters serotonin and norepinephrine, respectively. Vitamin C also assists in the making of hormones, including thyroxine, which regulates the metabolic rate; when metabolism speeds up in times of extreme physical stress, the body’s use of vitamin C increases. In stress: Among the stresses known to increase vitamin C needs are infections; burns; extremely high or low temperatures; intakes of toxic heavy metals such as lead, mercury, and cadmium; the chronic use of certain medications, including aspirin, barbiturates, and oral contraceptives; and cigarette smoking. During stress, the adrenal glands—which contain more vitamin C than any other organ in the body—release vitamin C and hormones into the blood. In the prevention and treatment of the common cold: Vitamin C has been a popular option for the prevention and treatment of the common cold for decades, but research supporting such claims has been conflicting and controversial. Some studies find no relationship between vitamin C and the occurrence of the common cold, whereas others report modest benefits—fewer colds, fewer days, and shorter duration of severe symptoms, especially for those exposed to physical and environmental stresses. A review of the research on vitamin C in the treatment and prevention of the common cold reveals a slight, but consistent reduction in the duration of the common cold in favor of those taking a daily dose of at least 200 milligrams of vitamin C. In disease prevention: Whether vitamin C may help in preventing or treating cancer, heart disease, cataract, and other diseases is still being studied.

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 105. Discuss vitamin C deficiency, including its symptoms and treatment. ANSWER: The early signs of vitamin C deficiency can be difficult to recognize. Two of the most notable signs of a vitamin C deficiency reflect its role in maintaining the integrity of blood vessels. The gums bleed easily around the teeth, and capillaries under the skin break spontaneously, producing pinpoint hemorrhages. When vitamin C concentrations fall to about a fifth of optimal levels (this may take more than a month when consuming a diet lacking vitamin C), symptoms of scurvy—the deficiency disease of vitamin C —symptoms begin to appear. Inadequate collagen synthesis causes further hemorrhaging. Muscles, including the heart muscle, degenerate. The skin becomes rough, brown, scaly, and dry. Wounds fail to heal because scar tissue will not form. Bone rebuilding falters; the ends of the long bones become soft, malformed, and painful, and fractures develop. The teeth become loose as the cartilage around them weakens. Anemia and infections are common. There are also characteristic psychological signs, including hysteria and depression. Sudden death is likely, caused by massive internal bleeding. Once diagnosed, scurvy is readily resolved by increasing vitamin C intake. Moderate doses of 100 mg per day are sufficient, curing the scurvy within about 5 days. Such an intake is easily achieved by including vitamin C–rich foods in the diet. 106. Discuss food sources for vitamin C: What foods are the best sources? What other foods can be important sources? What foods are poor sources? ANSWER: Citrus fruits are justly famous for being rich in vitamin C, but other fruits and vegetables also are in the same league. A half cup of broccoli, bell pepper, or strawberries provides more than 50 mg of the vitamin. Because vitamin C is vulnerable to heat, raw fruits and vegetables usually have a higher nutrient density than their cooked counterparts. Similarly, because vitamin C is readily destroyed by oxygen, foods and juices should be stored properly and consumed within a week of opening. The potato is an important source of vitamin C, not because one potato by itself meets the daily need but because potatoes are such a common staple that they make significant contributions. Grains, milk and milk products (especially breast milk), and most protein foods are notoriously poor sources of vitamin C. Organ meets (liver, kidneys, and others) and raw meats contain some vitamin C, but most people don’t eat large quantities of these foods. Raw meats and fish contribute enough vitamin C to be significant sources in parts of Alaska, Canada, and Japan, but elsewhere fruits and vegetables are necessary to supply sufficient vitamin C. Because of vitamin C’s antioxidant property, food manufacturers sometimes add a variation of vitamin C to some beverages and most cured meats, such as luncheon meats, to prevent oxidation and spoilage. This compound safely preserves these foods, but it does not have vitamin C activity in the body.

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Chapter 10- The Water-Soluble Vitamins: B Vitamins and Vitamin C 107. Under what circumstances might vitamin–mineral supplements be appropriate? ANSWER: To correct overt deficiencies: In the United States, adults rarely suffer nutrient deficiency diseases such as scurvy, pellagra, and beriberi, but nutrient deficiencies do still occur. To correct an overt deficiency disease, a physician may prescribe therapeutic doses 2 to 10 times the RDA (or AI) of a nutrient. At such high doses, the supplement is having a pharmacological effect and acting as a drug. To support increased nutrient needs: Nutrient needs increase during certain stages of life, making it difficult to meet some of those needs without supplementation. For example, women who lose a lot of blood and therefore a lot of iron during menstruation each month may need an iron supplement. Women of childbearing age need folate supplements to reduce the risks of neural tube defects. Similarly, pregnant women and women who are breastfeeding their infants have exceptionally high nutrient needs and so usually need special supplements. Newborns routinely receive a single dose of vitamin K at birth to prevent abnormal bleeding. Infants may need other supplements as well, depending on whether they are breastfed or receiving formula and on whether the water they drink contains fluoride. To improve nutrition status: In contrast to the classical deficiencies, which present a multitude of symptoms and are relatively easy to recognize, subclinical deficiencies are subtle and easy to overlook —and they are also more likely to occur. Without fortification or supplementation, many adults in the United States fall short of recommended intakes for several vitamins and minerals. People who do not eat enough food to deliver the needed amounts of nutrients, such as habitual dieters and the elderly, risk developing subclinical deficiencies. Similarly, vegetarians who restrict their use of entire food groups without appropriate substitutions may fail to fully meet their nutrient needs. If there is no way for these people to eat enough nutritious foods to meet their needs, then vitamin–mineral supplements may be appropriate to help prevent nutrient deficiencies. To improve the body’s defenses: Health care professionals may provide special supplementation to people being treated for addictions to alcohol or other drugs and to people with prolonged illnesses, extensive injuries, or other severe stresses such as surgery. Illnesses that interfere with appetite, eating, or nutrient absorption impair nutrition status. For example, the stomach condition atrophic gastritis often creates a vitamin B12 deficiency. In addition, nutrient needs are often heightened by diseases or medications. In all these cases, supplements are appropriate. To reduce disease risks: Few people consume the optimal amounts of all the vitamins and minerals by diet alone. Inadequate intakes have been linked to chronic diseases such as heart disease, some cancers, and osteoporosis. For this reason, some physicians recommend that all adults take vitamin– mineral supplements. Such regular supplementation would provide an optimal intake to enhance metabolic harmony and prevent disease at relatively little cost. Others recognize the lack of conclusive evidence and the potential harm of supplementation and advise against such a recommendation. A statement from the National Institutes of Health acknowledges that evidence is insufficient to recommend either for or against the use of supplements to prevent chronic diseases.

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 1. Upon absorption, fat-soluble vitamins travel through the lymphatic system within bloodstream. a. albumin b. cholesterol c. chylomicrons d. liposoluble binding proteins e. osteocalcin

before entering the

ANSWER: c 2. Risk for toxicity is greater for a. water-soluble, absorbed b. fat-soluble, excreted c. B, destroyed d. cooked, metabolized e. uncooked, digested

vitamins because they are not easily

ANSWER: b 3. Which of the following nutrients did researchers recognize first? a. vitamin D b. vitamin K c. calcitriol d. vitamin A e. vitamin E ANSWER: d 4. Which of the following is NOT a form of vitamin A? a. retinol b. retinal c. retinoic acid d. retinoquinone e. beta-carotene ANSWER: d 5. What is the alcohol form of vitamin A? a. retinal b. beta-carotene c. retinol d. retinoic e. alpha-carotene ANSWER: c Page 1

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 6. Retinol-binding protein picks up vitamin A from the a. intestines b. kidneys c. liver d. pancreas e. gallbladder

and carries it to the blood.

ANSWER: c 7. What happens to an animal raised on retinoic acid as its only source of vitamin A? a. It becomes blind. b. It cannot reproduce. c. Its growth is stunted. d. It grows to an abnormally large size. e. It produces more offspring. ANSWER: a 8. Which of the following statements accurately describes vitamin A’s role in vision? a. Retinoic acid is the form required for synthesis of retinoblasts. b. Light causes retinal to shift from a cis to a trans configuration. c. Retinol is the form bound to beta-carotene in the corneal membrane. d. Pigment molecules in the retina are composed of vitamin A and the protein elastin. e. Retinol protects the visual cortex from teratogenic chemicals. ANSWER: b 9. Which part of the eye contains billions of molecules of vitamin A? a. cornea b. sclera c. retina d. macula e. choroid ANSWER: c 10. Which of the following is a light-sensitive pigment found within the retina? a. rhodopsin b. opsin c. melanin d. chlorophyll e. xanthophylls ANSWER: a Page 2

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 11. Which of the following proteins is responsible for transporting vitamin A from the liver to other tissues? a. albumin b. rhodopsin c. retinol-binding protein d. transcarotenoid protein e. RBC ANSWER: c 12. Which of the following statements about vitamin A’s role in the body is FALSE? a. Only one-thousandth of the body’s vitamin A is in the retina. b. Vitamin A and beta-carotene protect the skin from sun damage. c. Vitamin A maintains healthy cells in the mucous membranes. d. Vitamin A supports normal fetal development during pregnancy. e. Lycopene serves as a vitamin A precursor and acts as an antioxidant. ANSWER: e 13. About a. 20% b. 30% c. 50%

of the body’s vitamin A stores are found in the liver.

d. 70% e. 90% ANSWER: e 14. How does vitamin A affect bone health? a. It stimulates uptake of calcium from the intestines. b. It promotes synthesis of specific bone proteins involved in the mineralization process. c. It assists enzymes that degrade certain regions of the bone, thereby allowing remodeling to occur. d. It inhibits oxidation of bone mucopolysaccharides, thereby preserving bone crystal integrity and promoting growth. e. It ensures the formation of healthy bone matrix in utero. ANSWER: c

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 15. If a normal, healthy adult stopped eating vitamin A–containing foods, deficiency symptoms would begin to appear in about _______ _. a. 6 weeks b. 2 to 3 months c. 3 to 6 months d. 6 months to 1 year e. 1 to 2 years ANSWER: e 16. Retinoic acid can stimulate cell growth in the a. skin, tumors b. tumors, skin c. hair, nails d. nails, hair e. lungs, heart

and inhibit cell growth in

ANSWER: a 17. The World Health Organization and UNICEF recommend supplements of and children. a. iron

for all measles-infected infants

b. vitamin A c. folic acid d. phylloquinone e. vitamin E ANSWER: b 18. Worldwide, vitamin A deficiency causes about a. 125,000 b. 250,000 c. 500,000

children to go blind each year.

d. 750,000 e. 1,000,000 ANSWER: c

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 19. Of the following, which is rapidly corrected when treated with vitamin A supplements? a. acne b. rickets c. osteomalacia d. night blindness e. scurvy ANSWER: d 20. Progressive blindness caused by severe vitamin A deficiency is called “ a. keratinization b. keratomalacia c. xerophthalmia d. teratogen e. xanthophyllia

.”

ANSWER: c 21. Vitamin A deficiency causes the epithelial cells of the skin to change shape and to secrete the protein a. keratin b. opsin c. elastin d. collagen e. beta globulin

ANSWER: a 22. Which of the following is a feature of Retin-A? a. It is effective in treating rickets. b. It is taken orally to treat the deep lesions of cystic acne. c. It is known to be effective in fighting acne and wrinkles. d. It prevents birth defects when used by pregnant women. e. It is known to cause inflammation and darkly pigmented skin. ANSWER: c 23. What form of vitamin A supports reproduction but not growth? a. retinal b. retinol c. retinoic acid d. retinyl esters e. Retin-A ANSWER: b Page 5

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 24. Which food is a rich source of retinoids? a. liver b. broccoli c. cantaloupe d. sweet potato e. spinach ANSWER: a 25. Which of the following accurately describes vitamin A in foods? a. Xanthophylls in beets and corn masks the presence of beta-carotene. b. Butter is a poor source of vitamin A. c. Most carotenoids can be converted in the body to active vitamin A. d. Chlorophyll in dark green, leafy vegetables masks the presence of beta-carotene. e. Plants contain retinoids but no carotenoids. ANSWER: d 26. Which of the following foods is a very good source of vitamin A? a. peanut butter b. butternut squash c. sunflower seeds d. whole-grain bread e. pinto beans ANSWER: b 27. Which of the following describes the effect of vitamin A in foods? a. Fast-food French fries are good sources of vitamin A. b. Arctic explorers who have eaten large quantities of polar bear liver have become ill with symptoms suggesting vitamin A toxicity. c. To date, scientists have been unable to solve the problem of vitamin A deficiencies in developing countries. d. Chlorophyll in vegetables can be converted to active vitamin A in the intestinal cells. e. Pregnant women should eat at least one ounce of beef liver per day to help ensure normal fetal eye development. ANSWER: b

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 28. The RDA for vitamin A is a. 100, 300 b. 300, 500 c. 500, 700 d. 700, 900 e. 900, 1100

μg RAE/day for women and

μg RAE/day for men.

ANSWER: d 29. Vitamin D2 is derived from plant foods and also is known as

a. ergocalciferol b. foliocalciferol c. cholecalciferol d. phyllocalciferol e. xanthociferol ANSWER: a 30. What is another name for vitamin D3? a. ergocalciferol b. foliocalciferol c. cholecalciferol d. phyllocalciferol e. xanthociferol ANSWER: c 31. With the help of sunlight, the body can synthesize vitamin D from a precursor made from a. cholesterol b. tryptophan c. beta-carotene d. eicosapentaenoic acid e. histamine

ANSWER: a

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 32. Diseases affecting the liver or the of deficiency. a. skin b. pancreas c. intestines d. kidneys e. stomach

can interfere with the activation of vitamin D and produce symptoms

ANSWER: d 33. What is the name of the type of reaction required to activate vitamin D? a. hydrogenation b. hydroxylation c. gluconeogenesis d. glycation e. hydration ANSWER: b 34. Vitamin D’s specific role in bone health is to assist in a. the secretion of calciol b. the synthesis of 7-dehydrocholesterol c. the synthesis of carotenoids

d. calcium and phosphorus absorption and calcium mobilization from bone e. converting magnesium and fluoride to more readily absorbable compounds ANSWER: d 35. Peak bone mass is developed by age a. 5 b. 10 c. 15 d. 30 e. 60

ANSWER: d 36. Which of the following statements about vitamin D’s role in the body is FALSE? a. Adequate intake slows the progression of Parkinson’s disease. b. Evidence shows supplementation has health benefits beyond correcting deficiencies. c. It signals cells of the immune system to defend against infectious diseases. d. Gene activity that regulates cell growth is enhanced or suppressed. e. It may protect against hypertension, inflammation, and type 2 diabetes. ANSWER: b Page 8

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 37. Where is calbindin primarily found in the body? a. liver b. kidneys c. intestine d. skin e. bones ANSWER: c 38. A child with beaded ribs is likely deficient in which vitamin? a. A b. B12 c. C d. D e. E ANSWER: d 39. An adult deficient in vitamin D may experience softening of the bones, which is called “ a. rickets b. osteomalacia c. keratomalacia d. hyperkeratosis e. osteopenia

.”

ANSWER: b 40. What U.S. population group is at highest risk for vitamin D deficiency? a. infants b. elderly c. adult women d. children ages 2–12 years e. whites living in tropical areas ANSWER: b 41. Excess vitamin D may result in a. increased bone density b. increased bone calcification

c. deformity of leg bones, ribs, and skull d. mineral deposits in soft tissues like the kidney e. osteoporosis ANSWER: d Page 9

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 42. Your old friend from high school has just moved to Northern Canada to do full-time research on bats in caves. She typically works in the caves during the day when the bats are there and leaves at sundown when the bats are active. Your friend is careful about her health and only purchases organic and all natural foods. Based on this information alone, which of the following foods would you recommend your friend regularly buy at the grocery store? a. whole-grain bread b. vitamin D–fortified milk c. vitamin A–fortified carrot juice d. wheat germ e. vitamin K–rich whole-grain cereals ANSWER: b 43. Which of the following is a naturally occurring food source of vitamin D? a. egg whites b. red meats c. tomato juice d. carrots e. salmon ANSWER: e 44. Which of the following accurately describes vitamin D from the sun? a. Sunscreens with an SPF of 8 or higher increase vitamin D synthesis. b. Only about one-half of the world’s population relies on sunlight to maintain adequate vitamin D nutrition. c. Prolonged exposure to sunlight degrades the vitamin D precursor in skin, thus preventing vitamin D toxicity. d. For someone living in Chicago, vitamin D stores from the summer months are usually sufficient to meet the needs during the winter. e. Pigments in dark skins increase vitamin D synthesis. ANSWER: c 45. Which of the following is the most reliable source of vitamin D in the diet? a. fruits b. sardines c. potatoes d. legumes e. whole grains ANSWER: b

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 46. What is the RDA for vitamin D for a 20-year-old person? a. 5 g b. 10 g c. 15 g d. 20 g e. 50 g ANSWER: c 47. Which of the following vitamins may reduce the risk of heart disease by slowing the oxidation of low-density lipoproteins? a. A b. E c. K d. D2 e. D3 ANSWER: b 48. Vitamin E functions primarily as a. a peroxide b. a coenzyme c. an antioxidant d. a free radical e. an immune stimulant

ANSWER: c 49. Which member of the vitamin E family is maintained in the body and can meet the body’s needs? a. alpha-tocotrienol b. alpha-tocopherol c. beta-tocopherol d. gamma-tocotrienol e. delta-tocopherol ANSWER: b

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 50. Which disorder is seen in premature infants deficient in vitamin E? a. rickets b. xerophthalmia c. muscular dystrophy d. erythrocyte hemolysis e. osteomalacia ANSWER: d 51. What is the RDA of vitamin E for adults? a. 5 mg b. 10 mg c. 15 mg d. 30 mg e. 60 mg ANSWER: c 52. What is the UL for vitamin E? a. 100 mg/day b. 120 mg/day c. 500 mg/day d. 1000 mg/day e. 1200 mg/day ANSWER: d 53. Much of the vitamin E in the diet comes from a. lean meats b. fish c. vegetable oils

d. tropical fruits e. tomatoes ANSWER: c 54. Which of the following statements accurately describes the vitamin E in foods? a. Vitamin E is fairly stable to heat. b. Most convenience foods are good sources of vitamin E. c. Saturated oils are the major dietary sources of vitamin E. d. The amount of alpha-tocopherol in foods is underestimated. e. Egg yolks are a good source of vitamin E. ANSWER: e Page 12

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 55. Which is the least toxic of the fat-soluble vitamins? a. A b. E c. K d. D2 e. D3 ANSWER: b 56. What is prothrombin? a. a storage protein for vitamin K b. a transport protein for vitamin E c. an active protein needed for bone formation d. an inactive protein needed for blood clot formation e. a soluble protein that decreases the “stickiness” of red blood cells ANSWER: d 57. What is the name of the disease that can result from absence of clotting factors? a. GI disorders b. arrythmia c. Alzheimer’s d. hemorrhagic disease e. hemophilia ANSWER: d 58. Vitamin K participates in the synthesis of prothrombin and a. osteocalcin b. adipose tissue c. calbindin d. calciferol e. teratogen

ANSWER: a 59. Osteocalcin _______ _. a. is a vitamin K–deficiency disease in children b. binds calcium in the GI tract to enhance absorption c. requires vitamin K to bind to bone-forming minerals d. is a disease characterized by softening of the bones e. binds to vitamin K and is excreted in feces ANSWER: c Page 13

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 60. Which of the following would cause a secondary vitamin K deficiency? a. excess bile production b. antibiotics c. presence of oxalic acid in food d. insufficient intake of green leafy vegetables e. a high-fat, high-protein diet ANSWER: b 61. How long does it take in newborn infants for establishment of vitamin K-producing bacteria in the intestinal tract? a. 2 days b. 2 weeks c. 1 day d. 1 week e. None of these is correct. ANSWER: b 62. At birth, a single dose of vitamin a. A b. D2

is given by intramuscular injection.

c. D3 d. E e. K ANSWER: e 63. Vitamin K deficiency is most likely in which of the following groups? a. young adults b. elderly c. newborns d. teenagers e. middle-aged adults ANSWER: c 64. Which of the following is a good source of vitamin K? a. pumpkin seeds b. bananas c. corn d. brussel sprouts e. egg yolks ANSWER: d Page 14

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 65. Which of the following terms refers to the plant form of vitamin K? a. ergodione b. menaquinone c. tocopherone d. phylloquinone e. ergotamine ANSWER: d 66. What percentage of vitamin K is derived from foods? a. less than 5 b. 25 c. 50 d. 85 e. 95 ANSWER: c 67. What is the UL for vitamin K? a. 200 μg/day b. 400 μg/day c. 600 μg/day d. 500 μg/day e. There is no UL. ANSWER: e 68. Which of the following accurately describes free radicals? a. They are destroyed by air pollution. b. They arise from normal metabolic reactions. c. They promote cell repair and act as an anti-inflammatory agent. d. They are immune to the presence of antioxidant nutrients. e. They are more common in infants and children than adults and the elderly. ANSWER: b 69. Substances that induce oxidative stress are called “ a. prooxidants b. antioxidants

.”

c. free radical generators d. reactive electron oxidants e. oxidative facilitators ANSWER: a Page 15

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 70. The best way to add antioxidants to the diet is to a. rely on supplements to meet RDA b. combine dietary intake and supplementation

c. add a selenium supplement to a diet rich in vitamin E d. eat generous servings of fruits and vegetables daily e. create a diet rich in low-carb, high-protein foods ANSWER: d 71. Pigments founds in plants and animals, some of which have vitamin A activity are

ANSWER: carotenoids 72. The transparent membrane covering the outside of the eye is called the “

.”

ANSWER: cornea 73.

is the normal protein of the hair and nails is called. ANSWER: Keratin

74. Pigments found in plants responsible for the color changes in autumn leaves are

ANSWER: xanthopylls 75. The highest attainable bone density for an individual is called

ANSWER: peak bone mass 76. A calcium-binding transport protein that requires vitamin D for its synthesis is

ANSWER: calbindin 77.

is a bone disease characterized by softening of the bones and occurs most often in adult women. ANSWER: Osteomalacia

78. The active vitamin E compound is

ANSWER: alpha-tocopherol 79. The condition of having too few red blood cells as a result of erythrocyte hemolysis is

ANSWER: hemolytic anemia 80. The bacteria-produced form of vitamin K, also called K2, is ____________________ _. ANSWER: menaquinone Match the correct answer with the appropriate term. a. Xerosis b. Rickets Page 16

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K c. Chlorophyll d. Tocopherols e. Beta-carotene f. Vitamin A g. Vitamin E h. Vitamin K i. Calciferol j. Hemophilia k. Antibiotics l. Osteomalacia m. Calbindin n. Xerophthalmia o. Osteocalcin p. Phylloquinone q. Wheat germ oil r. Erythrocyte hemolysis s. Cabbage t. Retinol 81. The alcohol form of vitamin A ANSWER: t 82. Promotes vision ANSWER: f 83. Blindness caused by severe vitamin A deficiency ANSWER: n 84. Green pigment of plants ANSWER: c 85. Abnormal drying of the skin due to vitamin A deficiency ANSWER: a 86. Vitamin A precursor found in plants ANSWER: e 87. Another name for vitamin D ANSWER: i 88. Disease characterized by bowed legs and beaded ribs ANSWER: b

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 89. Soft bones caused by vitamin D deficiency in adults ANSWER: l 90. A vitamin D–dependent transport protein ANSWER: m 91. Defends the body against free radicals ANSWER: g 92. Breaking open of red blood cells due to vitamin E deficiency ANSWER: r 93. Food source rich in vitamin E ANSWER: q 94. A subgroup of vitamin E ANSWER: d 95. Substance that promotes blood clotting ANSWER: h 96. Hereditary disease not caused or cured by vitamin K ANSWER: j 97. Kills vitamin K–producing bacteria in the intestine ANSWER: k 98. Calcium-binding protein in bones ANSWER: o 99. Vitamin K1 ANSWER: p 100. Food source of vitamin K ANSWER: s

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 101. Describe the two ways in which vitamin A promotes vision. ANSWER: Vitamin A plays two indispensable roles in the eye: it helps maintain a crystal-clear outer window, the cornea, and it participates in the conversion of light energy into nerve impulses at the retina. Some of the photosensitive cells of the retina contain pigment molecules called “rhodopsin.” Each rhodopsin molecule is composed of a protein called opsin bonded to a molecule of retinal, which plays a central role in vision. When light passes through the cornea of the eye and strikes the retina, rhodopsin responds. As it does, opsin is released and retinal shifts from a cis to a trans configuration, just as fatty acids do during hydrogenation. These changes generate an electrical impulse that conveys the message to the brain. Much of the retinal is then converted back to its active cis form and combined with the opsin protein to regenerate rhodopsin. Some retinal, however, may be oxidized to retinoic acid, a biochemical dead end for the visual process. Visual activity leads to repeated small losses of retinal, necessitating its constant replenishment either directly from foods or indirectly from retinol stores. 102. How does vitamin A deficiency affect the eyes? ANSWER: Night blindness is one of the first detectable signs of vitamin A deficiency and permits early diagnosis. In night blindness, the person loses the ability to recover promptly from the temporary blinding that follows a flash of bright light at night or to see after dark. In many parts of the world, after the sun goes down, vitamin A–deficient people become night blind. They often cling to others or sit still, afraid that they may trip and fall or lose their way if they try to walk alone. Treatment with vitamin A rapidly corrects night blindness. Beyond night blindness is total blindness—failure to see at all. Night blindness is caused by a lack of vitamin A at the back of the eye, the retina; total blindness is caused by a lack of vitamin A at the front of the eye, the cornea. Severe vitamin A deficiency is the leading cause of preventable blindness in the world, causing as many as half a million children to lose their sight each year; an estimated half of them die within a year of losing their sight. Blindness due to vitamin A deficiency, known as xerophthalmia, develops in stages. At first, the cornea becomes dry and hard because of inadequate mucus production —a condition known as xerosis. Then xerosis quickly progresses to keratomalacia, the softening of the cornea that leads to irreversible blindness. For this reason, prompt correction of vitamin A deficiency is essential to preserving eyesight. 103. What effect does vitamin A have on acne? ANSWER: Adolescents need to know that massive doses of vitamin A have no beneficial effect on acne. The prescription medicine Accutane is made from vitamin A but is chemically different. Taken orally, Accutane is effective against the deep lesions of cystic acne. It is highly toxic, however, especially during growth, and has caused birth defects in infants when women have taken it during pregnancy. For this reason, women taking Accutane must agree to pregnancy testing and to using two forms of contraception from at least 1 month before taking the drug through at least 1 month after discontinuing its use. Should they become pregnant, they need to stop taking Accutane immediately and notify their physician. Another vitamin A relative, Retin-A, fights acne, the wrinkles of aging, and other skin disorders. Applied topically, this ointment smooths and softens skin; it also lightens skin that has become darkly pigmented after inflammation. During treatment, the skin becomes red and tender and peels.

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 104. Liver is a rich source of vitamin A, so why should humans consume it with caution? ANSWER: People sometimes wonder if eating liver too frequently can cause vitamin A toxicity. Liver is a rich source because vitamin A is stored in the livers of animals, just as in humans. Arctic explorers who have eaten large quantities of polar bear liver have become ill with symptoms suggesting vitamin A toxicity. Liver offers many nutrients, and eating it periodically may improve a person’s nutrition status, but caution is warranted not to eat too much too often, especially for pregnant women. With 1 ounce of beef liver providing more than three times the RDA for vitamin A, intakes can increase quickly. 105. How does sunlight help the body synthesize and activate vitamin D? ANSWER: To make vitamin D, ultraviolet rays from the sun hit a precursor in the skin and convert it to previtamin D3, which is converted to vitamin D3 with the help of the body’s heat. To activate vitamin D— whether made in the body or consumed from the diet—two hydroxylation reactions must occur. First, the liver adds an OH group, and then the kidneys add another OH group to produce the active vitamin. As you might expect, diseases affecting either the liver or the kidneys can interfere with the activation of vitamin D and produce symptoms of deficiency. 106. What role does vitamin D play in bone growth? ANSWER: Vitamin D is a member of a large and cooperative bone-making and maintenance team composed of nutrients and other compounds, including vitamins A and K; the hormones parathyroid hormone and calcitonin; the protein collagen; and the minerals calcium, phosphorus, magnesium, and fluoride. Vitamin D’s specific role in bone health is to assist in the absorption of calcium and phosphorus, thus helping to maintain blood concentrations of these minerals. The bones grow denser and stronger as they absorb and deposit these minerals. Adequate nutrition and regular exercise are essential to achieving peak bone mass before age 30. Vitamin D raises blood concentrations of bone minerals in three ways. When the diet is sufficient, vitamin D enhances mineral absorption from the GI tract. When the diet is insufficient, vitamin D provides the needed minerals from other sources: reabsorption by the kidneys and mobilization from the bones into the blood. Vitamin D may work alone, as it does in the GI tract, or in combination with parathyroid hormone, as it does in the bones and kidneys.

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 107. Explain the potential difficulties in obtaining the recommended amounts of vitamin D from the sun. ANSWER: Most of the world’s population relies on natural exposure to sunlight to maintain adequate vitamin D nutrition. The sun imposes no risk of vitamin D toxicity; prolonged exposure to sunlight degrades the vitamin D precursor in the skin, preventing its conversion to the active vitamin. Prolonged exposure to sunlight can, however, prematurely wrinkle the skin and cause skin cancer. Sunscreens help reduce these risks, but sunscreens with a sun protection factor (SPF) of 8 or higher can also reduce vitamin D synthesis. Still, even with an SPF 15 to 30 sunscreen, sufficient vitamin D synthesis can be obtained in 10 to 20 minutes of sun exposure. Alternatively, a person could apply sunscreen after enough time has elapsed to provide sufficient vitamin D synthesis. For most people, exposing hands, face, and arms on a clear summer day for 5 to 10 minutes two or three times a week should be sufficient to maintain vitamin D nutrition. Avoiding sun exposure completely may be harmful to health. The pigments of dark skin provide some protection from the sun’s damage, but they also reduce vitamin D synthesis. Dark-skinned people require more sunlight exposure than light-skinned people—perhaps as much as 4 to 6 times longer. Latitude, season, and time of day also have dramatic effects on vitamin D synthesis and status. Heavy cloud cover, smoke, or smog block the ultraviolet (UV) rays of the sun that promote vitamin D synthesis. People who stay in the shade and wear long-sleeved clothing are twice as likely to develop vitamin D deficiency as those who rarely do so. Vitamin D deficiency is especially prevalent in the winter and in the Arctic and Antarctic regions of the world. To ensure an adequate vitamin D status, supplements may be needed. The body’s vitamin D supplies from summer synthesis alone are insufficient to meet winter needs. Depending on the radiation used, the UV rays from tanning lamps and tanning beds may also stimulate vitamin D synthesis. The potential hazards of skin damage, however, may outweigh any possible benefits. The Food and Drug Administration (FDA) warns that if the lamps are not properly filtered, people using tanning booths risk burns, damage to the eyes and blood vessels, and skin cancer. 108. How does vitamin E function as an antioxidant? ANSWER: Vitamin E is a fat-soluble antioxidant and one of the body’s primary defenders against the adverse effects of free radicals. Its main action is to stop the chain reaction of free radicals from producing more free radicals. In doing so, vitamin E protects the vulnerable components of the cells and their membranes from destruction. Most notably, vitamin E prevents the oxidation of the polyunsaturated fatty acids, but it protects other lipids and related compounds (for example, vitamin A) as well. Accumulating evidence suggests that vitamin E may reduce the risk of heart disease by protecting lowdensity lipoproteins (LDL) against oxidation and reducing inflammation. The oxidation of LDL and inflammation have been implicated as key factors in the development of heart disease.

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Chapter 11- The Fat-Soluble Vitamins: A, D, E, and K 109. Discuss the role of vitamin K in coagulation. ANSWER: Vitamin K appropriately gets its name from the Danish word koagulation (“coagulation” or “clotting”). Its primary action is blood clotting, in which its presence can make the difference between life and death. Blood has a remarkable ability to remain liquid, but it can clot within seconds when the integrity of that system is disturbed. More than a dozen different proteins and the mineral calcium are involved in making a blood clot. Vitamin K is essential for the activation of several of these proteins, among them prothrombin, made by the liver as a precursor of the protein thrombin. When any of the blood-clotting factors is lacking, hemorrhagic disease results. If an artery or vein is cut or broken, bleeding goes unchecked. Of course, this is not to say that hemorrhaging is always caused by vitamin K deficiency. Another cause is the genetic disorder hemophilia, which is neither caused nor cured by vitamin K. 110. Define free radicals and discuss their adverse effects. ANSWER: A free radical is a molecule with one or more unpaired electrons. An electron without a partner is unstable and highly reactive. To regain its stability, the free radical quickly finds a stable but vulnerable compound from which to steal an electron. With the loss of an electron, the formerly stable molecule becomes a free radical itself and steals an electron from another nearby molecule. Thus, an electron-snatching chain reaction is under way, with free radicals producing more free radicals. Antioxidants neutralize free radicals by donating one of their own electrons, thus ending the chain reaction. When they lose electrons, antioxidants do not become free radicals because they are stable in either form. Free radicals attack. Occasionally, these free-radical attacks are helpful. For example, cells of the immune system use free radicals as ammunition in an “oxidative burst” that demolishes disease-causing viruses and bacteria. Most often, however, free-radical attacks cause widespread damage. They commonly damage the polyunsaturated fatty acids in lipoproteins and in cell membranes, disrupting the transport of substances into and out of cells. Free radicals also alter DNA, RNA, and proteins, creating excesses and deficiencies of specific proteins, impairing cell functions, and eliciting an inflammatory response. All of these actions contribute to cell damage, disease progression, and aging.

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Chapter 12- Water and the Major Minerals 1. The body needs more a. fat b. water

each day in comparison to any other nutrient.

c. protein d. glucose e. sodium ANSWER: b 2. Water constitutes about a. 35% b. 40% c. 55% d. 60% e. 75%

of an adult’s body weight.

ANSWER: d 3. What term describes water that resides between cells? a. diuretic fluid b. interstitial fluid c. intracellular fluid d. intravascular fluid e. avascular fluid ANSWER: b 4. Where is intracellular fluid found? a. within cells b. between cells c. within the lungs d. within blood vessels e. within the digestive system ANSWER: a 5. Ions that carry a negative charge are called a. anions b. cations c. mineralytes d. valence ions e. prions

ANSWER: a Page 1

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Chapter 12- Water and the Major Minerals 6. Salts that dissociate into ions are called a. electrolytes b. osmolytes

c. diuretics d. antidiuretics e. angiotensinogens ANSWER: a 7. How is the concentration of electrolyte charges measured? a. by weight b. in milliequivalents c. by amperes d. by mass e. in millijoules ANSWER: b 8. What is the term for the amount of pressure needed to prevent the movement of water across a cell membrane? a. hypotension b. hypertension c. osmotic pressure d. solute pressure e. centripetal pressure ANSWER: c 9. Which of the following electrolytes is concentrated primarily outside the body’s cells? a. calcium b. potassium c. magnesium d. phosphate e. sulfate ANSWER: a 10. The extracellular fluid in the blood vessels is called “ a. interstitial fluid b. intracellular fluid

.”

c. intravascular fluid d. fluid within blood vessels e. fluid within lungs ANSWER: c Page 2

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Chapter 12- Water and the Major Minerals 11. Which statement accurately describes antidiuretic hormone? a. It is released by the glomerulus on a signal from the hypothalamus. b. It is produced in response to low sodium concentration in the blood. c. It stimulates water reabsorption by the kidneys. d. It lowers blood pressure. e. It signals the kidneys to excrete more bodily fluids. ANSWER: c 12. Which of the following is an enzyme released from the kidneys in response to low blood pressure? a. angiotensinogen b. angiotensin c. epinephrine d. renin e. aldosterone ANSWER: d 13. Aldosterone and renin each promote a. electrolyte balance b. sodium retention c. calcium excretion d. vasoconstriction e. potassium retention

ANSWER: b 14. Among the following, which is a powerful vasoconstrictor? a. angiotensin I b. angiotensin II c. aldosterone d. renin e. magnesium ANSWER: b 15. Aldosterone is released by the a. liver b. adrenal glands

c. kidneys d. pituitary gland e. hypothalamus ANSWER: b Page 3

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Chapter 12- Water and the Major Minerals 16. The concentration of a solution reflects the amount of a a. solute b. glucose

relative to its fluids?

c. sodium d. potassium e. anions ANSWER: a 17. The acidity of the body’s fluids is determined by the concentration of a. glucose b. sodium c. alcohol d. potassium e. hydrogen ions

ANSWER: d 18. Which two organs control the buffer system that regulate the body’s acid–base balance? a. skin and lungs b. liver and kidneys c. kidneys and lungs d. stomach and liver e. stomach and pancreas ANSWER: c 19. Which is an example of a protein that regulates the flow of fluids and ions in and out of cells a. calcium–magnesium pump b. sodium–potassium pump c. potassium–magnesium pump d. iron–sodium pump e. iron–potassium pump ANSWER: b 20. Obligatory water excretion is a minimum of about a. 75 b. 125 c. 250

milliliters of water each day.

d. 500 e. 1000 ANSWER: d Page 4

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Chapter 12- Water and the Major Minerals 21. Which of the following accurately describes water balance and recommended intakes? a. Water intoxication is rare but can result in death. b. Most water is lost in breathing through the lungs. c. The first sign of dehydration is an increased respiratory rate. d. The color of urine is used to diagnose a person’s hydration status. e. Liberal fluid intake, 2 liters or more, is recommended during times of heavy sweating. ANSWER: a 22. A decreased concentration of sodium in the blood is known specifically as a. hypertension b. hyponatremia c. hyperkalemia d. water intoxication e. hypodiuresis

ANSWER: b 23. Water derived daily from beverages, food, and metabolism averages about a. 750 b. 1000 c. 1500

milliliters.

d. 2500 e. 5000 ANSWER: d 24. Which are the principle minerals of soft water? a. sodium or calcium b. sodium or potassium c. potassium or iron d. sodium or selenium e. potassium or magnesium ANSWER: b 25. Which of the following is present in highest concentration in hard water? a. sodium b. potassium c. manganese d. phosphorus e. magnesium ANSWER: e Page 5

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Chapter 12- Water and the Major Minerals 26. Which of the following is not regulated by the FDA as water? a. soft water b. public water c. natural water d. distilled water e. carbonated water ANSWER: e 27. Of the following minerals, which is found in the body in the lowest amount? a. iron b. calcium c. potassium d. sodium e. phosphorus ANSWER: a 28. Which of the following accurately describes minerals? a. When a food is burned, all the minerals are found in the ash. b. The body absorbs each mineral from foods in much the same way. c. Minerals in food can be destroyed by acid. d. The body needs about 200 milligrams of each trace mineral each day. e. Major minerals are more important than trace minerals. ANSWER: a 29. Of the following, which food contains a phytate? a. rhubarb b. legumes c. spinach d. sweet potatoes e. beet greens ANSWER: b 30. What is the principal extracellular cation? a. sodium b. chloride c. potassium d. magnesium e. phosphorus ANSWER: a Page 6

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Chapter 12- Water and the Major Minerals 31. What percentage of the U.S. population exceeds the recommended intake for sodium? a. 50% b. 60% c. 70% d. 80% e. 90% ANSWER: e 32. On a typical day, what is the relationship of the amount of sodium ingested to the amount of sodium excreted? a. Intake is higher. b. Excretion is higher. c. Intake and excretion are equal. d. Excretion is unrelated to intake. e. With extreme sodium intake, they are unrelated; with normal sodium intake, ingestion is greater than excretion. ANSWER: c 33. What is the UL for sodium for adults? a. 750 mg b. 900 mg c. 1200 mg d. 2300 mg e. 3500 mg ANSWER: d 34. The DASH diet plan may prevent hypertension and a. dehydration b. ulcerative colitis c. osteoporosis d. constipation e. diabetes

ANSWER: c 35. The greatest source of sodium in the diet is a. processed foods b. unprocessed foods c. natural salt content of foods d. salt added during cooking e. salt added at the table

ANSWER: a Page 7

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Chapter 12- Water and the Major Minerals 36. What is the main extracellular anion? a. sodium b. chloride c. potassium d. magnesium e. phosphorus ANSWER: b 37. What does chloride do in the body? a. participates in blood clotting b. helps maintain gastric acidity c. stabilizes protein shape d. protects bone structures against degeneration e. supports immune system functioning ANSWER: b 38. Of the following, which person is most likely to experience a chloride imbalance? a. an Olympic weightlifter b. a teenager with bulimia nervosa c. an infant with sickle cell anemia d. an elderly person with dementia e. a vegan ANSWER: b 39. What is the principal intracellular cation? a. sodium b. chloride c. potassium d. magnesium e. phosphorus ANSWER: c 40. What does potassium do in the body? a. participates in blood clotting b. helps maintain gastric acidity c. acts as principal intracellular electrolyte d. stabilizes protein shape e. acts as a neurotransmitter ANSWER: c Page 8

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Chapter 12- Water and the Major Minerals 41. The AI for potassium is a. 1200 b. 2700 c. 3500 d. 4000 e. 4700

mg per day.

ANSWER: e 42. Which of the following foods is high in potassium and low in sodium? a. canned cream corn b. corn on the cob c. instant banana pudding d. frozen apple pie e. corn flake cereal ANSWER: b 43. Why is crucial to control potassium distribution for the body? a. It assists in wound healing. b. It is required to maintain homeostasis and a steady heartbeat. c. It is required to maintain structural integrity of the lungs. d. It is required for to maintain blood sugar balance. e. All of these are correct. ANSWER: b 44. Of the following, which person most likely at risk for potassium depletion? a. an Olympic weightlifter b. a teenager who eats few fruits and vegetables c. an woman with heavy menstrual periods d. an elderly person with dementia e. a vegan ANSWER: b 45. Potassium toxicity . a. can be caused by supplement overconsumption b. can be caused by diuretics c. is signaled by acute hypertension d. results from overeating foods high in potassium e. leads to kidney stones ANSWER: a Page 9

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Chapter 12- Water and the Major Minerals 46. What percent of the body’s calcium is found in the body fluids? a. 99% b. 50% c. 1% d. 5% e. 10% ANSWER: c 47. What is hydroxyapatite? a. a calcium-binding protein that regulates muscle contractions b. crystals made of calcium and phosphorus c. a calcium regulatory hormone secreted by the thyroid gland d. a compound in plant foods that binds to calcium and phosphorus and inhibits absorption e. potassium and sodium crystals found in the framework of bones ANSWER: b 48. Blood calcium levels above normal results in a. stronger bones and teeth b. weaker bones and teeth c. calcium surplus d. calcium rigor e. calcium tetany ANSWER: d 49. Abnormally low calcium levels in the blood results in a. calcium rigor b. calcium tetany c. myosinotoxicosis d. calmodulin dysfunction e. hyperkalemia

ANSWER: b 50. Which of the following helps make the calcium-binding protein needed for calcium absorption? a. fiber b. vitamin D c. phytic acid d. oxalic acid e. glucose ANSWER: b Page 10

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Chapter 12- Water and the Major Minerals 51. On average, adults absorb a. 20% b. 30% c. 50% d. 65% e. 80%

of the calcium they ingest.

ANSWER: b 52. What is the RDA of calcium (mg/day) for college-aged adults? a. 800 b. 1000 c. 1200 d. 1300 e. 1500 ANSWER: b 53. Which of the following is a good source (are good sources) of dietary calcium? a. berries and pineapple b. brown rice c. salmon d. broccoli and bok choy e. dark green leafy vegetables like spinach and swiss chard ANSWER: d 54. Calcium is the most abundant mineral in the body. Which mineral is the second most abundant? a. sodium b. chloride c. potassium d. magnesium e. phosphorus ANSWER: e 55. What does phosphorus do in the body? a. participates in blood clotting b. helps maintain gastric acidity c. acts as principal intracellular electrolyte d. stabilizes protein shape e. assists in energy metabolism ANSWER: e Page 11

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Chapter 12- Water and the Major Minerals 56. What is the UL for phosphorus? a. 1200 mg b. 2500 mg c. 3500 mg d. 4000 mg e. 4500 mg ANSWER: d 57. Which of the following accurately describes phosphorus as it relates to nutrition? a. Rich sources include fresh vegetables. b. Dietary deficiencies are virtually unknown. c. Soft drinks reduce absorption. d. Toxicity is common among vegetarians and causes kidney failure. e. Eggs and milk are relatively poor sources. ANSWER: b 58. More than half of the body’s magnesium is in the a. bones b. teeth c. extracellular fluid d. cells of soft tissue e. muscle

ANSWER: a 59. What does magnesium do in the body? a. participates in blood clotting b. helps maintain gastric acidity c. stabilizes protein shape d. assists in energy metabolism e. supports immune system functioning ANSWER: e 60. Which of the following accurately describes magnesium as it relates to nutrition? a. Toxicity is common in people taking diuretics. b. High intakes erode tooth enamel. c. Hard water has been shown to increase hypertension due to low levels of magnesium. d. Average intakes from food are below recommendations. e. There is no upper level for intake set for adults. ANSWER: d Page 12

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Chapter 12- Water and the Major Minerals 61. Which nutrient provides a major source of dietary sulfur? a. fats b. protein c. fat-soluble vitamins d. carbohydrates e. water ANSWER: b 62. Where in the body is sulfur concentrated and found in larger amounts? a. pancreas and liver b. intestines c. bones and teeth d. skeletal muscle e. skin, hair, and nails ANSWER: e 63. The inner, lacy matrix of bone is called “ a. cortical bone b. dolomitic bone c. trabecular bone d. hydroxyl bone e. structural bone

.”

ANSWER: c 64. About how many people never walk or live independently again after sustaining an osteoporosis-related hip fracture? a. 2% b. 6% c. 20% d. 33% e. 50% ANSWER: d 65. Losses of trabecular bone start becoming significant for men and woman at about age a. 20 b. 30

c. 35 d. 40 e. 50 ANSWER: b Page 13

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Chapter 12- Water and the Major Minerals 66. What does a DEXA scan measure? a. bone mineral density b. severity of bone microfractures c. effect of sodium and potassium supplements d. calcium and water balance e. movement of calcium throughout the body ANSWER: a 67. What is the strongest predictor of bone density? a. sex b. genetics c. nutrition d. age e. physical activity ANSWER: d 68. For women, soy consumption may lower the risk for osteoporosis because a. it prevents the kidneys from excreting calcium b. of the bioavailable calcium c. of its stable hydroxyapatite crystal formation d. its phytochemicals mimic the actions of estrogen in the body e. calcium alginate is used to process the soy bean

ANSWER: d 69. Calcium supplements should be taken . a. with a meal to enhance absorption of calcium b. with iron supplements to enhance absorption of iron c. with a meal to circumvent adverse nutrient interactions d. in large doses all at once e. in doses of 500 mg or more ANSWER: a 70. What toxic substance may be contained in calcium supplements made form bone meal, oyster shell, or dolomite? a. arsenic b. lead c. cyanide d. ricin e. hydrazine ANSWER: b Page 14

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Chapter 12- Water and the Major Minerals 71. Fluid within blood vessels is called

fluid.

ANSWER: intravascular 72. Positively charged ions are called “

.”

ANSWER: cations 73.

are the substances that are dissolved in a solution. ANSWER: Solutes

74. Compounds that keep a solution’s pH constant when acids or bases are added are called “

.”

ANSWER: buffers 75. Water drawn from a well that taps a confined aquifer in which the water is under pressure is called water. ANSWER: artesian 76. The process in which calcium, phosphorus, and other minerals crystallize on the collagen matrix of a growing bone is termed “ ________.” ANSWER: mineralization 77.

is the hormone secreted by the thyroid gland that regulates blood calcium by lowering it when levels rise too high. ANSWER: Calcitonin

78. The highest attainable bone density for an individual, developed during the first three decades of life is termed “ ______ _.” ANSWER: peak bone mass 79. A protein in the intestinal cells, made with the help of vitamin D, that facilitates calcium absorption is a

ANSWER: calcium-binding protein 80. A bone condition in which bone loss is significant, but not as severe as in osteoporosis is termed

ANSWER: osteopenia Match the correct answer with the appropriate term. a. 30 b. 75 c. 150 d. 600 e. Osmosis f. Oral hydration therapy g. Intracellular fluid Page 15

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Chapter 12- Water and the Major Minerals h. Extracellular fluid i. Sulfur j. Calcium k. Vitamin D l. Phytate m. Phosphorous n. Oxalate o. Aldosterone p. Parathyroid hormone q. Hydroxyapatite r. Antidiuretic hormone s. Sodium in solution t. Chloride in solution 81. Typical amount (in mL) of water lost from GI tract every day ANSWER: c 82. Accounts for 2/3 of the body’s water ANSWER: g 83. Includes interstitial fluid and intravascular fluid ANSWER: h 84. Signals kidneys to retain sodium ANSWER: o 85. Signals kidneys to retain water ANSWER: r 86. A cation ANSWER: s 87. An anion ANSWER: t 88. Percentage of lean tissue weight consisting of water ANSWER: b 89. Water movement toward concentrated solutes ANSWER: e 90. Simple solution of sugar, salt, and water ANSWER: f

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Chapter 12- Water and the Major Minerals 91. Crystals of calcium and phosphorus ANSWER: q 92. Hormone that regulates blood calcium ANSWER: p 93. Age when peak bone mass is reached ANSWER: a 94. Milligrams of chloride in 1 gram of table salt ANSWER: d 95. Most prevalent major mineral in the body ANSWER: j 96. Binder found in rhubarb ANSWER: n 97. Binder found in nuts and seeds ANSWER: l 98. Mineral found in milk protein ANSWER: m 99. Enhances absorption of calcium ANSWER: k 100. Mineral present in the body as part of some proteins ANSWER: i

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Chapter 12- Water and the Major Minerals 101. How do the kidneys regulate blood volume and blood pressure? ANSWER: Fluids maintain the blood volume, which in turn influences blood pressure. The kidneys are central to the regulation of blood volume and blood pressure. All day, every day, the kidneys reabsorb needed substances and water and excrete wastes with some water in the urine. The kidneys meticulously adjust the volume and the concentration of the urine to accommodate changes in the body, including variations in the day’s food and beverage intakes. Instructions on whether to retain or release substances or water come from antidiuretic hormone, renin, angiotensin, and aldosterone. Whenever blood volume or blood pressure falls too low, or whenever the extracellular fluid becomes too concentrated, the hypothalamus signals the pituitary gland to release antidiuretic hormone (ADH). ADH is a water-conserving hormone that stimulates the kidneys to reabsorb water. Consequently, the more water you need, the less your kidneys excrete. These events also trigger thirst. Drinking water and retaining fluids raise the blood volume and dilute the concentrated fluids, thus helping to restore homeostasis. Cells in the kidneys respond to low blood pressure by releasing an enzyme called “renin.” Through a complex series of events, renin causes the kidneys to reabsorb sodium. Sodium reabsorption, in turn, is always accompanied by water retention, which helps to raise blood volume and blood pressure. In addition to its role in sodium retention, renin hydrolyzes a protein from the liver called angiotensinogen to angiotensin I. Angiotensin I is inactive until another enzyme converts it to its active form—angiotensin II. Angiotensin II is a powerful vasoconstrictor that narrows the diameters of blood vessels, thereby raising the blood pressure. In addition to acting as a vasoconstrictor, angiotensin II stimulates the release of the hormone aldosterone from the adrenal glands. Aldosterone signals the kidneys to excrete potassium and to retain more sodium, and therefore water, because when sodium moves, water follows. Again, the effect is that when more water is needed, less is excreted. 102. How should you treat a severe electrolyte imbalance? ANSWER: Normally, the body defends itself successfully against fluid and electrolyte imbalances. With minor imbalances, people can replace the fluids and minerals lost in sweat or in a temporary bout of diarrhea, for example, by drinking plain cool water and eating regular foods. Certain situations and some medications, however, may overwhelm the body’s ability to compensate. Severe, prolonged vomiting and diarrhea as well as heavy sweating, burns, and traumatic wounds may incur such great fluid and electrolyte losses as to precipitate a medical emergency. Appropriate medical intervention depends on the circumstances surrounding the loss of fluids and their solutes. If fluid is lost by vomiting or diarrhea, sodium is lost indiscriminately. If the adrenal glands oversecrete aldosterone, as may occur when a tumor develops, the kidneys may excrete too much potassium. A person with uncontrolled diabetes may lose glucose (a solute not normally excreted) and large amounts of fluid with it. Each situation results in dehydration, but drinking water alone will not restore balance. Medical intervention is required to restore balance. In some cases, restoring balance demands rapid replacement of fluids and electrolytes—for example, when diarrhea threatens the life of a malnourished child. Caregivers around the world have learned to use oral rehydration therapy (ORT)—a simple solution of sugar, salt, and water, taken by mouth—to treat dehydration caused by severe diarrhea. These lifesaving formulas do not require hospitalization and can be prepared from ingredients available locally. Caregivers need only learn to measure ingredients carefully and use sanitary water. Once rehydrated, a person can begin eating foods.

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Chapter 12- Water and the Major Minerals 103. Briefly describe the problems with too little intake and with too much water intake. ANSWER: When too much water is lost from the body and not replaced, dehydration develops. A first sign of dehydration is thirst, the signal that the body has lost some fluid. If a person is unable to obtain water or, as in many elderly people, fails to perceive the thirst message, the symptoms of dehydration may progress rapidly from thirst to weakness, exhaustion, and delirium—and end in death if not corrected. Notice that an early sign of dehydration is fatigue; keep that in mind when considering caffeinated beverages for an afternoon “pick-me-up” and choose water instead. Dehydration develops with either inadequate water intake or excessive water losses. Water intoxication, on the other hand, is rare but can occur with excessive water intake and kidney disorders that reduce urine production. The symptoms may include confusion, convulsions, and even death in extreme cases. Excessive water ingestion (10 to 20 liters) within a few hours dilutes the sodium concentration of the blood and contributes to a dangerous condition known as hyponatremia. For this reason, guidelines suggest limiting fluid intake during times of heavy sweating to between 1 and 1.5 liters per hour. 104. How does sodium affect hypertension? ANSWER: Most sodium is consumed as salt (sodium chloride), and a high salt intake correlates strongly with high blood pressure and heart disease. A salt-restricted diet lowers blood pressure and improves heart disease risk in healthy people as well as in those with hypertension. For this reason, the Dietary Guidelines for Americans advise limiting daily salt intake to about 1 teaspoon (the equivalent of about 2.3 grams or 2300 milligrams of sodium). For adults with prehypertension and hypertension, a reduction to 1500 milligrams of sodium per day is of even greater benefit. Most people will benefit from a sodium intake within this range (1500 to 2300 milligrams). Limited evidence suggests that lower sodium intakes may be associated with health problems for some groups of people. Because sodium is so prevalent in the food supply, consumers need to use multiple strategies to lower their intake. Given the current U.S. food supply and typical eating habits, creating a nutritionally balanced diet that meets sodium recommendations can be a challenge. One eating pattern, known as the DASH (Dietary Approaches to Stop Hypertension) Eating Plan, is especially effective in lowering blood pressure. Like other USDA Food Patterns, the DASH Eating Plan reflects the Dietary Guidelines and allows people to stay within their energy allowance, meet nutrient needs, and lower disease risk. The DASH approach emphasizes potassium-rich fruits, vegetables, and low-fat milk products; includes whole grains, nuts, poultry, and fish; and calls for reduced intakes of sodium, red and processed meats, sweets, and sugar-containing beverages.

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Chapter 12- Water and the Major Minerals 105. What accounts for the liberal sodium intake in the U.S. diet? List five ways an individual can reduce the sodium in his diet. ANSWER: In general, processed foods have the most sodium, whereas unprocessed foods such as fresh fruits and vegetables have the least. In fact, most of the sodium in people’s diets comes from salt added to foods during food processing and preparation; only a small proportion comes from salt added during cooking and at the table or from the natural content in foods. Among foods with the highest sodium density (milligrams of sodium per kcalorie) are mixed foods such as sandwiches, pizza, tacos, and soups. Because sodium intake tends to increase as kcalories increase, making food choices based on low sodium density is a practical and effective way to meet sodium recommendations. To help consumers limit their intake, public health organizations and policymakers worldwide have called for manufacturers and restaurants to reduce sodium in the food supply. Quite simply, removing salt from processed foods is a more effective option than educating consumers. Unfortunately, several studies report that these voluntary reductions in sodium by the food industry are slow and not particularly meaningful. Because processed foods may contain sodium without chloride, as in additives such as sodium bicarbonate or sodium saccharin, they do not always taste salty. Most people are surprised to learn that 1 ounce of some cereals contains more sodium than 1 ounce of salted peanuts—and that ½ cup of instant chocolate pudding contains still more. The peanuts taste saltier because the salt is all on the surface, where the tongue’s taste receptors immediately pick it up. Techniques to reduce sodium: • Select fresh or frozen vegetables. If buying canned vegetables, drain and rinse in water to remove some of the sodium or select those labeled low-sodium or no-salt-added. • Cook with little or no added salt. • Prepare foods with sodium-free herbs and spices such as basil, bay leaves, curry, garlic, ginger, mint, oregano, pepper, rosemary, and thyme; lemon juice; vinegar; or wine. • Add little or no salt at the table; taste foods before adding salt. • Read labels with an eye open for sodium. • Select low-salt or salt-free products when available. • Use these foods sparingly: o Foods prepared in brine, such as pickles, olives, and sauerkraut o Salty or smoked meats, such as bologna, corned or chipped beef, bacon, frankfurters, ham, luncheon meats, salt pork, sausage, and smoked tongue o Salty or smoked fish, such as anchovies, caviar, salted and dried cod, herring, sardines, and smoked salmon o Snack items such as potato chips, pretzels, salted popcorn, salted nuts, and crackers o Condiments such as bouillon cubes; seasoned salts; MSG; soy, teriyaki, Worcestershire, and barbeque sauces o Prepared horseradish, ketchup, and mustard o Cheeses, especially processed types o Canned and instant soups o Packaged instant or flavored rice, pasta, and cereal mixes

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Chapter 12- Water and the Major Minerals 106. Briefly describe the roles of chloride in the body. ANSWER: Chloride is the major anion of the extracellular fluids (outside the cells), where it occurs mostly in association with sodium. Chloride moves passively across membranes through channels and so also associates with potassium inside cells. Like sodium and potassium, chloride maintains fluid and electrolyte balance. In the stomach, the chloride ion is part of hydrochloric acid, which maintains the strong acidity of gastric juice. One of the most serious consequences of vomiting is the loss of this acid from the stomach, which upsets the acid–base balance. Such imbalances are commonly seen in bulimia nervosa. 107. Compare and contrast how the body maintains blood calcium from the diet and from the bones. ANSWER: Calcium homeostasis involves a system of hormones and vitamin D. Whenever blood calcium falls too low or rises too high, three body systems respond: the intestines, bones, and kidneys. The calcium in bones provides a nearly inexhaustible bank of calcium for the blood. The blood borrows and returns calcium as needed so that even with an inadequate diet, blood calcium remains normal—even as bone calcium diminishes. Blood calcium changes only in response to abnormal regulatory control, not to diet. A person can have an inadequate calcium intake for years and have no noticeable symptoms. Only later in life does it become apparent that bone integrity has been compromised. Blood calcium above normal results in calcium rigor: the muscles contract and cannot relax. Similarly, blood calcium below normal causes calcium tetany—also characterized by uncontrolled muscle contraction. These conditions do not reflect a dietary excess or lack of calcium; they are caused by a lack of vitamin D or by abnormal secretion of the regulatory hormones. A chronic dietary deficiency of calcium, or a chronic deficiency due to poor absorption over the years, depletes the bones. Again, the bones, not the blood, are robbed by a calcium deficiency. 108. What problems do processed foods pose to recommended phosphorus intakes? ANSWER: Because phosphorus is commonly found in almost all foods, dietary deficiencies are unlikely. Foods rich in proteins—such as meat, poultry, fish, milk, and cheese—are the best sources of phosphorus. Many processed foods and soft drinks contain phosphate-based additives, and phosphorus intakes in the United States have increased as consumption of processed foods and beverages has increased. Phosphate toxicity is rare and usually reflects a significant problem such as kidney failure. Still, phosphorus intakes can be excessive when processed foods take center stage, disrupting kidney function and bone metabolism; high intakes are also associated with increased mortality. A UL of 4000 milligrams has been established.

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Chapter 12- Water and the Major Minerals 109. How do physical activity and body weight affect the risk of osteoporosis? ANSWER: Physical activity may be the single most important factor supporting bone growth during adolescence. Active adolescents have stronger bones in adulthood. Muscle strength and bone strength go together. When muscles work, they pull on the bones, stimulating them to grow denser. The hormones that promote new muscle growth also support bone growth. As a result, active bones are denser and stronger than sedentary bones. Both the muscle contraction and the gravitational pull of the body’s weight create a load that benefits bone metabolism. To keep bones healthy, a person should engage in weight training or weight-bearing endurance activities (such as tennis and jogging or sprint cycling) regularly. Regular physical activity combined with an adequate calcium intake helps maximize bone density in children and adolescents. Adults can also maximize and maintain bone density with a regular program of weight training. Even past menopause, when most women are losing bone, weight training improves bone density. Heavier body weights and weight gains place a similar stress on the bones and promote their density. In contrast, weight losses reduce bone density and increase the risk of fractures—in part because energy restriction diminishes calcium absorption and compromises calcium balance. The relative energy deficiency that results from a combination of restricted energy intake and extreme daily exercise reliably predicts bone loss. 110. How do alcohol and smoking affect bone health? ANSWER: Add bone damage to the list of ill consequences associated with smoking. The bones of smokers are less dense than those of nonsmokers— even after controlling for differences in age, body weight, and physical activity habits. Fortunately, the damaging effects can be reversed with smoking cessation. Blood indicators of beneficial bone activity are apparent 6 weeks after a person stops smoking. In time, bone density is similar for former smokers and nonsmokers. People who abuse alcohol often suffer from osteoporosis and experience more bone breaks than others. Several factors appear to be involved. Alcohol enhances fluid excretion, leading to excessive calcium losses in the urine; upsets the hormonal balance required for healthy bones; slows bone formation, leading to lower bone density; stimulates bone breakdown; and increases the risk of falling.

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Chapter 13- The Trace Minerals 1. Which of the following is not an essential trace mineral? a. selenium b. copper c. nickel d. chromium e. molybdenum ANSWER: c 2. Which of the following is a characteristic of trace minerals? a. A deficiency sign common to many trace minerals is dermatitis b. The amounts in foods are dependent, in part, on soil composition c. Deficiencies are more difficult to recognize in children than in adults d. The amount of all trace minerals in the average person totals approximately 100 grams e. They function independently in the body ANSWER: b 3. What is the oxygen-carrying protein of muscle cells? a. transferrin b. myoglobin c. hemoglobin d. cytochrome e. oxyglobin ANSWER: b 4. What is transferrin? a. an enzyme b. an iron-storage protein c. an iron transport protein d. a muscle protein e. a ketone ANSWER: c 5. Iron balance is maintained in the body mainly through a. absorption b. excretion

c. gluconeogenesis d. glycolysis e. bile production ANSWER: a Page 1

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Chapter 13- The Trace Minerals 6. About what percentage of the iron consumed in one day represents heme iron? a. 5% b. 10% c. 25% d. 50% e. 90% ANSWER: b 7. Which of the following foods provides iron in the most absorbable form? a. rice b. spinach c. chicken d. orange juice e. watermelon ANSWER: c 8. Which of the following substances enhances absorption of nonheme iron? a. MFP factor b. phytates c. calcium d. polyphenols e. tannic acid ANSWER: a 9. Which of these statements is true of nonheme iron? a. It is present in plant-derived foods only. b. It is present in both plant-derived and animal-derived foods. c. Only about 25 % of nonheme iron in food is absorbed. d. Citric acid interferes with its absorption. e. Its absorption is enhanced by phytates. ANSWER: b 10. About what percentage of iron is absorbed from a vegetarian diet? a. 10% b. 15% c. 25% d. 30% e. 35% ANSWER: a Page 2

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Chapter 13- The Trace Minerals 11. Which one of these foods contains a substance that inhibits absorption of nonheme iron? a. orange juice b. pork c. chicken d. milk e. fish ANSWER: d 12. What is hemosiderin? a. the part of iron that is not used by the body b. another term for ferritin c. a protein that carries iron in the blood d. an enzyme that helps in absorption of iron e. a storage protein for iron ANSWER: e 13. What is the name of the hormone that regulates iron balance in the body? a. ferritin b. transferrin c. hemosiderin d. hepcidin e. MFP factor ANSWER: d 14. Which statement is NOT true about how the body uses iron? a. Most iron entering the body is recycled. b. Iron can be lost from bleeding and sweating, as well as through the GI tract, skin, and urine. c. Blood loss is the only way the body loses iron. d. Surplus iron is stored in the muscles. e. Iron is carried in the blood by transferrin. ANSWER: c 15. How is iron used in the bone marrow? a. It is converted to myoglobin and sent to the muscle for storage. b. It is used to produce transferrin. c. It is used to make hemoglobin. d. It is used to convert hemoglobin to myoglobin. e. It becomes a cofactor and used during energy metabolism. ANSWER: c Page 3

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Chapter 13- The Trace Minerals 16. About what percentage of the US population is deficient in iron? a. 5% b. 10% c. 20% d. 33% e. 42% ANSWER: b 17. In developing countries, blood loss is often brought on by a. lack of sufficient intake of foods b. frequent injuries c. pregnancy and childbirth d. iron overload e. malaria and parasitic infections of the GI tract ANSWER: e 18. What tests are typically used to evaluate iron status? a. serum ferritin b. hemoglobin and hematocrit c. transferrin saturation d. erythrocyte protoporphyrin level e. urine analysis ANSWER: b 19. The term iron-deficiency anemia refers specifically to . a. low transferrin levels b. severe depletion of iron stores that results in a low hemoglobin concentration c. elevated levels of iron in the urine d. insufficient hepcidin e. severe depletion of myoglobin from muscle cells ANSWER: b 20. Which of the following characterizes iron-deficiency anemia? a. macrocytic red blood cells b. microcytic red blood cells c. purplish tongue d. reddened cheeks e. hyperchromic red blood cells ANSWER: b Page 4

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Chapter 13- The Trace Minerals 21. The erythrocyte protoporphyrin level is an indicator of a. late iron toxicity b. early iron toxicity

c. late iron deficiency d. early iron deficiency e. adequacy or iron stores ANSWER: c 22. What measurement is useful for detecting iron deficiency in its earliest stage? a. hematocrit b. serum iron level c. red blood cell count d. serum ferritin e. transferrin saturation ANSWER: d 23. Which of these groups is vulnerable to iron overload? a. female athletes b. pregnant women c. breastfed infants d. alcoholics e. cigarette smokers ANSWER: d 24. Which of these therapies may be used to treat iron overload? a. gastric bypass surgery b. chelation c. vitamin C supplements d. calcium supplements e. blood transfusion ANSWER: b 25. What is pica? a. the craving for and consumption of nonfood substances b. a condition in which the body fails to adequately absorb iron c. an iron supplement d. a measure of hepcidin in the liver e. the part of the liver where iron is stored ANSWER: a Page 5

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Chapter 13- The Trace Minerals 26. About how much iron does the usual US diet provide per 1000 kcalories? a. 3 to 5 mg b. 6 to 7 mg c. 10 to 12 mg d. 15 mg e. 18 mg ANSWER: b 27. What is the RDA for iron for women in their reproductive years? a. 8 mg b. 12 mg c. 18 mg d. 20 mg e. 24 mg ANSWER: c 28. Which of these foods is a good vegetarian source of iron? a. yogurt b. milk c. cashews d. apples e. honey ANSWER: c 29. Of these foods, which is the best source of iron? a. parsley b. peanut butter c. pinto beans d. tuna e. tofu ANSWER: a 30. Which of the following would represent a source of possible iron contamination? a. an iron frying pan b. an iron chelate c. a ferric iron supplement d. a ferrous iron supplement e. a vitamin C supplement ANSWER: a Page 6

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Chapter 13- The Trace Minerals 31. Which of the following is a common side effect from taking iron supplements? a. itching b. diarrhea c. constipation d. insomnia e. arrythmia ANSWER: c 32. Where are the highest concentrations of zinc in the body? a. liver and pancreas b. brain c. small intestine d. blood e. muscle and bone ANSWER: e 33. In which of the following functions is zinc NOT involved? a. regulation of gene expression b. blood clotting c. insulin storage d. growth and development e. secretion of stomach acids ANSWER: e 34. Zinc is primarily carried in the blood via a. hemoglobin b. metallothionein c. albumin

d. high-density lipoproteins e. low-density lipoproteins ANSWER: c 35. Zinc supports the work of thousands of proteins in the body, such as a. metalloenzymes b. lipase

c. lactase d. CCK e. oxidoreductase ANSWER: a Page 7

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Chapter 13- The Trace Minerals 36. What is the Tolerable Upper Intake Level (UL) for zinc for adults? a. 20 mg b. 40 mg c. 80 mg d. 120 mg e. 160 mg ANSWER: b 37. Of these foods, which is the best source of zinc? a. oysters b. potatoes c. eggs d. watermelon e. tomato juice ANSWER: a 38. Zinc toxicity . a. is unknown b. may occur at doses of more than 50 mg of zinc per day c. is most likely to occur in developing countries d. often goes hand in hand with iron toxicity e. is common in people who eat high-protein diets ANSWER: b 39. Which of the following statements is true about zinc lozenges and the common cold? a. There is no known relationship. b. Zinc lozenges help reduce the severity of cold symptoms. c. Zinc taken with vitamin C may help prevent the common cold. d. Zinc lozenges may shorten the duration but not the severity of common cold symptoms. e. Any positive effect requires at least 500 mg zinc daily. ANSWER: d 40. What is the main symptom of iodine deficiency? a. anemia b. goiter c. skin lesions d. diarrhea e. purplish tongue ANSWER: b Page 8

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Chapter 13- The Trace Minerals 41. Which of the following is true of iodine deficiency? a. It can cause mental impairment and brain damage. b. It mainly affects the very elderly. c. It often is accompanied by zinc deficiency. d. Treatment often includes increased consumption of vegetables high in goitrogens. e. Worldwide, the incidence is rare, thanks in large part to the iodization of salt. ANSWER: a 42. Iodine plays an integral part in which hormone? a. insulin b. thyroid hormone c. estrogen d. hepcidin e. testosterone ANSWER: b 43. The iodization of salt . a. began in the United States in the 1880s b. has helped eradicate most cases of cretinism in the United States c. is mandatory in the United States d. is available to only about 10% of households in developing countries e. has no benefit except for children ANSWER: b 44. What other nutrient deficiency is common among people with iodine deficiency? a. calcium b. iron c. vitamin C d. vitamin D e. zinc ANSWER: b 45. Goitrogens are substances that . a. naturally occur in certain vegetables, such as collards, brussels sprouts, and kale b. are additives used in food processing c. develop as a result of iodine toxicity d. help in uptake of iodine by the thyroid e. can lead to cancerous growths in the pituitary gland ANSWER: a Page 9

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Chapter 13- The Trace Minerals 46. The RDA for iodine . a. can be met only by consuming iodized salt b. can be met in 1 tablespoon of iodized salt c. is the same for men and women d. is higher in men e. is higher in women ANSWER: c 47. Of these foods, which is a significant source of iodine? a. dairy products b. kale c. orange juice d. processed foods e. brussels sprouts ANSWER: a 48. What does severe iodine deficiency cause during pregnancy? a. gestational diabetes b. iron deficiency c. protein malabsorption d. ketosis e. cretinism ANSWER: e 49. To avoid iodine toxicity, the UL is set at a. 75 µg/day b. 500 µg/day c. 1100 µg/day

d. 1200 µg/day e. 1500 µg/day ANSWER: c 50. The baking industry uses a. sugars b. alcohol

as dough conditioners

c. carbon dioxide d. iodates e. triglycerides ANSWER: d Page 10

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Chapter 13- The Trace Minerals 51. An important function of selenium is to a. help blood clot b. prevent free-radical formation

c. stimulate the taste buds d. help in metabolism of cholesterol e. work with vitamin E in formation of hemoglobin ANSWER: b 52. The deficiency of which mineral causes Keshan disease? a. iron b. zinc c. selenium d. molybdenum e. copper ANSWER: c 53. With which of these nutrients does selenium work in tandem? a. iron b. vitamin A c. vitamin C d. vitamin E e. manganese ANSWER: d 54. How is copper like iron? a. Both are needed in many of the reactions involved in energy metabolism. b. Both are found in ample amounts in milk. c. A deficiency of both causes anemia. d. Both are better absorbed in the presence of ascorbic acid. e. Deficiencies of both are related to the development of pica. ANSWER: a 55. What is the Tolerable Upper Intake Level for copper? a. 5 mg/day b. 105 mg/day c. 100 mg/day d. 5000 mg/day e. 1000 mg/day ANSWER: b Page 11

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Chapter 13- The Trace Minerals 56. Which of these diseases is a possible cause of copper toxicity? a. Huntington’s disease b. Wilson’s disease c. Menkes disease d. Parkinson’s disease e. Keshan disease ANSWER: c 57. Which of the following is NOT true of copper? a. It is a key factor in hemoglobin synthesis. b. It helps make collagen. c. It depends on triglycerides to maintain balance and for transport in the body. d. It helps inactivate histamine. e. It is a constituent of several enzymes. ANSWER: c 58. Which of the following protein foods is the best source of copper? a. chicken b. shellfish c. beefsteak d. hamburger e. lamb ANSWER: b 59. Treatment for copper deficiency that results from the genetic disorder, such as Menkes disease, involves a. chelation b. zinc supplements c. copper supplements

d. intravenous copper e. low-iron diet ANSWER: d 60. Which of the following is true of manganese? a. It is found in all organs of the body. b. Its absorption is improved by phytates. c. Toxicities are more likely to occur from a contaminated environment than from excess dietary intake. d. It is found in a wide range of foods, including meat and milk. e. There is no RDA because deficiencies are unknown. ANSWER: c Page 12

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Chapter 13- The Trace Minerals 61. For most people in the United States, the best source of fluoride is a. fluoridated drinking water b. toothpaste

c. fresh fruits and vegetables d. fluoride supplements e. meat ANSWER: a 62. Which of the following is true of fluoride? a. A deficiency causes the condition fluorosis. b. Toxicity is unknown. c. A deficiency can lead to pica. d. It is added to about 25% of community water systems in the United States. e. It makes teeth stronger and more resistant to decay. ANSWER: e 63. Which of the following is NOT a function of chromium? a. It enhances the activity of insulin. b. It is involved in carbohydrate metabolism. c. It is involved in protein metabolism. d. It is involved in fat metabolism. e. It helps maintain glucose homeostasis. ANSWER: c 64. Chromium deficiency is characterized by a. hypertension b. hyperglycemia c. hypoglycemia

d. weight loss e. hyperparathyroidism ANSWER: b 65. Characteristics of molybdenum toxicity as reported in animal studies includes? Kidney damage and reproductive abnormalities a. Kidney damage and reproductive abnormalities b. Enhances activity of insulin c. Liver abnormalities d. The RDA is 0.1 mcg per day. e. It does not have an RDA because not enough is known about it. ANSWER: a Page 13

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Chapter 13- The Trace Minerals 66. Which of the following substances is a contaminant mineral? a. nickel b. copper c. cadmium d. bromine e. boron ANSWER: c 67. Which nutrient deficiency makes children particularly vulnerable to lead toxicity? a. calcium b. vitamin C c. chromium d. iron e. selenium ANSWER: d 68. Which of the following is true of heavy metals? a. They have a high number of double bonds. b. They have a relatively high atomic weight. c. They all are considered contaminant minerals. d. They are introduced to food during food processing, when exposed repeatedly to metal food surfaces. e. A few, but not all, are toxic. ANSWER: b 69. Lycopene . a. is one of many flavonoids b. may help protect against cancer and heart disease c. is abundant in apples d. is another name for vitamin E e. may promote growth of estrogen-dependent cancers ANSWER: b 70. What is a possible health benefit of anthocyanins? a. to promote weight loss b. to prevent some cancers c. to reduce complications of diabetes d. to protect against the effects of aging e. to lower blood cholesterol levels ANSWER: d Page 14

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Chapter 13- The Trace Minerals 71. Essential mineral nutrients needed in amounts of less than 100 milligrams a day are known as ____________________. ANSWER: trace minerals (or microminerals) 72. Most of the body’s iron is found in the proteins

and

ANSWER: hemoglobin, myoglobin 73. The state of having depleted iron stores is known as

ANSWER: iron deficiency 74. Enzymes that contain one or more minerals as part of their structures are known as

ANSWER: metalloenzymes Match the correct answer with the appropriate term a. Contaminant minerals b. Iron c. Milk d. Zinc e. Heme f. Goiter g. Nonessential trace minerals h. Ferritin i. Keshan j. Nonheme k. Chromium l. Molybdenum m. Myoglobin n. MFP factor o. Hemoglobin p. Calcium q. Fluoride r. Iodized salt s. Metallothionein t. Hepcidin 75. DRIs not yet determined ANSWER: g 76. Iron-storage protein that captures iron from food and stores it in cells of small intestine ANSWER: h

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Chapter 13- The Trace Minerals 77. Form of iron found only in meat, fish, and poultry ANSWER: e 78. Form of iron found in both plant and animal foods ANSWER: j 79. Oxygen-carrying protein in muscle ANSWER: m 80. Iron-containing protein in erythrocytes ANSWER: o 81. Peptide that enhances absorption of nonheme iron ANSWER: n 82. Mineral that inhibits absorption of nonheme iron ANSWER: p 83. Mineral most often deficient in diets ANSWER: b 84. Hormone that regulates iron balance ANSWER: t 85. Notoriously poor source of iron ANSWER: c 86. Mineral whose deficiency is related to stunted growth and immature sexual development ANSWER: d 87. Zinc-binding protein of the intestine ANSWER: s 88. Enlargement in neck caused by iodine deficiency ANSWER: f 89. Fortification that has helped reduce incidence of goiter and cretinism ANSWER: r 90. Disease associated with severe selenium deficiency ANSWER: i 91. Trace mineral that reduces dental caries ANSWER: q 92. Deficiency leads to diabetes-like condition ANSWER: k Page 16

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Chapter 13- The Trace Minerals 93. Nutrient whose amount is as little as 0.1 parts per million parts of body tissue ANSWER: l 94. Examples include lead, mercury, and cadmium ANSWER: a 95. The congenital disease caused by severe iodine deficiency during pregnancy that results in severe mental impairment and stunted growth is known as . ANSWER: cretinism 96. The genetic disorder

interferes with copper metabolism and creates a copper toxicity.

ANSWER: Wilson’s disease 97. The condition in which the teeth are damaged from too much fluoride is called “

.”

ANSWER: fluorosis 98. Explain heme and nonheme iron, and discuss the factors that influence their absorption in the body. ANSWER: Iron occurs in two forms in foods: as heme iron, which is found only in foods derived from the flesh of animals, such as meats, poultry, and fish, and as nonheme iron, which is found in both plant-derived and animal-derived foods. On average, heme iron represents about 10% of the iron a person consumes in a day. Even though heme iron accounts for only a small proportion of the intake, it is so well absorbed that it contributes significant iron. About 25% of heme iron and 17% of nonheme iron is absorbed, depending on dietary factors and the body’s iron stores. In iron deficiency, absorption increases. In iron overload, absorption declines. Heme iron has a high bioavailability and is not influenced by dietary factors. In contrast, several dietary factors influence nonheme iron absorption. Meat, fish, and poultry contain not only the well-absorbed heme iron but also a peptide (sometimes called the MFP factor) that promotes the absorption of nonheme iron from other foods eaten at the same meal. Vitamin C (ascorbic acid) also enhances nonheme iron absorption from foods eaten at the same meal by capturing the iron and keeping it in the reduced ferrous form, ready for absorption. Some acids (such as citric acid) and sugars (such as fructose) also enhance nonheme iron absorption. Some dietary factors bind with nonheme iron, inhibiting absorption. These factors include the phytates in legumes, whole grains, and rice; the vegetable proteins in soybeans, other legumes, and nuts; the calcium in milk; and the polyphenols (such as tannic acid) in tea, coffee, grain products, oregano, and red wine. The many dietary enhancers, inhibitors, and their combined effects make it difficult to estimate iron absorption. Most of these factors exert a strong influence individually but not when combined with the others in a meal. Furthermore, the impact of the combined effects diminishes when a diet is evaluated over several days. When multiple meals are analyzed together, three factors appear to be most relevant: MFP factor and vitamin C as enhancers and phytates as inhibitors.

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Chapter 13- The Trace Minerals 99. Describe the development of iron deficiency, including measurements used to assess iron status, and the development of iron-deficiency anemia. ANSWER: Iron deficiency develops in stages. In the first stage, iron stores are diminished. Measures of serum ferritin (in the blood) reflect iron stores and are most valuable in assessing iron status at this stage. The second stage of iron deficiency is characterized by a decrease in transport iron: the iron-carrying protein transferrin increases (an adaptation that enhances iron absorption). Together, measurements of serum ferritin and transferrin can determine the severity of the deficiency—the more transferrin and the less serum ferritin, the more advanced the deficiency is. Transferrin saturation—the percentage of transferrin that is saturated with iron—decreases as iron stores decline. The third stage occurs when the lack of iron limits hemoglobin production. Now the hemoglobin precursor, erythrocyte protoporphyrin, begins to accumulate as hemoglobin and hematocrit values decline. Hemoglobin and hematocrit tests are easy, quick, and inexpensive, so they are the tests most commonly used in evaluating iron status. Iron-deficiency anemia refers to the severe depletion of iron stores that results in a low hemoglobin concentration. In iron-deficiency anemia, hemoglobin synthesis decreases, resulting in red blood cells that are pale (hypochromic) and small (microcytic). Without adequate iron, these cells can’t carry enough oxygen from the lungs to the tissues. Energy metabolism in the cells falters. The result is fatigue, weakness, headaches, apathy, pallor, and poor resistance to cold temperatures. 100. Discuss the pros and cons of iron supplementation for people who are iron-deficient. What are some recommendations on how to get the most from them? ANSWER: People who are iron-deficient may need supplements, as well as an iron-rich, absorption-enhancing diet. Many physicians routinely recommend iron supplements to pregnant women, infants, and young children. Iron from supplements is less well absorbed than that from food, so the doses must be high. The absorption of iron taken as ferrous sulfate is better than that from other iron supplements. Absorption also improves when supplements are taken between meals, at bedtime on an empty stomach, and with liquids (other than milk, tea, or coffee, all of which inhibit absorption). Taking iron supplements in a single dose instead of several doses per day is equally effective and may improve a person’s willingness to take it regularly. There is no benefit to taking iron supplements with orange juice because vitamin C does not enhance absorption from supplements as it does from foods. Vitamin C enhances iron absorption by converting insoluble ferric iron in foods to the more soluble ferrous iron, and supplemental iron is already in the ferrous form. Constipation is a common side effect of iron supplementation; drinking plenty of water helps relieve this problem. The best strategy to ensure compliance is to individualize the dose, formulation, and schedule. Most importantly, iron supplements should be taken only when prescribed by a physician who has assessed an iron deficiency.

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Chapter 13- The Trace Minerals 101. What are the concerns of iron nutrition in vegetarians? ANSWER: Overall, about 18% of dietary iron is absorbed from mixed diets and only about 10% from vegetarian diets. Vegetarian diets do not have the benefit of easy-to-absorb heme iron or the help of the MFP factor in enhancing absorption. Vegetarians need 1.8 times as much iron to make up for the low bioavailability typical of their diets. Good vegetarian sources of iron include soy foods (such as soybeans and tofu), legumes (such as lentils and kidney beans), nuts (such as cashews and almonds), seeds (such as pumpkin seeds and sunflower seeds), cereals (such as cream of wheat and oatmeal), dried fruit (such as apricots and raisins), vegetables (such as mushrooms and potatoes), and blackstrap molasses. 102. Describe zinc’s role in the body. What are significant sources of zinc? ANSWER: Zinc supports the work of thousands of proteins in the body, such as the metalloenzymes, which participate in a variety of metabolic processes, and transcription factors, which regulate gene expression. In addition, zinc stabilizes cell membranes and DNA, helping to strengthen antioxidant defenses against free-radical attacks. Zinc also assists in immune function and in growth and development. Zinc participates in the synthesis, storage, and release of the hormone insulin in the pancreas, although it does not appear to play a direct role in insulin’s action. Zinc interacts with platelets in blood clotting, affects thyroid hormone function, and influences behavior and learning performance. It is needed to produce the active form of vitamin A in visual pigments and the retinolbinding protein that transports vitamin A. It is essential to normal taste perception, wound healing, sperm production, and fetal development. Zinc is highest in protein-rich foods, such as shellfish (especially oysters), meats, poultry, milk, and cheese. Legumes and whole-grain products are good sources, if eaten in large quantities. Vegetables vary in zinc content depending on the soil in which they are grown. 103. Describe the effects that the two rare genetic disorders, Menkes disease and Wilson’s disease, have on copper status and the treatment for both. ANSWER: These two disorders affect copper status in opposite directions. In Menkes disease, the intestinal cells absorb copper but cannot release it into circulation, causing a life-threatening deficiency. Treatment involves giving copper intravenously. In Wilson’s disease, copper accumulates in the liver and brain, creating a life-threatening toxicity. Wilson’s disease can be controlled by reducing copper intake, using chelating agents such as penicillamine, and taking zinc supplements, which interfere with copper absorption. 104. What relationship, if any, does chromium have to diabetes? Name foods that are significant sources of chromium. ANSWER: Chromium helps maintain glucose homeostasis by enhancing the activity of the hormone insulin. When chromium is lacking, a diabetes-like condition may develop, with elevated blood glucose and impaired glucose tolerance, insulin response, and glucagon response. Research suggests that chromium supplements provide little or no benefit to people with type 2 diabetes. Chromium is present in a variety of foods. The best sources are unrefined foods, particularly liver, brewer’s yeast, and whole grains. The more refined foods people eat, the less chromium they ingest.

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Chapter 13- The Trace Minerals 105. Name and describe an example of a food or water fortification or enrichment program in the United States aimed at reducing deficiencies of an essential trace mineral. ANSWER: Iron enrichment of flour and grain products. While the federal government does not mandate iron enrichment, most states require manufacturers to enrich flour and grain products with iron. One serving of enriched bread or cereal provides only a little iron, but because people eat many servings of these foods, the contribution can be significant. Iron fortification of grain products effectively reduces the prevalence of iron deficiency. Iron added to foods is nonheme iron, which is not absorbed as well as heme iron, but when eaten with absorption-enhancing foods, enrichment iron can increase iron stores and reduce iron deficiency. In cases of iron overload, enrichment may exacerbate the problem. Iodization of salt. In the United States, the iodization of salt provides about 60 micrograms of iodine per gram of salt. The term iodized salt on labels means that iodine has been added. Labels on salt that do not provide added iodine must state “This salt does not supply iodide, a necessary nutrient.” The iodization of salt has helped reduce the incidence of conditions related to iodine deficiency: goiters and cretinism. Fluoridation of public drinking water. Drinking water is usually the best source of fluoride, and 75% of the U.S. population served by community water systems receives fluoridated water. Fluoridation of drinking water (to raise the concentration to 0.7 milligram per liter of water) protects against dental caries and supports oral health. By fluoridating the drinking water, a community offers its residents, particularly children, a safe, economical, practical, and effective way to defend against dental caries. 106. What are the concerns about lead? What effect does it have on the body, specifically nutrition status. ANSWER: Lead is an example of a contaminant mineral, which are minerals that impair the body’s growth, work capacity, and general health. They enter the food supply by way of soil, water, and air pollution. Lead is a serious environmental threat to young children, and reducing blood lead levels in children is a goal of the Healthy People initiative. Chemically similar to nutrient minerals such as iron, calcium, and zinc (cations with two positive charges), lead displaces them from some of the metabolic sites they normally occupy so they are then unable to perform their roles. For example, lead competes with iron in heme, but it cannot carry oxygen. Similarly, lead competes with calcium in the brain, but it cannot signal messages from nerve cells. Excess lead in the blood also deranges the structure of red blood cell membranes, making them leaky and fragile. Lead interacts with white blood cells, too, impairing their ability to fight infection, and it binds to antibodies, thwarting their effort to resist disease. Eating nutrient-rich foods and preserving a clean environment are the best ways to prevent lead contamination. 107. Discuss phytochemicals. What are they? What functions do they provide? What effect, if any, do they have on health? ANSWER: Phytochemicals are compounds found in plant-derived foods that have biological activity in the body. In foods, they impart tastes, aromas, colors, and other characteristics. For example, they give peppers their burning sensation, garlic its pungent flavor, and tomatoes their red color. In the body, phytochemicals can have profound physiological effects—acting as antioxidants, mimicking hormones, stimulating enzymes, interfering with DNA replication, suppressing inflammation, destroying bacteria, and binding to cell walls. Any of these actions may prevent the development of chronic diseases, depending in part on how genetic factors interact with the phytochemicals. Phytochemicals might also have adverse effects when consumed in excess as a dietary supplement.

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 1. A fertilized ovum is known as a a. zygote b. embryo

c. fetus d. placenta e. implantation egg ANSWER: a 2. All of the following are associated with reduced fertility, except a. malnutrition. b. overweight dad. c. underweight dad. d. overweight mom. e. obese mom. ANSWER: c 3. The is the organ from which the infant receives nourishment. a. placenta b. umbilical cord c. amniotic sac d. blastocyte e. sac in which the developing infant is contained prior to birth ANSWER: a 4. A developing infant from 2 to 8 weeks is known as a(n) a. fetus b. ovum c. zygote

d. embryo e. blastocyst ANSWER: d 5. A healthy full-term infant weighs approximately a. 5½ to 7 b. 6 to 7

pounds.

c. 6½ to 8 d. 8 to 9 e. over 7 ANSWER: c Page 1

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 6. What is the approximate length of the fetus at 11 weeks of development? a. 1 inch b. 2 inches c. 1 foot d. 1.5 feet e. 2 feet ANSWER: a 7. The is the time period during which irreversible damage to the fetus may occur from specific events such as malnutrition or exposure to toxins. a. period of maximal sensitivity b. critical period c. fertility period d. conceptual period e. teratogenic period ANSWER: b 8.

is the term used for a developing infant from the eighth week after conception until birth. a. Fetus b. Ovum c. Zygote d. Embryo e. Blastocyst ANSWER: a

9. The influence of how a mother’s nutrient intake may change gene expression to increase the infant’s development of obesity or chronic diseases later in life is referred to as . a. fetal programming b. overnutrition c. malnutrition d. fertilization e. critical periods ANSWER: a

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 10. Which organ system is most vulnerable to adverse influences during its critical period? a. cardiovascular system b. circulatory system c. digestive system d. nervous system e. endocrine system ANSWER: d 11. Which of the following is NOT a risk factor for neural tube defects? a. inadequate folate b. the mother being obese c. the mother being underweight d. family history of spina bifida e. the mother being of Hispanic ethnicity ANSWER: c 12. An infant born at 39 weeks would be described as a. preterm b. complete c. full-term d. postterm e. after due date

ANSWER: c 13.

supplementation is associated with a lower incidence of neural tube defects. a. Iron b. Folate c. Calcium d. Cobalamin e. Iodine ANSWER: b

14. A “belly button” is the scar in the middle of the abdomen that marks the former attachment of the a. blastocyte b. amniotic sac

c. placenta d. umbilical cord e. uterus ANSWER: d Page 3

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 15.

is a primary determinant of beta cell growth in infants a. Prenatal supplements b. Nutrition c. Overnutrition d. Undernutrition e. Paternal body weight ANSWER: b

16. Which of the following is true about low-birthweight infants? a. They show greater prevalence for liver fat infiltration. b. They demonstrate catch-up growth within 3 months of birth. c. They have an increased risk for insulin resistance later in life. d. They have proportionately larger kidneys and greater risks for low blood pressure. e. They are more commonly born to upper socioeconomic status women. ANSWER: c 17. Which of the following is an example of macrosomia? a. a neural tube defect in a fetus b. a baby born at 37 weeks’ gestation c. a mother gaining excessive weight during pregnancy d. a baby born after the fortieth week of gestation e. a baby born weighing 9 lb 6 oz ANSWER: e 18. Compared to other women, obese women are more likely to have all of the following, except a. complications during delivery. b. gestational hypertension. c. large-for-gestational-age babies. d. gestational oxygen deprivation. e. gestational diabetes. ANSWER: d 19. Sue has a BMI of 23.4 at conception. What is her recommended range of weight gain? a. 10 to 18 lb b. 19 to 24 lb c. 25 to 35 lb d. 36 to 44 lb e. 45 to 55 lb ANSWER: c Page 4

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 20. Sonya is overweight when she becomes pregnant. What is her recommended range of weight gain? a. 10 to 18 lb b. 15 to 25 lb c. 25 to 35 lb d. 36 to 44 lb e. 45 to 55 lb ANSWER: b 21. Based on the weight gain patterns discussed, a woman who was at a healthy BMI when she became pregnant should have gained approximately pounds by the twentieth week of gestation. a. 7 b. 10½ c. 20 d. 14½ e. 17½ ANSWER: b 22. What is the recommended range of weight gain for a mother at healthy BMI at conception who is pregnant with twins? a. 28 to 40 lb b. 31 to 50 lb c. 37 to 54 lb d. 50 to 70 lb e. There are insufficient data to make a recommendation. ANSWER: c 23. Which of the following is a correct statement with regard to the mother’s weight and weight loss after pregnancy? a. Most women return to their prepregnancy weight. b. Women who do lose all their pregnancy weight are more likely to gain additional weight during adult years. c. A combination of diet and breastfeeding is the most effective method to use to support weight loss. d. Retaining some pregnancy weight has little effect on the mother’s future health and chronic disease risk. e. The more weight a woman gains beyond needed pregnancy weight, the more weight she will likely retain. ANSWER: e

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 24. All of the following are benefits of physical activity during pregnancy except a. reduced stress. b. fewer discomforts associated with pregnancy. c. maintenance of health habits to help lose weight after birth. d. weight maintenance or loss. e. reduced risk for gestational hypertension. ANSWER: d 25. Sally weighed 160 lb and had a BMI of 28 when she got pregnant. What weight, in pounds, is within the recommended weight gain range for her at the end of her pregnancy? a. 173 b. 182 c. 189 d. 194 e. 196 ANSWER: b 26. Which of the following is a correct statement regarding recommended weight gain for an obese pregnant woman? a. Since she already has excess fat stores, she should try to not gain any weight during pregnancy. b. Her goal is to gain a minimum of 5 pounds but no more than 10 pounds. c. Regardless of weight status, all mothers need to gain 25 to 35 pounds while pregnant. d. Her goal is to gain a minimum of 15 pounds but no more than 25 pounds. e. Her goal is to gain between 11 and 20 pounds. ANSWER: e 27.

are the two components that make up approximately 15 lb of the recommended weight gain during pregnancy. a. The placenta and the mother’s fat stores b. The amniotic sac fluid and the infant at birth c. The maternal fat stores and the additional blood volume d. The infant at birth and the mother’s fat stores e. The increased size of the uterus and increases in the mother’s fluid volume ANSWER: d

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 28. For the normal-weight woman, weight gain ideally follows a pattern of __________ per week thereafter. a. 4 lb and 2 lb b. 3.5 lb and 1 lb c. 2 lb and 1 lb

during the first trimester and

d. 3.5 lb and 3 lb e. 2 lb and 4 lb ANSWER: b 29. The increased needs for recommended. a. protein b. calcium c. iron d. zinc e. vitamin B12

during pregnancy cannot be met by diet or existing stores so supplements are

ANSWER: c 30. A pregnant woman needs to increase her intake by approximately the second trimester of pregnancy. a. 200 b. 340 c. 450 d. 540 e. 600

kcal to account for increased energy need in

ANSWER: b 31.

are two nutrients required in higher amounts during pregnancy due to their roles in the synthesis of red blood cells. a. Protein and iron b. Folate and vitamin B12 c. Calcium and vitamin A d. Calcium and B6 e. Selenium and iron ANSWER: b

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 32. Nancy’s protein RDA before she got pregnant was 47 grams per day. What is her protein RDA now that she is pregnant? a. 47 grams b. 1.0 grams per kilogram of body weight c. 72 grams d. 1.2 grams for each kilogram of pregnancy weight gained e. 94 grams ANSWER: c 33. Which nutrient does the body show a dramatic increase in absorption for during pregnancy? a. sodium b. protein c. calcium d. thiamin e. magnesium ANSWER: c 34. The developing brain depends heavily on infant’s brain function and cognition. a. essential amino acids

, and the mother’s intake of during pregnancy may improve an

b. omega-3 fatty acids c. iron d. saturated fats e. vitamins B6 and B12 ANSWER: b 35. Which of the following is a correct statement about calcium during pregnancy? a. Calcium intakes usually meet the recommendations. b. The RDA for calcium is the same as before pregnancy. c. Calcium absorption efficiency is the same as before pregnancy. d. Adequate intake prevents the calcium from being taken from the mother’s bones. e. The body prioritizes the mother’s need bone calcium over that of the fetus. ANSWER: b

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 36. Pregnant women younger than age 25 who receive less than their intake of milk, cheese, yogurt, and other calcium rich foods. a. 800 mg b. 600 m c. 900 mg d. 500 mg e. 1000 mg

of dietary calcium daily need to increase

ANSWER: b 37. Jennifer craves a bowl of ice cream every night while pregnant and has heard that this craving may be due to her body’s need for additional calcium. What would you tell her? a. Cravings usually suggest the body’s need for particular nutrient in the food being craved. b. Cravings usually suggest the body’s need for additional protein. c. Cravings do not seem to indicate a physiological need for a nutrient d. Cravings usually suggest the body’s need for additional energy due to rapid growth spurts in the fetus. e. Cravings suggest physiological need for a nutrient and should be given in to. ANSWER: c 38. Which of the following is a correct statement about morning sickness? a. It may occur any time of day, not just in the morning hours. b. It typically peaks at the start of the second trimester. c. It can be effectively treated by eating foods high in vitamin B6. d. Citrus juices, water, and milk are the best beverages to treat nausea. e. Taking prenatal supplements will ease symptoms. ANSWER: a 39. Pica is often associated with a. calcium deficiency b. sodium deficiency c. iron deficiency anemia d. protein deficiency

e. glucose deficiency ANSWER: c

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 40. Hormone changes experienced during early pregnancy seem to peak at a. 9 weeks of gestation b. 12 weeks of gestation c. 15 weeks of gestation d. 25 weeks of gestation e. 30 weeks of gestation ANSWER: a 41. Which of the following is correct about a woman’s energy needs during the first trimester? a. Only a very small additional amount of energy (150 to 250 kcal) is typically needed. b. They are approximately the same as those for a nonpregnant woman. c. The energy needs are the same as what is needed in the second trimester. d. No additional energy is needed if a vitamin and mineral supplement is being taken. e. Energy needs are the same across all three trimesters. ANSWER: b 42. Which of the following is the standard classification for a very-low-birthweight infant? a. 3½ lb or less b. 4½ lb or less c. 5½ lb or less d. 6½ lb or less e. none of these are correct ANSWER: a 43. A high-quality, cost-effective health care and nutrition services program that provides women who are pregnant, breastfeeding, or have children ages 0 to 5 years is . a. the SNAP program b. the March of Dimes c. food stamp d. the WIC program e. the OAA program ANSWER: d

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 44. Which of the following is not a characteristic of a mother who has experienced malnutrition prior to or after conception? a. inadequate fetal nourishment due to a poorly developed placenta. b. a temporary loss of insulin secretion c. if the baby is female, an elevated risk of that baby later in life to develop a chronic disease that could impair her ability to give birth to a healthy infant. d. growth restriction in the fetus e. higher risk of spontaneous abortion or stillbirth ANSWER: b 45. What is gestational diabetes? a. a severe form of type 1 diabetes in newborns b. glucose intolerance with onset or first recognition during pregnancy c. reactive hypoglycemia expressed during the third trimester of pregnancy d. a temporary loss of insulin secretion during the first trimester of pregnancy e. absence of beta cells in the newborn ANSWER: b 46.

is a condition characterized by high blood pressure and protein in the urine of a pregnant woman. a. Preeclampsia b. Gestational diabetes c. Teratogenic hypertension d. Pregnancy-induced blood pressure crisis e. Malignant renal hypertension syndrome ANSWER: a

47. Which of the following is not a risk factor for gestational diabetes? a. the mother being 33 years old b. the mother being 24 years old c. BMI of 29 at conception d. the mother’s sister having type 2 diabetes e. the mother being African American or Native American ANSWER: b

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 48. To reduce risk of the development of type 2 diabetes after pregnancy, health professional strongly advise women to _______. a. avoid excessive weight gain during and after pregnancy b. gain less than the recommended weight indicated for their BMI at conception c. control blood glucose with insulin or medications rather than rely on diet and exercise if diagnosed with gestational diabetes d. follow a low-carbohydrate diet if diagnosed with gestational diabetes e. avoid foods high in sugar and alcohol ANSWER: a 49. What pregnancy condition can also be an early indicator of preeclampsia? a. chronic hypertension b. gestational diabetes c. gestational hypertension d. preexisting diabetes e. slow, but excessive weight gain ANSWER: c 50. Which of the following is a correct statement about preeclampsia? a. A woman is more likely to have preeclampsia if her mother experienced symptoms when pregnant with her. b. When it progresses, the rate of death is twice as high in white women as in black women. c. It usually occurs in a woman’s second or third pregnancy. d. It’s often seen in the first trimester. e. Symptoms dissipate within 4 to 6 hours after delivery. ANSWER: a 51. All of the following are signs or symptoms of preeclampsia, except a. hypertension. b. severe headaches. c. swelling of hands, feet, and face. d. hypoglycemia. e. sudden weight gain of approximately 1 lb per day. ANSWER: d

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 52. Which of the following is a characteristic associated with adolescent pregnancy? a. Labor is typically shorter due to the baby being smaller. b. Maternal death is highest for those younger than age 20. c. Socioeconomic status has little effect on pregnancy health and complications. d. Young mothers are less likely to smoke. e. They are more likely to deliver a baby that weighs 5½ pounds or less. ANSWER: e 53. Which of the following is not typically something that a pregnant woman of 35 years or older is at higher risk for? a. cesarean sections b. preterm births c. macrosomia d. genetic abnormalities in the fetus e. low-birthweight babies ANSWER: c 54. What is the recommendation for pregnant women regarding alcohol intake during pregnancy? a. They should drink absolutely no alcohol. b. They should refrain from drinking hard liquor only. c. They are permitted to ingest no more than two drinks per day. d. They are permitted to ingest small amounts of alcohol during the last trimester. e. Organic beer and wine is acceptable. ANSWER: a 55. What substance increases the risk of sudden infant death syndrome (SIDS)? a. mercury b. second-hand cigarette smoke c. some herbal supplements d. lead e. prescription medications ANSWER: b 56. Which fish is considered a good choice for pregnant women to eat and can be consumed up to two to three times per week if desired? a. Chilean sea bass b. Atlantic mackerel c. tuna d. orange roughy e. king mackerel ANSWER: b Page 13

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 57. Consumption of unpasteurized dairy products and soft cheeses can lead to a. mercury contamination b. intake of heavy metals like lead c. low birthweights d. foodborne illness from listeriosis. e. phenylketonuria (PKU)

ANSWER: d 58. A low-birthweight infant is defined as a baby that weighs a. 3½ lb or less b. 4 lb or less c. 5 ½ lb or less d. 6½ lb or less e. 9 lb or less

at birth.

ANSWER: c 59.

triggers the “let-down reflex,” where the mammary glands are triggered to eject milk into the milk ducts. a. oxytocin b. estrogen c. prepartum amenorrhea d. postpartum amenorrhea e. FSH ANSWER: a

60. All of the following are potential health benefits of lactation that benefit the mother except a. reduced risk of developing type 2 diabetes. b. lengthened birth intervals or time between pregnancies. c. increased energy expenditure may aid in weight loss. d. reduced risk of all types of cancer. e. contraction of the uterus after birth. ANSWER: d 61. A nursing mother needs at least a. 1200 kcal b. 1400 kcal c. 1800 kcal

a day to receive all the nutrients required for successful lactation.

d. 2000 kcal e. 2400 kcal ANSWER: c Page 14

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 62. What happens to a mother’s milk if she lacks certain nutrients in her diet? a. The milk quantity stays the same but is of lower quality. b. The milk quantity decreases, and the milk is lower in those nutrients. c. The milk quality stays the same, but the quantity of the milk decreases. d. The missing nutrients affect levels of other nutrients in the milk. e. The milk is not an appropriate source of nutrition and formula should be used. ANSWER: c 63. To prevent dehydration, it is recommended that a lactating mother consume approximately a. 6 to 7 cups b. 8 cups c. 10 to 11 cups d. 13 cups e. 16 cups

of water per day.

ANSWER: d 64. Preparation for breastfeeding includes acquiring and learning how to a. use a breast-pump b. weighing the baby c. measuring the quantity of milk d. testing the nutritional quality of milk e. all of these are correct ANSWER: a 65. Breastfeeding is not recommended when the mother has a. hepatitis b. common cold c. tuberculosis

d. sinus infection e. HIV ANSWER: e

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 66. Which of the following can help to minimize the effects of an occasional alcoholic drink in the milk of lactating women? a. Drink alcohol before breastfeeding, rather than after. b. Breastfeed immediately after drinking prior to alcohol entering the bloodstream. c. Pump and discard the milk following alcohol consumption. d. Consume alcohol on an empty stomach. e. Scientific evidence recommends consuming a glass of alcohol while lactating, and it will have no effect on milk. ANSWER: c 67. A lactating mother produces approximately a. 12 oz b. 18 oz c. 25 oz d. 28 oz e. 32 oz

of milk each day.

ANSWER: c 68. Which of the following is not a potential risk or side effect of caffeine intake by a mother when pregnant or breastfeeding? a. irritability in the infant b. infant’s iron stores may be impaired c. increased risk of low-birthweight infant d. increased risk of stillborn infant e. impaired cognitive development ANSWER: e 69. When does the most severe damage associated with fetal alcohol syndrome (FAS) occur? a. around the time of conception b. between weeks 8 and 12 c. after week 24 d. the second trimester e. the third trimester ANSWER: a

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 70. What level of alcohol consumption does the U.S. Surgeon General advice for pregnant women? a. None b. No more than 1 drink per day c. No more than 2 drinks per day d. Between ½ and 1 drink per day e. Less than 1 oz per drink ANSWER: a 71. Which of the following is a correct statement about fetal alcohol syndrome (FAS)? a. FAS cannot be treated, only prevented. b. Cognitive function is affected the least when physical abnormalities are most severe. c. Diagnosis is apparent within 6 months after birth for virtually all children with FAS. d. The most severe physical abnormalities in most FAS children are covert rather than overt. e. No harm will result to the infant unless the mother is actually drunk. ANSWER: a 72. A baby born between 39 and 40 weeks gestation is referred to as

ANSWER: full term 73.

is a condition that normally develops in the second half of pregnancy and that can increase risk of developing type 2 diabetes after pregnancy if overweight. ANSWER: Gestational diabetes

74.

are strong desires to avoid particular foods and are thought to be due to hormonal changes. ANSWER: Food aversions

75. A woman who is

at the time of conception is advised to gain 15 to 20 pounds during pregnancy.

ANSWER: overweight 76.

is the ability of a man and women to reproduce. ANSWER: Fertility

77.

is a genetic abnormality that causes metal impairment, short stature, and flattened facial features. ANSWER: Down’s syndrome

78. The temporary absence of menstrual periods immediately following childbirth is referred to as

ANSWER: postpartum amenorrhea 79.

is the influence of substances during fetal growth on the development of diseases in later life. ANSWER: Fetal programming Page 17

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 80. A health care provider who specializes in helping new mothers establish a healthy breastfeeding relationship with their infant is called a . ANSWER: certified lactation consultant 81.

is an infection caused by eating unpasteurized juice and dairy products, soft cheeses, or certain readyto-eat foods like hot dogs and deli meats. ANSWER: Listeriosis Match the correct answer with the appropriate term. a. Implantation b. Teratogenic c. Perinatal d. Macrosomia e. Oxytocin f. Fetus g. Preterm h. Heartburn i. Pica j. Caffeine k. Zygote l. Embryo m. Alcohol n. Eclampsia o. Amniotic sac p. Birthweight q. Preeclampsia r. Morning sickness s. Prolactin t. Smoking

82. Associated with iron-deficiency anemia ANSWER: i 83. The “bag of waters” in the uterus, in which the fetus floats ANSWER: o 84. The developing infant from 2 to 8 weeks after conception ANSWER: l

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 85. An infant with a birthweight at the 90th percentile or higher for gestational age ANSWER: d 86. The embedding of the blastocyst in the inner lining of the uterus ANSWER: a 87. Heavy use during pregnancy may increase the risk of miscarriage or low birthweight ANSWER: j 88. Common discomfort during pregnancy caused by relaxed digestive muscles and pressure on the stomach ANSWER: h 89. An infant born before 38 weeks ANSWER: g 90. The developing infant from 8 weeks after conception until birth ANSWER: f 91. The time period between the 28th week of gestation and 1 month after birth ANSWER: c 92. Hormone that stimulates the mammary glands to eject milk ANSWER: e 93. The best indicator of an infant’s health ANSWER: p 94. Hormone secreted by the pituitary gland that promotes the production of milk ANSWER: s 95. Increases the risk of sudden infant death syndrome ANSWER: t 96. A newly fertilized ovum ANSWER: k 97. A condition characterized by seizures ANSWER: n 98. A condition characterized by high blood pressure and protein in the urine ANSWER: q 99. Something that causes abnormal fetal development or birth defects ANSWER: b

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 100. Excess intake of this substance in pregnancy is known to result in mental retardation of the child ANSWER: m 101. Discomfort typically during the first trimester of pregnancy due to hormonal changes ANSWER: r 102. Describe the stages of fetal development from fertilization to birth. ANSWER: A newly fertilized ovum is called a “zygote” and is about the size of a period at the end of this sentence. Less than 1 week after fertilization, these cells have rapidly divided multiple times to become a blastocyst ready for implantation. After implantation, the developing infant is referred to as an “embryo” from week 2 to week 8, and this is when critical periods of intense development and rapid cell division occur. The developing infant has the beginnings of most body systems, as well as a beating heart, defined fingers and toes, and the beginnings of facial features. Following week 8, the developing infant is referred to as a “fetus” and continues to grow for the next 7 months. The developing infant is known as a “fetus” until birth. 103. Explain why normal development is so crucial during critical periods, and give an example of what can happen if normal development does not occur. ANSWER: Critical periods are times of intense development and rapid cell division, and they are critical in the sense that those cellular activities can occur only at those times. If cell division and number are limited during a critical period, full recovery is not possible. Damage during these critical times of pregnancy has permanent consequences for the life and health of the fetus. The development of each organ and tissue is most vulnerable to adverse influences (such as nutrient deficiencies or toxins) during its own critical period. Examples will vary some by student. An example is as follows: The neural tube, for example, is the structure that eventually becomes the brain and the spinal cord, and its critical period of development is from 17 to 30 days of gestation. Consequently, neural tube development is most vulnerable to nutrient deficiencies, nutrient excesses, or toxins during this critical time—when most women do not yet even realize they are pregnant. Any abnormal development of the neural tube or its failure to close completely can cause a major defect in the central nervous system. 104. Explain the effect that maternal body weight has on the health of the mother and infant by describing the increased health risks seen in underweight mothers and obese mothers. ANSWER: Underweight women have a higher risk of having a low-birthweight infant, especially if she is malnourished or unable to gain sufficient weight during pregnancy. In addition, the rates of preterm births and infant deaths are higher for underweight women. An underweight women improves her chances of having a healthy baby by gaining extra pounds during pregnancy. Obese women have an especially high risk of medical complications such as gestational hypertension, gestational diabetes, and postpartum infections. Compared with other women, obese women are also more likely to have other complications of labor and delivery. Infants of obese women are more likely to be large for gestational age, weighing more than 9 pounds. Problems associated with macrosomia include increases in the likelihood of a difficult labor and delivery, birth trauma, and cesarean delivery, which presents a high risk in obese women. Consequently, these infants have a greater risk of poor health and death than infants of normal weight. Of greater concern than infant birthweight is the poor development of infants born to obese mothers. Obesity may double the risk for neural tube defects. Page 20

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 105. Mary was physically active before becoming pregnant, and she has continued doing regular exercise during her pregnancy based on her doctor’s recommendations and guidelines. Mary’s mother does not approve and says women need “to relax and put their feet up” when pregnant like she did and to avoid physical activity like exercise. What can Mary tell her mother about why her doctor encourages her to exercise during pregnancy and about the possible health benefits? ANSWER: An active, physically fit woman experiencing a normal pregnancy can continue to exercise throughout pregnancy, adjusting the duration, intensity, and type of activity as the pregnancy progresses. In fact, physical activity during pregnancy offers many benefits. Staying active can improve cardiovascular fitness, limit excessive weight gain, prevent or manage gestational diabetes and hypertension, and reduce stress. Women who exercise during pregnancy report fewer discomforts throughout their pregnancies. Regular exercise develops the strength and endurance a woman needs to carry the extra weight through pregnancy and to labor through an intense delivery. It also maintains the habits that help a woman lose excess weight and get back into shape after birth. Inactive women and those experiencing pregnancy complications should discuss physical activity with their health care provider. With approval, inactive women can safely begin walking three to four times per week, gradually increasing from 25 to 40 minutes per session. 106. Discuss the energy needs and energy-yielding nutrient needs for a pregnant woman. ANSWER: The enhanced work of pregnancy raises the woman’s basal metabolic rate dramatically and demands extra energy, but the woman does not typically need any extra energy during the first trimester. After the first trimester, energy needs of pregnant women are greater than those of nonpregnant women—an additional 340 kcal per day during the second trimester and an extra 450 kcal per day during the third trimester. A woman can easily get these added kcalories with nutrient-dense selections from the five food groups. Ample carbohydrate (ideally, 175 grams or more per day and certainly no less than 135 grams) is necessary to fuel the fetal brain. Sufficient carbohydrate also ensures that the protein needed for growth will not be broken down and used to make glucose. The protein RDA for pregnancy is an additional 25 grams per day higher than for nonpregnant women. Pregnant women can easily meet their protein needs by selecting meats, milk products, and proteincontaining plant foods such as legumes, whole grains, nuts, and seeds. Because use of high-protein supplements during pregnancy may be harmful to the infant’s development, it is discouraged unless medically prescribed and carefully monitored to treat fetal growth problems. The high nutrient requirements of pregnancy leave little room in the diet for excess fat, but the essential long-chain polyunsaturated fatty acids are particularly important to the growth and development of the fetus. The brain is largely made of lipid material, and it depends heavily on the long-chain omega-3 and omega-6 fatty acids for its growth, function, and structure.

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 107. Discuss the causes of two nutrition-related concerns during pregnancy and suggested strategies to alleviate discomfort. ANSWER: Answers will vary among students, but should include two of the following: nausea and vomiting or “morning sickness,” constipation and hemorrhoids, heartburn, or food cravings. Nausea and vomiting (often referred to as “morning sickness”) are due to hormonal changes in early pregnancy. The problem typically peaks at 9 weeks of gestation and resolves within a month or two. Strategies to manage or alleviate symptoms include rising slowly upon waking, eating dry toast or crackers, chewing gum or sucking on hard candies, eating small, frequent meals, avoiding foods with offensive odors, drinking carbonated beverages when nauseated instead of citrus juice, water, milk, tea, or coffee. Constipation often develops due to altered muscle tone from the hormones of pregnancy, as well as the growing fetus crowding intestinal organs. Hemorrhoids may also develop due to straining during bowel movements. Strategies to prevent or alleviate constipation include eating foods high in fiber (like fruits, vegetables, and whole grains), exercising regularly, drinking at least 8 glasses of liquids a day, responding promptly to the urge to defecate, and using laxatives only as prescribed by a doctor. Heartburn occurs when stomach acid splashes back up into the lower esophagus, and is common during pregnancy owing to the hormones of pregnancy relaxing digestive muscles and the pressure that the growing fetus puts on the stomach. Strategies to prevent or relieve heartburn include relaxing and eating slowly, chewing food thoroughly, eating small, frequent meals, drinking liquids between meals, avoiding spicy and greasy foods, sitting up when eating, elevating the head when sleeping, waiting 3 hours after eating before lying down, and waiting 2 hours after eating before exercising. Food cravings, or aversions, are fairly common and are most likely due to hormone-induced changes in sensitivity to taste and smell. They do not seem to reflect real physiological needs. 108. Define low-birthweight infants, and discuss health risks and complications usually seen in low-birthweight infants. ANSWER: Low-birthweight infants, defined as infants who weigh 5½ pounds or less, are classified according to their gestational age. Preterm infants are born before they are fully developed; they are often underweight and have trouble breathing because their lungs are immature. Preterm infants may be small, but if their size and weight are appropriate for their gestational age, they can catch up in growth given adequate nutrition support. In contrast, small-for-gestational-age infants have suffered growth failure in the uterus and do not catch up as well. For the most part, survival improves with increased gestational age and birthweight. Low-birthweight infants are more likely to experience complications during delivery than normal-weight babies. They also have a statistically greater chance of having physical and mental birth defects, becoming ill, and dying early in life. Of infants who die before their first birthdays, about two thirds were low-birthweight newborns. Very-low-birthweight infants (3½ pounds or less) struggle not only for their immediate physical health and survival, but for their future cognitive development and abilities as well.

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 109. Discuss two maternal health conditions and the effects that not managing or detecting these conditions can have on the health of the mother, as well as on the developing infant. ANSWER: Answers will vary among students based on the health conditions chosen. Medical disorders in the mother can threaten the life and health of both the mother and the fetus. If diagnosed early, many diseases can be managed to ensure a healthy outcome. Disorders and/or symptoms that should be managed and/or monitored for include preexisting diabetes, gestational diabetes, chronic hypertension, gestational hypertension, and preeclampsia. • Preexisting diabetes: The risk of diabetes depends on how well it is managed by the mother before and during pregnancy. Without proper management, pregnant women with existing diabetes may experience episodes of severe hypoglycemia, or hyperglycemia, preterm labor, and pregnancy-related hypertension. Infants may be large, suffer physical and mental abnormalities, and experience other complications such as severe hypoglycemia or respiratory distress, which can be fatal. • Gestational diabetes: The most common consequences of gestational diabetes are complications during labor and delivery and a high infant birthweight. Birth defects associated with gestational diabetes include heart damage, limb deformities, and neural tube defects. To ensure that the problems of gestational diabetes are dealt with promptly, physicians screen for risk factors and test high-risk women for glucose intolerance immediately and average-risk women between 24 and 28 weeks of gestation. Gestational diabetes usually develops during the second half of pregnancy, with subsequent return to normal after childbirth. Some women with gestational diabetes, however, develop diabetes (usually type 2) after pregnancy, especially if they are overweight. For this reason, health care professionals strongly advise against excessive weight gain during—and after—pregnancy. Weight gains after pregnancy increase the risk of gestational diabetes in the next pregnancy. • Chronic hypertension: In addition to the threats hypertension always carries (such as heart attack and stroke), high blood pressure increases the risk of fetal growth restriction, preterm birth, and separation of the placenta from the wall of the uterus before birth, resulting in stillbirth. • Gestational hypertension: Gestational hypertension is high blood pressure during the second half of pregnancy, and blood pressure usually returns to normal during the first few weeks following childbirth. Gestational hypertension increases the risk for subsequent hypertension and heart disorders, and it is also a sign of the most serious complication of pregnancy, preeclampsia. • Preeclampsia: Preeclampsia is a condition characterized not only by gestational hypertension but also by protein in the urine. The cause of preeclampsia remains unclear, but it usually occurs with first pregnancies and most often after 20 weeks of gestation. Obesity may increase the risk. Symptoms typically regress within 2 days of delivery. Both men and women who were born of pregnancies complicated by preeclampsia are more likely to have a child born of a pregnancy complicated by preeclampsia, suggesting a genetic predisposition. They also tend to have a higher BMI and increased blood pressure during childhood and adolescence, indicating a greater risk for heart disease. Black women have a much greater risk of preeclampsia than white women. Preeclampsia affects almost all of the mother’s organs—the circulatory system, liver, kidneys, and brain. Blood flow through the vessels that supply oxygen and nutrients to the placenta diminishes. For this reason, preeclampsia often restricts fetal growth. It also seems to increase the risk of epilepsy for the infant. In some cases, the placenta separates from the uterus, resulting in preterm birth or stillbirth.

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 110. Teresa just gave birth to a healthy infant, and she is not sure that she wants to breastfeed her baby. She says that the idea of breastfeeding makes her feel uncomfortable, and she does not see any benefits to choosing breast milk instead of formula. What would you tell Teresa about the benefits that breastfeeding can provide her and the benefits that breastmilk can offer the baby? ANSWER: Answers will differ slightly among students. The benefits that breastfeeding can provide Teresa include the following: • Contracts the uterus • Delays the return of regular ovulation, thus lengthening birth intervals (this is not, however, a dependable method of contraception) • Conserves iron stores (by prolonging amenorrhea) • May protect against breast and ovarian cancer and reduce the risk of type 2 diabetes • Increases energy expenditure, which may contribute to weight loss The benefits that breast milk provides infants include all of the following: • Provides the appropriate composition and balance of nutrients with high bioavailability • Provides hormones that promote physiological development • Improves cognitive development • Protects against a variety of infections and illnesses, including diarrhea, ear infections, and pneumonia • May protect against some chronic diseases—such as diabetes (both types), obesity, atherosclerosis, asthma, some cancers, and hypertension—later in life • Protects against food allergies • Reduces the risk of SIDS • Supports healthy weight Other benefits associated include: • Cost and time savings from not needing medical treatment for childhood illnesses or leaving work to care for sick infants • Cost and time savings from not needing to purchase and prepare formula (even after adjusting for added foods in the diet of a lactating mother) • Environmental savings to society from not needing to manufacture, package, and ship formula and dispose of the packaging • Convenience of not having to shop for and prepare formula

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Chapter 14- Life Cycle Nutrition: Pregnancy and Lactation 111. What are the health implications seen in infants that are associated with the mother consuming alcohol during pregnancy? ANSWER: Drinking alcohol during pregnancy endangers the fetus because alcohol crosses the placenta freely and deprives the developing fetus of both nutrients and oxygen. The damaging effects of alcohol on the developing fetus cover a range of abnormalities referred to as fetal alcohol spectrum disorder. Diagnosis is based on specific criteria, and those at the most severe end of the spectrum are described as having fetal alcohol syndrome (FAS), a cluster of symptoms that includes the following: • Prenatal and postnatal growth restriction • Abnormalities of the brain and central nervous system, with consequent impairment in cognition and behavior • Physical abnormalities of the face and skull that alter normal patterns of symmetry • Increased frequency of major birth defects such as cleft palate, heart defects, and defects in ears, eyes, genitals, and urinary system FAS damage at birth is persistent, and children with FAS never fully recover. An occasional drink may appear harmless, but researchers are unable to say how much alcohol is safe to consume during pregnancy. For this reason, health care professionals urge women to stop drinking alcohol as soon as they become pregnant. The only sure way to protect an infant from alcohol damage is for the mother to abstain.

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 1. A healthy infant that weighs 7 pounds at birth likely will weigh a. 14 b. 21

pounds by her/his first birthday.

c. 28 d. 35 e. 42 ANSWER: b 2. During the second year, a healthy infant gains less than a. 10, 5 b. 10, 10 c. 15, 5 d. 15, 10 e. 20, 5

pounds and grows about

inches taller.

ANSWER: a 3. A healthy adult requires less than 40 kcal per kilogram of body weight. A healthy infant requires about kcalories per kilogram of body weight. a. 25 b. 75 c. 100 d. 225 e. 450 ANSWER: c 4. In an infant, which organ uses about 60% of the day’s total energy intake? a. liver b. brain c. kidney d. skeletal muscle e. small and large intestines ANSWER: b 5. The term failure to thrive sometimes is used to describe infants and children with a. carbohydrate deficiency b. carbohydrate toxicity c. protein deficiency d. protein toxicity

e. vitamin D deficiency ANSWER: c Page 1

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 6. On what are infant recommendations for vitamins and minerals based? a. average amounts present in body tissues of thriving infants b. adult RDA scaled down to infants on a per kg body weight basis c. an out-of-date scale from the 1950s d. average amounts consumed by thriving infants breastfed by well-nourished mothers e. average amounts found in breast milk ANSWER: d 7. An infant’s brain weight is about of body weight, whereas an adult’s brain weight is about ___________ a. 12%, 2%. b. 2%, 12% c. 10%, 4% d. 4%, 10% e. Brain development in an infant is difficult to measure. ANSWER: a 8. What is alpha-lactalbumin? a. the primary carbohydrate in human breast milk b. the primary carbohydrate in cow’s milk c. a fatty acid in human breast milk d. the chief protein in human breast milk e. the chief protein in cow’s milk ANSWER: d 9. Which of the following supplements are recommended for infants who are breastfed exclusively? a. DHA b. vitamin D c. calcium d. sodium e. casein ANSWER: b 10. What is colostrum? a. a clot in the bloodstream b. a major sugar in breast milk c. a hormone that promotes milk production d. a milklike substance secreted right after delivery e. a vitamin in breast milk ANSWER: d Page 2

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 11. Infants benefit from bifidus factors in breast milk because bifidus factors a. prevent respiratory infections b. favor the growth of “friendly” bacteria in the digestive tract c. regulate cell growth d. prevent bacteria from getting the iron needed to grow e. kill bacteria

ANSWER: b 12. What factor in breast milk inhibits inflammatory bowel disease and supports a healthy epithelial barrier? a. colostrum b. lactoferrin c. TGF-β d. bifidus factor e. lysozyme ANSWER: b 13. As compared to breast milk or infant formula, cow’s milk contains too much a. protein, carbohydrate b. protein, fat c. fat, protein

and too little

d. fat, carbohydrate e. carbohydrate, protein ANSWER: a 14. Which of the following represents a risk of formula feeding? a. lead deficiencies in available water sources for infants over 6 months old b. excessive fluoride levels in available water sources for infants of any age c. inadequate fluoride levels in available water sources for infants under 6 months old d. lack of sufficient FDA oversight on currently available formulas e. lack of sufficient FDA testing for contamination with Salmonella ANSWER: b 15. Which of the following formulas should be used first when an infant is found to be lactose-intolerant? a. egg b. soy c. barley d. hydrolyzed protein e. goat’s milk ANSWER: b Page 3

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 16. Why is goat’s milk inappropriate for infants? a. It is high in iron. b. It has a low folate content. c. It is low in protein. d. It is high in calcium. e. It lacks vitamin D. ANSWER: b 17. Which of the following defines nursing bottle tooth decay? a. development of caries resulting from frequent use of nonsterile bottles and nipples b. bacterial attack of teeth due to use of lead-rich drinking water c. extensive tooth decay in infants due to prolonged exposure to carbohydrate-rich fluids from a bottle d. tooth decay resulting from prolonged exposure to soft food due to the infant’s inability to swallow normally e. tooth decay resulting from the rubbing of the nipple against the teeth and consequent thinning of enamel ANSWER: c 18. When is it potentially acceptable for an infant to be fed fat-free milk? a. after 6 months of age b. after 1 year of age c. after 2 years of age d. as soon as complementary foods are introduced e. when the diet supplies 30% of kcalories from fat ANSWER: c 19. Of the following cereals, which is LEAST likely to result in an allergic reaction upon first feeding? a. oat b. rice c. corn d. wheat e. barley ANSWER: b 20. Breastfeeding may also reduce the risk of a. contamination b. sudden infant death syndrome c. arrythmias d. eating disorders e. pica ANSWER: a Page 4

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 21. Which of the following nutrients need to be supplied by solid foods in a baby’s diet? a. vitamin C and iron b. vitamin A and zinc c. vitamin B12 and fluoride d. vitamin E and magnesium e. sodium and iron ANSWER: a 22. Which of the following foods should not be fed to infants because of the risk of botulism? a. peanut butter b. honey c. gum d. fruit juice e. rice milk ANSWER: b 23. A 1-year-old who drinks more than 3 cups of cow’s milk a day is at an increased risk for developing a deficiency of which nutrient? a. iron b. folate c. vitamin A d. vitamin C e. vitamin D ANSWER: a 24. Each year from age 1 to adolescence, a child typically grows taller by 2 to 3 inches and heavier by pounds. a. 2 to 3 b. 5 to 6 c. 10 to 12 d. 15 to 18 e. 20 to 23 ANSWER: b

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 25. Which of the following is true regarding children’s energy intake and activity levels? a. Children tend to eat the same amount of food at each meal. b. Overweight children have appetites similar to normal-weight children. c. Energy needs per kilogram of body weight continually increase from 1 to 5 years of age. d. Children following a vegan diet may have difficulty meeting their energy needs. e. An active 10-year-old child requires about 3200 kcal/day. ANSWER: d 26. An active 6-year-old child needs about a. 400 b. 800 c. 1600 d. 2400 e. 3200

kcalories per day to meet energy needs.

ANSWER: c 27. Which of the following is the most prevalent nutrient deficiency among U.S. toddlers 1 to 3 years of age? a. iron b. protein c. calcium d. vitamin C e. fiber ANSWER: a 28. Which of the following accurately describes the need for supplements in childhood? a. Very few children take nutrient supplements of any kind. b. A child’s diet typically is rich in iron-fortified foods, so supplementation is not recommended. c. The American Academy of Pediatrics recommends a daily multivitamin for all children under the age of 12. d. Children who fail to consume vitamin D–fortified foods should receive a daily supplement of 15 µg. e. The FDA is responsible for testing all dietary supplements for their safe use in children. ANSWER: d 29. Which of the following statements about the diets of today’s children is FALSE? a. Few children eat the USDA recommended daily amounts from each food group. b. Children 2 to 6 years of age eat more solid fat, added sugar, and sodium. c. Preschool children eat more pizza and candy than those in previous decades. d. Children consume adequate amounts of vitamin E, potassium, and fiber. e. Children consume more fruit than they did in previous years. ANSWER: d Page 6

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 30. Approximately how many children live in U.S. households without enough available food? a. 1 million b. 6 million c. 10 million d. 16 million e. 60 million ANSWER: d 31. Which of the following accurately describes how hunger affects behavior in children? a. Children who fail to eat breakfast typically become hyperactive after eating lunch. b. Children who skip breakfast typically make up the nutrient deficits at later meals. c. Midmorning snacks improve classroom performance all the way to lunchtime. d. Although breakfast-skippers show reduced attention spans, they tend to perform well on tasks requiring concentration. e. Hunger’s short-term effects on behavior are well researched, but there is little evidence regarding its longterm effects. ANSWER: c 32. Which of the following describes how iron deficiency affects children’s behavior? a. It affects brain function long before blood effects appear. b. Testing is a tedious, cost-prohibitive process for many families. c. It is the primary factor in tension-fatigue syndrome. d. Mild deficiency enhances mental performance by lowering physical activity level, thereby leading to increased attention span. e. Children who had iron deficiency as infants recover completely when iron levels are normalized. ANSWER: a 33. Children absorb more lead if their stomachs are empty and when they have low intakes of _________ a. glucose, water b. selenium, magnesium c. calcium, vitamin d

and

d. lycopene, folate e. mercury, molybdenum ANSWER: c

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 34. Pica, a craving for nonfood items like dirt and old paint, can lead to a. lead poisoning b. hyperactivity

in children.

c. food allergies d. obesity e. type 2 diabetes ANSWER: a 35. What percentage of young school-aged children exhibit hyperactivity? a. 7% b. 11% c. 15% d. 17% e. 23% ANSWER: b 36. What percentage of children younger than 4 years are diagnosed with food allergies? a. 1 to 3% b. 4 to 8% c. 10 to 12% d. 15 to 18% e. 22 to 25% ANSWER: b 37. What is thought to account, in part, for the rise in the prevalence of peanut allergy? a. excess sodium consumed as part of the peanuts b. exposure to medicinal skin creams containing peanut oil c. impaired digestion/absorption resulting from elevated leptin and adiponectin levels d. increased inflammation of the immune system due to altered ratio of omega-6 to omega-3 fatty acids e. hyperstimulation of the immune system by multiple vaccines ANSWER: b 38. A child who develops antibodies to a certain food is said to have a a. food allergy b. food intolerance

c. food-hyposensitivity reaction d. transient immune suppression e. food tolerance ANSWER: a Page 8

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 39. Symptoms of anaphylactic shock can include: a. drop in blood pressure and/or loss in consciousness b. sleepiness c. memory loss d. ADHD e. All of these are correct. ANSWER: a 40. Brady is allergic to peanuts. In the school cafeteria, he begins to have difficulty breathing, his tongue and face swell, and he begins vomiting. Brady most likely is in immediate need of a lifesaving injection of . a. cortisone b. serotonin c. epinephrine d. dopamine e. histamine ANSWER: c 41. Approximately what percentage of U.S. children between 2 and 19 years of age are either overweight or obese? a. 8% b. 16% c. 32% d. 48% e. 56% ANSWER: c 42. Based on data from the BMI-for-age growth charts, children and adolescents are categorized as overweight at the __________and above and as obese at the ____________and above a. 75th percentile, 80th percentile b. 85th percentile, 95th percentile c. 90th percentile, 92nd percentile d. 65th percentile, 75th percentile e. 55th percentile, 85th percentile. ANSWER: b

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 43. In children 2 to 18 years of age, about one third of total energy intake comes from a. empty calories b. grains c. meat d. milk e. vegetables and fruits ANSWER: a 44. About how many hours of television do children aged 8 to 18 years watch each day? a. 2.5 b. 3 c. 4.5 d. 5 e. 6.5 ANSWER: c 45. According to the American Academy of Pediatrics, what is the recommended maximum number of hours/day of television viewing for a child between 2 and 5 years of age? a. 0 b. 1 c. 2 d. 3 e. 5 ANSWER: b 46. How many ounces of sugar-sweetened soft drinks do adolescent boys consume each day at school? a. 8 b. 12 c. 20 d. 24 e. 26 ANSWER: d

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 47. To help improve a child’s BMI, the American Academy of Pediatrics recommends limiting television and video time for children older than 5 years to hours per day. a. 2 b. 3 c. 3.5 d. 4 e. 4.5 ANSWER: a 48. What is the leading cause of pediatric hypertension? a. obesity b. high sodium intake c. insufficient calcium intake d. potassium deficiency e. high HDL cholesterol ANSWER: a 49. Which of the following statements accurately describes how obesity affects the physical and psychological health of a child? a. Overweight children begin puberty later than their normal-weight peers. b. Overweight children have less bone and muscle mass than their peers. c. Negative stereotypes typically lead to emotional and social problems. d. Risks for developing asthma are low, but may rise after puberty. e. Researchers find that underweight children tend to react most positively to overweight bodies, which makes them supportive playmates for overweight children. ANSWER: c 50. To maintain skeletal, muscular, and cardiovascular health, a child should be physically active for at least minutes each day? a. 20 b. 30 c. 45 d. 60 e. 90 ANSWER: d

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 51. Which of the following is an effective strategy for dealing with obesity in a child? a. Treat the child with Alli, the over-the-counter version of orlistat. b. Institute a “Clean Plate Club” for the family dinner table. c. Set a good example by eating healthy nutritious meals and exercising each day. d. Take control and strongly encourage the child to limit food intake and exercise vigorously. e. Begin a behavior-modification program that rewards healthy choices and punishes unhealthy choices. ANSWER: c 52. Which of the following people would be considered a gatekeeper of nutrition? a. A mother who works two part-time jobs to afford the high cost of groceries, which the children feed themselves. b. A father who shops for fruits and vegetables at the local farmer’s market and prepares family meals. c. A child who begs for, but is denied, a breakfast cereal with a coveted toy inside. d. A cashier at a convenience store that sells snacks and local bakery items. e. A local farmer who grows corn and soybeans. ANSWER: b 53. Which of the following is a recommended strategy for honoring children’s mealtime preferences? a. Offer vegetables that are raw or undercooked and served separate from other foods. b. Serve varied, spicy flavors to entice a child’s taste buds. c. Cook food until very hot to keep a child from eating too quickly. d. Allow children to eat at the “grown-up” table using china and silverware. e. Try a series of gourmet foods with fancy names to build the child’s cultural awareness. ANSWER: a 54. Like overweight adults, overweight and obese children display a blood lipid profile indicating that beginning to develop a. cognitive impairment b. GI disorders c. atherosclerosis d. angina

e. osteoarthritis ANSWER: c

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 55. Which of the following statements accurately describes healthy snacking advice? a. Parents should teach children not to snack so that they are hungry at mealtimes. b. Children should be discouraged from snacking when their parents are not present. c. Children should be given an abundance of pocket money to purchase snacks at school, where options are always healthier. d. Exceptionally active children can enjoy high-calorie snacks like pudding or pancakes. e. Snacks like potato chips should be available to children so that they fulfill their cravings for nutrient-poor foods, which then “frees them up” to make healthy choices at mealtime. ANSWER: d 56. Approximately how many children receive free or reduced-price lunches through the National School Lunch Program? a. 1 million b. 3 million c. 13 million d. 31 million e. 113 million ANSWER: d 57. School lunches must meet at least a. 1/4 b. 1/3 c. 1/2 d. 2/3 e. 7/8

of the RDA for key nutrients.

ANSWER: b 58. Approximately how many children participate in the School Breakfast Program? a. 1 million b. 2 million c. 12 million d. 21 million e. 112 million ANSWER: c

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 59. Which of the following factors has limited the success of the School Breakfast Program? a. The cost is prohibitive. b. The meals are not nutritious. c. Children simply do not participate in it. d. Only about 25% of the nation’s schools participate in it. e. Recent legislation has reduced funding for it. ANSWER: c 60. In general, how long does the adolescent growth spurt last? a. 1 year b. 2.5 years c. 3.5 years d. 4 years e. 4.5 years ANSWER: b 61. In general, the adolescent growth spurt begins at age a. 12 to 13, 10 to 11 b. 10 to 11, 12 to 13 c. 7 to 8, 8 to 9

for females and at

for males.

d. 14 to 16, 14 to 18 e. None of these are correct ANSWER: b 62. Energy and nutrient needs are greater during lactation. a. infancy b. early childhood

than at any other time of life, except during pregnancy and

c. adolescence d. early adulthood e. late adulthood ANSWER: c 63. Which of the following statements accurately describes energy and nutrient needs during adolescence? a. Blacks, females, and overweight children are most at risk for vitamin D deficiencies. b. Girls in an adolescent growth spurt need an additional 2.9 mg of iron a day. c. More nutrient-dense foods are needed by males because of their faster development. d. The risk for calcium insufficiency is greatest in males owing to their high intake of soft drinks. e. The adolescent growth spurt begins around age 12 for females and 10 for males. ANSWER: a Page 14

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 64. Caitlin is a 12-year-old girl and has started to menstruate. Caitlin needs an additional a. 1.9 b. 2 c. 2.5

mg of iron per day.

d. 3.1 e. 4 ANSWER: c 65. Approximately what percentage of an average teenager’s daily food energy intake is derived from snacks? a. 15% b. 25% c. 35% d. 50% e. 75% ANSWER: b 66. Which of the following accurately describes beverage intake by adolescents? a. Soft drinks have been replaced with sweetened fruit juices. b. Milk is typically used as a snack, not a mealtime beverage. c. Males typically drink more milk than females. d. Drinking two cans of caffeinated soft drinks in a day can cause sweating and an inability to concentrate. e. Soft drinks are typically consumed in addition to milk, not instead of it. ANSWER: c 67. About how many meals each week are eaten outside the home by adolescents? a. 7 b. 10 c. 14 d. 17 e. 21 ANSWER: a 68. For children born in the year 2000, the risk of developing type 2 diabetes is girls. a. 10%, 20% b. 20%, 10%

for boys and

for

c. 30%, 40% d. 40%, 30% e. 50%, 75% ANSWER: c Page 15

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 69. On any given day, how many adolescents smoke a cigarette for the first time? a. 1000 b. 2000 c. 3000 d. 4000 e. 5000 ANSWER: c 70. Without intervention, how many children are destined to suffer from adult heart disease within the next 30 years? a. 600,000 b. 6 million c. 60 million d. 600 million e. 6 billion ANSWER: c 71.

are services that collect, screen, process, and distribute donated human milk. ANSWER: Breast milk banks

72. The energy-yielding nutrient that makes up 55% of breast milk is

ANSWER: fat 73. An often fatal foodborne illness caused by the ingestion of foods containing a bacteria that grow without oxygen is ________. ANSWER: botulism 74. The iron-deficiency anemia that develops when an excessive milk intake displaces iron-rich foods from the diet is called “ .” ANSWER: milk anemia 75.

is inattentive and impulsive behavior that is more frequent and severe than is typical of others a similar age. ANSWER: Hyperactivity

76. A life-threatening, whole-body allergic reaction to an offending substance is called “

.”

ANSWER: anaphylactic shock 77. A is the maximum amount of residue permitted in a food when a pesticide is used according to the label directions. ANSWER: tolerance level Page 16

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 78. Key people who control other people’s access to foods and thereby exert profound impacts on their nutrition are called “ .” ANSWER: gatekeepers 79. The period from the beginning of puberty until maturity is called “

.”

ANSWER: adolescence 80.

is a type of artery disease characterized by plaques on the inner walls of the arteries. ANSWER: Atherosclerosis

MATCHING a. 4–8 c. 14 e. 80 g. Casein i. Corn syrup k. Food intolerance m. Weaning o. Colostrum

b. 10 d. 25 f. Lead h. Folate j. DHA l. Food allergy n. Vitamin D p. Nursing bottle tooth decay

q. Milk anemia

r. Epinephrine

s. Fluoride

t. Alpha-lactalbumin

81. Expected weight at 5 months, in pounds, of an infant with a birthweight of 7 lb ANSWER: c 82. Possible source of infant botulism ANSWER: i 83. Structural component of the brain found in breast milk and fortified infant formulas ANSWER: j 84. Main protein in human breast milk ANSWER: t 85. Main protein in cow’s milk ANSWER: g 86. Nutrient that is low in breast milk ANSWER: n 87. Milk-like secretion from the breast, present during first few days after delivery ANSWER: o Page 17

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 88. Mineral found in drinking water and infant formulas made with tap water ANSWER: s 89. Result of prolonged contact with carbohydrate-rich liquids in baby bottles ANSWER: p 90. Result of excessive milk intake replacing iron-rich foods in the diet ANSWER: q 91. To gradually replace breast milk with formula or other foods ANSWER: m 92. Nutrient lacking in goat’s milk ANSWER: h 93. Adverse reaction to food involving an immune response ANSWER: l 94. Adverse reaction to food that does not involve antibody production ANSWER: k 95. Substance ingested by children who eat dirt or chips of old paint ANSWER: f 96. Approximate percentage of children younger than 4 years diagnosed with food allergies ANSWER: a 97. Substance that prevents anaphylactic shock after exposure to a food allergen ANSWER: r 98. Percent chance of becoming an obese adult for an overweight teen with one obese parent ANSWER: e 99. Percent chance of becoming an obese adult for a child with normal-weight parents ANSWER: b 100. Percentage of high school students who use some type of tobacco products ANSWER: d

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 101. How do the energy nutrients in breast milk compare to those in cow’s milk? ANSWER: The energy-nutrient composition of breast milk differs dramatically from that recommended for adult diets. Yet for infants, breast milk is nature’s most nearly perfect food, providing the clear lesson that people at different stages of life have different nutrient needs. The main carbohydrate in breast milk (and standard infant formula) is the disaccharide lactose. In addition to being easily digested, lactose enhances calcium absorption. The carbohydrate component of breast milk also contains abundant oligosaccharides, which are present only in trace amounts in cow’s milk and infant formula made from cow’s milk. Breast milk oligosaccharides help protect the infant from infection by preventing the binding of pathogens to the infant’s intestinal cells. The amount of protein in breast milk is less than in cow’s milk, but this quantity is actually beneficial because it places less stress on the infant’s immature kidneys to excrete urea, the major end product of protein metabolism. Much of the protein in breast milk is alpha-lactalbumin, which is efficiently digested and absorbed. As for the lipids, breast milk contains a generous proportion of the essential fatty acids linoleic acid and linolenic acid, as well as their longer-chain derivatives arachidonic acid and DHA. DHA accumulation in the brain is higher in breastfed infants than in formula-fed infants. Research has focused on the mental and visual development of breastfed infants and infants fed standard formula with and without DHA added. Results of studies for visual acuity are mixed, perhaps because of factors such as the amount of DHA provided, the source of the DHA, and the sensitivity of different measures for visual acuity. Some evidence from studies examining the effects of DHA status during fetal and infant development on cognitive function suggests that DHA supplementation can make a positive difference. Adding DHA to standard infant formulas has no adverse effects; most standard formulas are currently fortified with both DHA and arachidonic acid.

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 102. What are the benefits and risks of formula feeding? ANSWER: Formula manufacturers attempt to copy the nutrient composition of breast milk as closely as possible. All formula-fed infants should be given iron-fortified infant formulas. The increasing use of ironfortified formulas over the past few decades is responsible for the decline in iron-deficiency anemia among infants in the United States. Infant formulas contain no protective antibodies for infants, but in general, vaccinations, purified water, and clean environments in developed countries help protect infants from infections. Formulas can be prepared safely by following the rules of proper food handling and by using water that is free of contamination. Of particular concern is lead-contaminated water, a major source of lead poisoning in infants. Because the first water drawn from the tap each day is highest in lead, a person living in a house with old, lead-soldered plumbing should let the water run a few minutes before drinking or using it to prepare formula or food. Water supplies contain variable concentrations of minerals, including fluoride. Optimal levels of fluoride protect against dental caries, but too much fluoride during tooth development can cause defects in the teeth known as “fluorosis.” Inadequate fluoride after 6 months of age may also be a concern. Thus, health experts urge caregivers to have their well water analyzed for mineral contents and to check with the local health department to determine the fluoride content of the community water supply. Caregivers should reconstitute powdered or concentrated liquid formulas with optimally fluoridated water (0.7 to 1.2 parts per million). If fluoride levels are excessive, readyto-feed formulas or formulas prepared with fluoride-free or low-fluoride water can be used. Such waters are labeled “purified,” “demineralized,” “deionized,” or “distilled.” If fluoride levels are inadequate, formulas may need to be prepared with fluoridated bottled water once the infant is 6 months of age. In developing countries and in poor areas of the United States, formula may be unavailable, prepared with contaminated water, or overdiluted in an attempt to save money. Contaminated formulas may cause infections, leading to diarrhea, dehydration, and malabsorption. Without sterilization and refrigeration, formula is an ideal breeding ground for bacteria. Whenever such risks are present, breastfeeding can be a lifesaving option: breast milk is sterile, and its antibodies enhance an infant’s resistance to infections.

103. What is the best way to introduce new foods to infants? ANSWER: In addition to breast milk or formula, an infant can begin eating solid foods between 4 and 6 months. The American Academy of Pediatrics supports exclusive breastfeeding for 6 months but recognizes that infants are often developmentally ready to accept complementary foods between 4 and 6 months of age. The main purpose of introducing solid foods is to provide needed nutrients that are no longer supplied adequately by breast milk or formula alone. The foods chosen must be those that the infant is developmentally capable of handling both physically and metabolically. As digestive secretions gradually increase throughout the first year of life, the digestion of complementary foods becomes more efficient. The exact timing depends on the individual infant’s needs and developmental readiness, which vary from infant to infant because of differences in growth rates, activities, and environmental conditions. In addition to the infant’s nutrient needs and physical readiness to handle different forms of foods, the need to detect and control allergic reactions should also be considered when introducing complimentary foods. With respect to nutrient needs, the nutrients needed earliest are iron and zinc, then vitamin C.

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 104. Explain how vitamin and mineral needs change after infancy and what supplementation might be needed. ANSWER: The vitamin and mineral needs of children increase with age. A balanced diet of nutritious foods can meet children’s needs for these nutrients, with the notable exception of iron, and possibly vitamin D. Iron-deficiency anemia is a major problem worldwide and is prevalent among U.S. children, especially toddlers 1 to 3 years of age. During the second year of life, toddlers progress from a diet of iron-rich infant foods such as breast milk, iron-fortified formula, and iron-fortified infant cereal to a diet of adult foods and iron-poor cow’s milk. In addition, their appetites often fluctuate—some become finicky about the foods they eat, and others prefer milk and juice to solid foods. These situations can interfere with children eating iron-rich foods at a critical time for brain growth and development. To prevent iron deficiency, children’s foods must deliver 7 to 10 mg of iron per day. To achieve this goal, snacks and meals should include iron-rich foods, and milk intake should be reasonable so that it will not displace lean meats, fish, poultry, eggs, legumes, and whole-grain or enriched products. According to the DRI committee, children’s intakes of vitamin D–fortified foods—including milk, ready-to-eat cereals, and juices—should provide 15 mg of vitamin D each day to maximize calcium absorption and ensure normal, healthy bone growth. Children who do not meet their RDA from these sources should receive a vitamin D supplement. Remember that sunlight is also a source of vitamin D, especially in tropical climates and warm seasons. With the exception of specific recommendations for fluoride, iron, and vitamin D during infancy and childhood, the American Academy of Pediatrics and other professional groups agree that well-nourished children do not need vitamin and mineral supplements. Despite this, many children and adolescents take supplements. Researchers are still studying the safety of supplement use by children. The Federal Trade Commission has warned parents about giving supplements advertised to prevent or cure childhood illnesses such as colds, ear infections, or asthma. Dietary supplements on the market today include many herbal products that have not been tested for safety and effectiveness in children.

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 105. Describe the physical and mental effects of lead exposure on children. ANSWER: Children who are malnourished are vulnerable to lead poisoning. They absorb more lead if their stomachs are empty; if they have low intakes of calcium, zinc, vitamin C, or vitamin D; and, of greatest concern because it is so common, if they have an iron deficiency. Iron deficiency weakens the body’s defenses against lead absorption, and lead poisoning can cause iron deficiency. Common to both iron deficiency and lead poisoning are a low socioeconomic background and a lack of immunizations against infectious diseases. Another common factor is pica—a craving for nonfood items. Many children with lead poisoning eat dirt or chips of old paint, two common sources of lead. The anemia brought on by lead poisoning may be mistaken for a simple iron deficiency and therefore may be incorrectly treated. Like iron deficiency, mild lead toxicity has nonspecific symptoms, including diarrhea, irritability, and fatigue. Adding iron to the diet does not reverse the symptoms; exposure to lead must stop and treatment for lead poisoning must begin. With further exposure, the symptoms become more pronounced, and children develop learning disabilities and behavioral problems. Still more severe lead toxicity can cause irreversible nerve damage, paralysis, mental retardation, and death. Approximately half a million children between the ages of 1 and 5 in the United States have blood lead concentrations above 5 µg per deciliter, the level at which the Centers for Disease Control and Prevention recommend public health actions be initiated. Lead toxicity in young children comes from their own behaviors and activities—putting their hands in their mouths, playing in dirt and dust, and chewing on nonfood items. Unfortunately, the body readily absorbs lead during times of rapid growth and hoards it possessively thereafter. Lead is not easily excreted and accumulates mainly in the bones, but also in the brain, teeth, and kidneys. Tragically, a child’s neuromuscular system is also maturing during these first few years of life. No wonder children with elevated lead levels experience impairment of balance, motor development, and the relaying of nerve messages to and from the brain. Deficits in intellectual development are only partially reversed when lead levels decline.

106. What effects does iron deficiency have on a child’s behavior and on school performance? ANSWER: Iron deficiency has well-known and widespread effects on children’s behavior and intellectual performance. In addition to carrying oxygen in the blood, iron transports oxygen within cells, which use it during energy metabolism. Iron is also used to make neurotransmitters—most notably, those that regulate the ability to pay attention, which is crucial to learning. Consequently, iron deficiency not only causes an energy crisis, but also directly impairs attention span and learning ability. Iron deficiency is often diagnosed by a quick, easy, inexpensive hemoglobin or hematocrit test that detects a deficit of iron in the blood. A child’s brain, however, is sensitive to low iron concentrations long before the blood effects appear. Iron deficiency lowers the motivation to persist in intellectually challenging tasks and impairs overall intellectual performance. Anemic children perform poorly on tests and are disruptive in the classroom; iron supplementation improves learning and memory. When combined with other nutrient deficiencies, iron-deficiency anemia has synergistic effects that are especially detrimental to learning. Furthermore, children who had iron-deficiency anemia as infants continue to perform poorly as they grow older, even if their iron status improves. The long-term damaging effects on mental development make prevention and treatment of iron deficiency during infancy and early childhood a high priority.

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 107. Explain the possible relationships between nutrition and hyperactivity. ANSWER: Hyperactive children have trouble sleeping, cannot sit still for more than a few minutes at a time, act impulsively, and have difficulty paying attention. These behaviors interfere with social development and academic progress. The cause of hyperactivity remains unknown, but it affects about 11% of young school-age children. To resolve the problems surrounding hyperactivity, physicians often recommend specific behavioral strategies, special educational programs, and psychological counseling. If these interventions are ineffective, they may prescribe medication. Research on hyperactivity has focused on several nutritional factors as possible causes or treatments. Parents often blame sugar. They hopefully believe that simply eliminating candy and other sweet treats will solve the problem. Studies have found no convincing evidence that sugar causes hyperactivity or worsens behavior, but dietary changes may still be helpful. Sugar-sweetened foods and beverages displace more nutritious choices from the diet, and, as stated previously, nutrient deficiencies are known to cause behavioral problems. Food additives have also been blamed for hyperactivity and other behavior problems in children, but scientific evidence to substantiate the connection has been elusive. Limited research suggests that food additives such as artificial colors or sodium benzoate preservative (or both) may exacerbate hyperactive symptoms such as inattention and impulsivity in some children. Additional studies are needed to confirm the findings and to determine which additives might be responsible for specific negative behaviors.

108. How does obesity affect growth, physical health, and psychological development in children? ANSWER: Overweight children develop a characteristic set of physical traits. They typically begin puberty earlier and so grow taller than their peers at first, but then they stop growing at a shorter height. They develop greater bone and muscle mass in response to the demand of having to carry more weight—both fat and lean weight. Consequently, they appear “stocky” even when they lose their excess fat. Like overweight adults, overweight and obese children display a blood lipid profile indicating that atherosclerosis is beginning to develop—high levels of total cholesterol, triglycerides, and LDL cholesterol. Overweight and obese children also tend to have high blood pressure; in fact, obesity is a leading cause of pediatric hypertension. Their risks for developing type 2 diabetes and respiratory diseases (such as asthma) are also exceptionally high. In addition to the physical consequences, childhood obesity brings a host of emotional and social problems. Because people frequently judge others on appearance more than on character, overweight and obese children are often victims of prejudice and bullying. Many suffer discrimination by adults and rejection by their peers. They may have poor self-images, a sense of failure, and a passive approach to life. Television shows, which are a major influence in children’s lives, often portray the fat person as the bumbling misfit. Overweight children may come to accept this negative stereotype in themselves and in others, which can lead to additional emotional and social problems. Researchers investigating children’s reactions to various body types find that both normal-weight and underweight children respond unfavorably to overweight bodies.

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 109. How can obesity be prevented? How should it be treated if it develops in young children? ANSWER: To help prevent childhood obesity, these healthy habits are recommended: Limit consumption of sugar-sweetened beverages, such as soft drinks and fruit-flavored punches. Eat the recommended amounts of fruits and vegetables every day. Learn to eat age-appropriate portions of foods. Eat foods low in energy density, such as those high in fiber and/or water and modest in fat. Eat a nutritious breakfast every day. Eat a diet rich in calcium. Eat a diet balanced in recommended proportions for carbohydrate, fat, and protein. Eat a diet high in fiber. Eat together as a family as often as possible. Limit the frequency of restaurant meals. Limit television watching or other screen time to no more than 2 hours per day and do not have televisions or computers in bedrooms. Engage in at least 60 minutes of moderate to vigorous physical activity every day. The initial goal for overweight children is to reduce the rate of weight gain; that is, to maintain weight as the child grows taller. Continued growth will then accomplish the desired change in BMI. Weight loss is usually not recommended because diet restriction can interfere with growth and development. Intervention for some overweight children with accompanying medical conditions may warrant weight loss, but this treatment requires an individualized approach based on the degree of overweight and severity of the medical conditions. The many benefits of physical activity are well known but often are not enough to motivate overweight people, especially children. Yet regular vigorous activity can improve a child’s weight, body composition, and physical fitness. Ideally, parents will limit sedentary activities and encourage at least 1 hour of daily physical activity to promote strong skeletal, muscular, and cardiovascular development and instill in their children the desire to be physically active throughout life. Weight-loss programs that involve parents and other caregivers in treatment report greater success than those without parental involvement. Because obesity in parents and their children tends to be positively correlated, both benefit when parents participate in a weight-loss program. Parental attitudes about food greatly influence children’s eating behavior, so it is important that the influence be positive. Otherwise, eating problems may become exacerbated. The use of weight-loss drugs to treat obesity in children merits special concern because the long-term effects of these drugs on growth and development have not been studied. The drugs may be used in addition to structured lifestyle changes for carefully selected children or adolescents who are at high risk for severe obesity in adulthood. Orlistat is the only prescription weight-loss medication that has been approved for use in adolescents 12 years of age and older. Alli, the over-the-counter version of orlistat, should not be given to anyone younger than age 18.

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 110. Describe the importance of iron and calcium intake during adolescence. ANSWER: The need for iron increases during adolescence for both females and males, but for different reasons. Iron needs increase for females as they start to lose blood through menstruation and for males as their lean body mass develops. Hence, the RDA increases at age 14 for both males and females. For females, the RDA remains high into late adulthood. For males, the RDA returns to preadolescent values in early adulthood. In addition, iron needs increase when the adolescent growth spurt begins, whether that occurs before or after age 14. Therefore, boys in a growth spurt need an additional 2.9 mg of iron per day above the RDA for their age; girls need an additional 1.1 mg per day. Furthermore, iron recommendations for girls before age 14 do not reflect the iron losses of menstruation. The average age at menarche (first menstruation) in the United States is 12.5 years. Therefore, for girls younger than the age of 14 who have started to menstruate, an additional 2.5 milligrams of iron per day is recommended. Thus, the RDA for iron depends not only on age and sex but also on whether the individual is in a growth spurt or has begun to menstruate. Iron intakes often fail to keep pace with increasing needs, especially for females, who typically consume fewer iron-rich foods such as meat and fewer total kcalories than males. Not surprisingly, iron deficiency is most prevalent among adolescent girls. Iron-deficient children and teens score lower on standardized tests than those who are not iron-deficient. Adolescence is a crucial time for bone development, and the requirement for calcium reaches its peak during these years. Unfortunately, many adolescents, especially females, have calcium intakes below recommendations. Low calcium intakes during times of active growth, especially if paired with physical inactivity, can compromise the development of peak bone mass, which is considered the best protection against adolescent fractures and adult osteoporosis. Increasing milk and milk products in the diet to meet calcium recommendations greatly increases bone density. Once again, however, teenage girls are most vulnerable because their milk—and therefore their calcium—intakes begin to decline at the time when their calcium needs are greatest. Furthermore, women have much greater bone losses than men in later life. In addition to dietary calcium, physical activity causes bones to grow stronger. Because some high schools do not require students to participate in physical education classes, however, many adolescents are not as physically active as healthy bones demand.

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Chapter 15- Life Cycle Nutrition: Infancy, Childhood, and Adolescence 111. Briefly explain the relationship between obesity and the early development of chronic diseases. ANSWER: Today, unprecedented numbers of U.S. children are being diagnosed with obesity and serious “adult diseases,” such as type 2 diabetes, that accompany overweight. When type 2 diabetes develops before the age of 20, the incidence of diabetic kidney disease and death in middle age increases dramatically, largely because of the long duration of the disease. For children born in the United States in the year 2000, the risk of developing type 2 diabetes at some time in their lives is estimated to be 30% for boys and 40% for girls. U.S. children are not alone—rapidly rising rates of obesity threaten the health of an alarming number of children around the globe. Without immediate intervention, millions of children are destined to develop type 2 diabetes and hypertension in childhood followed by cardiovascular disease (CVD) in early adulthood. Invariably, questions arise as to what extent genetics is involved in disease development. For heart disease and type 2 diabetes, genetics does not appear to play a determining role; that is, a person is not simply destined at birth to develop these diseases. Instead, genetics appears to play a permissive role— the potential is inherited and will develop if given a push by poor health choices such as excessive weight gain, poor diet, sedentary lifestyle, and cigarette smoking. Many experts agree that preventing or treating obesity in childhood will reduce the rate of chronic diseases in adulthood. Without intervention, most obese children become obese adolescents who become obese adults, and being obese exacerbates every chronic disease that adults face. Fatty liver, a condition that correlates directly with BMI, was not even recognized in pediatric research until recently. Today, fatty liver disease has a high prevalence in obese children.

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 1. By 2030, approximately what fraction of the U.S. population is projected to be 65 years or older? a. 1/100 b. 1/25 c. 1/10 d. 1/8 e. 1/5 ANSWER: e 2. What is the fastest-growing age group in the United States? a. 21–34 years b. 35–49 years c. 50–64 years d. 65–84 years e. Over 85 years ANSWER: e 3. What is the average life expectancy in the United States today? a. 79 years b. 81 years c. 86 years d. 89 years e. 93 years ANSWER: a 4. What was the average life expectancy in the United States in 1900? a. 42 years b. 47 years c. 55 years d. 59 years e. 65 years ANSWER: b 5. The maximum potential human life span is currently about a. 110 b. 120 c. 130 d. 140 e. 150

years.

ANSWER: c Page 1

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 6. In the United States, woman who live to the age of 85, can expect to survive an additional average. a. 3 b. 5 c. 7 d. 9 e. 11

years, on

ANSWER: c 7. The verifiably oldest person died in 1997 at the age of a. 100 years b. 122 years c. 145 years d. 134 years ANSWER: b 8. Nora says her grandfather acts like a 25-year-old man. Nora is referring to her grandfather’s a. chronological b. physiological c. ephemeral d. transient

age.

e. historical ANSWER: b 9. Gavin says his grandmother celebrated her 93rd birthday. Gavin is referring to his grandmother’s a. life expectancy b. physiological age c. life span d. chronological age e. quality of life

ANSWER: d 10. Since 1950, the population of those older than 65 has almost is expected to again by 2050. a. tripled, double b. doubled, tripled

—and it

c. doubled, no change d. no change, tripled e. tripled, no change ANSWER: a Page 2

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 11. The CDC recommends that older adults engage in strength training at least two (nonconsecutive) days a week, at a moderate to high intensity, for repetitions per exercise. a. 10 to 15 b. 15 to 20 c. 20 to 25 d. 25 to 30 e. 35 to 40 ANSWER: a 12. Animal research has shown life-prolonging benefits when energy intake is restricted to about a. 90% b. 85% c. 80% d. 75% e. 70%

of normal.

ANSWER: e 13. Which of the following statements accurately describes the relationship between energy restriction and longevity? a. Improvements in longevity depend on reducing energy intake and not on the amount of body fat. b. Restriction of energy intake in genetically obese animals does not seem to improve longevity. c. Biochemical markers for longevity in humans are improved only when energy intake is reduced by at least one third. d. The activities of the genes of older mice on energy-restricted diets are similar to those of mice on standard diets. e. Research with humans has found a substantial increase in longevity, with a 5% reduction in energy intake. ANSWER: a 14. Hunger is persistent when energy is restricted by a. 5% b. 10% c. 25%

d. 30% e. 50% ANSWER: d

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 15. Reducing energy intake by a minimum of pressure, insulin response, and blood lipids. a. 10% b. 15% c. 20% d. 25% e. 30%

brings about measurable improvements in body fat, blood

ANSWER: a 16. Using animal data to extrapolate to humans, researchers estimate that it would take a person restricting energy intake to 30% of normal, to increase life expectancy by 3 years. a. 5 b. 7 c. 10 d. 15 e. 30

years of

ANSWER: e 17. In Sardinia, Italy, and Nicoya, Costa Rica, people live long, healthy, and active lives well past 100 years. These places collectively are called . a. Red Zones b. Blue Zones c. Age Hot Spots d. Longevity Hot Spots e. Quality Circles ANSWER: b 18. An estimated a. 40% b. 35% c. 37%

of older adults in the United States are deemed obese.

d. 55% e. 50% ANSWER: b

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 19. Which of the following accurately describes how men and women respond to stress? a. Women’s general reactions to stress are different from those of men. b. The ability to respond is weaker in older women than in older men. c. Elderly women invite lighten by sharing experiences with others; elderly men alleviate stress by compartmentalizing. d. Psychological stressors such as divorce or death of a loved one are handled much less well by elderly men than by elderly women. e. There are no clinically important differences in men’s and women’s responses to stress. ANSWER: a 20. In general, older people tend to a. lose bone and muscle, gain body fat b. lose body fat, gain bone mass c. lose lean muscle and gain bone mass d. lose bone, gain muscle e. All of these are incorrect

and muscle and

ANSWER: a 21. For adults older than 65, mortality is lowest among individuals who are a. underweight b. at a healthy weight c. slightly overweight d. obese e. classified with clinically severe obesity

ANSWER: c 22. What is sarcopenia? a. loss of central visual activity b. loss of muscle mass and strength c. softening of bones d. difficulty swallowing e. paralysis of GI tract muscles ANSWER: b

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 23. Which of the following best describes the effect of aging on the immune system? a. Immunity is improved by abundant intake of iron-rich red meats and calcium-rich butter. b. In the United States, infectious diseases are rarely the cause of deaths in the elderly. c. Immune function does not decline with age in people who maintain good nutrition. d. Antibiotics are often ineffective in treating infections in older people who have deficient immune systems. e. In elderly persons, nutritional status rarely influences immune functioning. ANSWER: d 24.

is the combination of an inefficient and overactive immune response in the aging population. a. Inflammaging b. Dysphagic cell mass c. Sarcopenic undermining d. Edentulous-induced wasting e. Cachexia of aging ANSWER: a

25. A person who has difficulty swallowing has a. edentulous b. sarcopenia c. dysphagia

d. pressure ulcers e. gout ANSWER: c 26. A person who is edentulous should eat a. soft foods b. red meats

c. raw fruits and vegetables d. leafy green vegetables e. foods rich in vitamin C ANSWER: a 27. Researchers have studied several nutrient interventions aimed at relieving depression in older adults. They found that these interventions . a. may or may not be effective b. are never effective c. are mildly effective for women, but not men d. are greatly effective for both men and women e. may worsen depression in very old individuals ANSWER: a Page 6

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 28. How many eligible seniors participate in the Supplemental Nutrition Assistance Program? a. 1/10 b. 1/4 c. 1/3 d. 1/2 e. 2/3 ANSWER: c 29. Even with the help of Social Security, how many adults over age 65 live in poverty? a. 9 b. 15 c. 26 d. 33 e. 40 ANSWER: a 30. How many adults over age 65 would live in poverty without the help of Social Security? a. 9 b. 15 c. 26 d. 33 e. 40 ANSWER: e 31. Dehydrated older adults seem to be more susceptible to a. UTI, pressure ulcers b. memory loss, dementia c. Alzheimer’s, blood loss

and

d. weight gain, polyuria e. bulimia, bingeing ANSWER: a 32. Which of the following accurately describes concerns about water intake in elderly people? a. They may not feel thirsty or recognize dryness of the mouth. b. They have an increased total body water content as compared with younger adults. c. They urinate more frequently, so require greater hydration. d. They tend toward overhydration, which results in mental lapses and disorientation. e. They develop pressure ulcers and urinary tract infections due to abundant intake of foods with high-water content. ANSWER: a Page 7

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 33. What is the minimum number of glasses of water an older adult must drink each day to prevent dehydration? a. 2 b. 4 c. 6 d. 8 e. 10 ANSWER: c 34. Betty was diagnosed with a pressure ulcer, which means she has damage to her a. skin b. colon c. mouth d. stomach e. eye

ANSWER: a 35. The basal metabolic rate declines a. 1 to 2% b. 2 to 4% c. 4 to 8% d. 8 to 16% e. 16 to 24%

per decade due to lean muscle mass and diminishing thyroid hormones.

ANSWER: a 36. Louis is an 80-year-old man. How much have his energy needs declined since he was 30 years old? a. 5% b. 15% c. 25% d. 35% e. 45% ANSWER: c 37. Older adults with atrophic gastritis are vulnerable to a. folate b. calcium

deficiency.

c. vitamin D d. vitamin B12 e. zinc ANSWER: d Page 8

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 38. Adults aged 51 to 70 who engage in minimal outdoor activity, need a. 15 b. 20

micrograms of vitamin D daily.

c. 25 d. 30 e. 35 ANSWER: a 39. Vitamin D deficiency is associated with two common problems of aging: osteoporosis and a. dysphagia b. dementia c. atrophic gastritis d. cataracts e. gout

ANSWER: b 40. The DRI recommends a. 1000 b. 1200 c. 1400

milligrams of calcium for women over 50 and older and men over 70.

d. 1600 e. 1800 ANSWER: b 41. Which of the following statements describes the mineral nutrition of older adults? a. Zinc intake is adequate for about 95% of this group. b. Iron absorption is reduced due to low stomach acidity. c. Calcium intakes of females are near the RDA for this group. d. Vitamin D is more readily absorbed by the thinner skin of this group. e. Folate excesses are fairly common. ANSWER: b 42. Which of the following statements describes the iron intake of older adults? a. Iron needs of men increase throughout their lifetime. b. Iron-deficiency anemia is more common among older adults than among younger people. c. Antacids tend to increase iron stores. d. Elevated iron stores are likely to be found in older people who eat red meat and take iron supplements. e. Elevated iron stores impair immunity, which can lead to infectious diseases. ANSWER: d Page 9

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 43. Which of the following statements describes a connection between nutrition and cataract formation? a. Obese and lean people have the same risk for cataracts. b. Adequate intakes of vitamin K and folate seem to delay the onset of cataract formation. c. Nutrition seems to play little, if any, role in the onset of cataracts. d. Vitamin C supplements in doses of 1000 mg for several years appear to raise the risk for cataracts. e. Antioxidant supplements appear to prevent cataracts. ANSWER: d 44. Which term refers the clouding of the eye lenses that impairs vision and can lead to blindness? a. retinitis b. keratoids c. cataracts d. rhodolipids e. glaucoma ANSWER: c 45. What percentage of people in the United States has a cataract by age 75? a. 15% b. 25% c. 33% d. 50% e. 75% ANSWER: d 46. What organ is affected by macular degeneration, a common condition for older people? a. bone b. eyes c. liver d. kidneys e. stomach ANSWER: b 47. Approximately how many people in the United States are diagnosed with some form of arthritis each year? a. 5 million b. 10 million c. 50 million d. 500 million e. 5 billion ANSWER: c Page 10

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 48. Which type of arthritis most commonly disables older people? a. osteoarthritis b. rheumatoid arthritis c. gout d. fibromyalgia e. psoriatic arthritis ANSWER: a 49. Which of the following foods has been shown to reduce joint inflammation in people with rheumatoid arthritis? a. red meat b. whole grains c. fruit juices d. fish with omega-3 fatty acids e. vitamin D–fortified milk ANSWER: d 50. What form of arthritis is characterized by deposits of uric acid crystals in the joints? a. osteoarthritis b. rheumatoid arthritis c. gout d. fibromyalgia e. psoriatic arthritis ANSWER: c 51. The brain degeneration of an overweight 60-year-old person is comparable to that of a a. 62 b. 65 c. 67

-year-old adult.

d. 70 e. 72 ANSWER: d 52. 1 in a. 2 b. 5

U.S. adults is affected by Alzheimer’s disease after age 65.

c. 8 d. 12 e. 15 ANSWER: c Page 11

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 53. What is the most important nutrition concern for people with Alzheimer’s disease? a. ensuring adequate intakes of antioxidant nutrients and DHA b. maintaining appropriate body weight c. monitoring intake of medications that may interfere with nutrient bioavailability d. treatment for iron overload to prevent formation of new neurofibrillary tangles e. taking vitamin and mineral supplements appropriate for dementia treatment ANSWER: b 54. Which of the following statements accurately describes alcohol use among the elderly? a. Binge drinking is more frequent in the elderly than in younger persons. b. The proportion of binge drinkers is greater in the elderly than in any other age group. c. In elderly individuals, unlike in younger individuals, alcohol use is not associated with other risky behavior, such as illicit drug use. d. Determining alcohol abuse among the elderly community requires costly assessment by medical professionals. e. Elderly individuals are rarely successfully treated for alcohol abuse and dependence. ANSWER: a 55. Older adults primarily diet in order to a. economize when food prices increase b. improve appearance

c. pursue a medical goal such as reducing cholesterol or blood glucose control d. reduce risks for development of atrophic gastritis and pernicious anemia e. reduce feelings of depression ANSWER: c 56. To ascertain the risk of malnutrition among older people, the Nutrition Screening Initiative uses a checklist based on the word _______ _. a. evaluate b. identify c. decide d. assess e. determine ANSWER: e

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 57. What is a congregate meal? a. a meal provided for groups of elderly in a place like a community center b. a meal prepared for the elderly that meets two thirds of the Dietary Recommended Intakes c. a meal prepared for individual elderly members of large church organizations and delivered to their homes d. a meal provided through the Nutrition Screening Initiative for nursing home residents e. a meal prepared by a community organization and delivered to home-bound individuals where they live ANSWER: a 58. Which of the following is true of food assistance programs of the Older Americans Act? a. Eligibility begins at 50. b. There are no income limits for eligibility. c. Meals on Wheels is generally preferred to congregate meals. d. Currently, only luncheon meals are offered. e. Meals for people with special dietary needs are offered, but less frequently that regular meals. ANSWER: b 59. What is the name of the program that provides low-income older adults with coupons that are exchangeable for fresh vegetables and fruits at community-supported farmers’ markets and roadside stands? a. Senior Farmers Market Nutrition Program b. Fresh Food for the Disadvantaged Elderly c. Old Age and Survivors Health Benefits Program d. Federal Food Pantry e. Eldercare Food Assistance ANSWER: a 60. Which of the following would be the best substitute for fresh milk for the elderly person living alone who wishes to avoid food waste? a. UHT milk b. low-cost expired milk c. calcium carbonate tablets d. rice milk e. soy milk ANSWER: a

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 61. What percentage of adults aged 65 years and older takes at least one prescription medicine? a. 50% b. 60% c. 70% d. 80% e. 90% ANSWER: e 62. How does aspirin reduce inflammation and relieve pain? a. It acts as a sedative. b. It promotes wound healing and blood clotting. c. It interferes with prostaglandins. d. It binds to nerve receptors. e. It stimulates endorphins. ANSWER: c 63. Antibiotics and antacids often contain large amounts of a. sugar b. sodium c. sorbitol

d. lactose e. niacin ANSWER: b 64. The medication megestrol acetate a. relieves depression b. promotes weight loss c. enhances appetite d. stimulates insulin production e. treats dementia

ANSWER: c 65. Which of the following interferes significantly with the utilization of the antibiotic tetracycline? a. folate b. zinc c. calcium d. vitamin B12 e. vitamin C ANSWER: c Page 14

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 66. What is a common side effect from taking certain prescription drugs and consuming grapefruit juice? a. metallic taste in the mouth appears b. increased blood concentrations c. weight gain of 5 to 7 lb d. diminished physiological effects e. greatly reduced absorption ANSWER: b 67. The activity of the anticoagulant drug warfarin is affected by its interaction with a. vitamin K b. grapefruit juice c. sodium d. aged meats e. vitamin B12

ANSWER: a 68. People who take diuretic medications may need to take a a. vitamin K b. vitamin D c. iron

supplement.

d. potassium e. sodium ANSWER: d 69. Which of the following foods in particular must be restricted in the diet of a person taking a monoamine oxidase inhibitor drug to treat Parkinson’s disease? a. red meat b. sauerkraut c. salmon d. cruciferous vegetables e. chocolate ANSWER: b 70. Which of the following is commonly used as an additive in liquid medicines and causes diarrhea? a. sorbitol b. maltose c. saccharin d. aspartame e. lactulose ANSWER: a Page 15

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 71. A person’s perceived physical and mental well-being is referred to as

ANSWER: quality of life 72. The age in years from the date of birth is the

ANSWER: chronological age is a general term referring to any threat to a person’s well-being.

73.

ANSWER: Stress 74.

is a deterioration of the macular area of the eye that can lead to loss of central vision and eventual blindness. ANSWER: Macular degeneration

is inflammation of a joint, usually accompanied by pain, swelling, and structural changes.

75.

ANSWER: Arthritis 76. Compounds of nitrogen-containing bases such as adenine, guanine, and caffeine are called “

.”

ANSWER: purines 77.

initiate and conduct nerve impulse transmissions. ANSWER: Neurons

78. The loss of brain function beyond the normal loss of physical adeptness and memory that occurs with aging is called “ _______ _.” ANSWER: senile dementia are clumps of beta-amyloid protein pieces, commonly found on the brains of people with Alzheimer’s

79. disease

ANSWER: Senile plaques 80. Snarls of threadlike strands that extend from the nerve cells, commonly found on the brains of people with Alzheimer’s disease are called “ ................. ” ANSWER: neurofibrillary tangles Match the correct answer with the appropriate term. a. Fight or flight b. Tend and befriend c. Life span d. Life expectancy e. Iron f. Cataracts Page 16

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years g. Vitamin D h. Zinc i. Beta-amyloid j. Sarcopenia k. Purines l. Gout m. Vitamin K n. Acetylcholine o. Osteoarthritis p. Grapefruit juice q. Pressure ulcers r. Hydrochloric acid s. Omega-3 fatty acids t. Rheumatoid arthritis 81. Maximum number of years of life for a species ANSWER: d 82. Average number of years lived in a given society ANSWER: c 83. Loss of skeletal muscle mass, strength, and quality ANSWER: j 84. Typical stress response for women ANSWER: b 85. Typical stress response for men ANSWER: a 86. Damage to the skin commonly seen in people who are bedridden ANSWER: q 87. Atrophic gastritis is characterized by inadequate amounts of this substance ANSWER: r 88. In the elderly, elevated stores of this mineral are more likely than deficiencies ANSWER: e 89. Breakdown of these compounds can lead to gout ANSWER: k

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 90. Deficiency of this nutrient blunts the sense of taste ANSWER: h 91. Deficiency caused, in part, by the elderly’s low intake of milk ANSWER: g 92. Age-related cloudy areas of the eye lenses ANSWER: f 93. Also called “degenerative arthritis” ANSWER: o 94. Nutrient that may reduce inflammation in joints of those with rheumatoid arthritis ANSWER: s 95. Joint inflammation involving a defective immune system ANSWER: t 96. Form of arthritis characterized by deposits of uric acid crystals ANSWER: l 97. Substance that is essential to memory ANSWER: n 98. Clumps of this substance make up senile plaques ANSWER: i 99. The anticoagulant warfarin acts by blocking the enzyme that activates this nutrient ANSWER: m 100. Intake of this substance interferes with utilization of many cholesterol-lowering drugs ANSWER: p

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 101. How does physical activity promote longevity? ANSWER: The many remarkable benefits of regular physical activity are not limited to the young. Compared with those who are inactive, older adults who are active weigh less; have greater strength and flexibility, reduced inflammation, increased bone density, more endurance, and better balance; and they live longer. Perhaps most importantly, they enjoy better overall health. They reap additional benefits from various activities as well: aerobic activities improve cardiorespiratory endurance, blood pressure, and blood lipid concentrations; moderate-endurance activities improve the quality of sleep; and strength training improves posture and mobility. In fact, regular physical activity is the most powerful predictor of a person’s mobility in the later years. Mobility, in turn, is closely associated with longevity. Physical activity also increases blood flow to the brain, thereby preserving mental ability, alleviating depression, supporting independence, and improving quality of life. Muscle mass and muscle strength tend to decline with aging, making older people vulnerable to falls and immobility. Falls are a major cause of fear, injury, disability, and even death among older adults. Many lose their independence as a result of falls. Regular physical activity tones, firms, and strengthens muscles, helping to improve balance, restore confidence, reduce the risk of falling, and lessen the risk of injury should a fall occur. Even without a fall, older adults may become so weak that they can no longer perform life’s daily tasks, such as climbing stairs, carrying packages, and opening jars. Resistance training helps older adults to maintain independence by improving mobility and muscle strength to perform these tasks. Even in frail, elderly people older than 85 years of age, strength training not only improves balance, muscle strength, and mobility, but it also increases energy expenditure and energy intake, thereby enhancing nutrient intakes. This finding highlights another reason to be physically active: a person who is committed to an ongoing fitness program can benefit from higher energy and nutrient intakes and still maintain a healthy body weight. Ideally, physical activity should be part of each day’s schedule and should be intense enough to prevent muscle atrophy and to speed the heartbeat and respiration rate. Although aging reduces both speed and endurance to some degree, older adults can still train and achieve exceptional performances. Some older adults may enjoy pumping iron and running marathons, but such activities are not essential to good health. Daily activities can be as simple as gardening and doing household chores. Healthy older adults who have not been active can ease into a suitable routine, becoming as physically active as their abilities allow. They can start by walking short distances until they are walking at least 10 minutes continuously, and then gradually increase their workout to 30 to 60 minutes at least 5 days a week.

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 102. What have researchers discovered about how the manipulation of diet affects the longevity of animals? What implications does this information have for humans? ANSWER: Decades of research has revealed that animals live longer and have fewer age-related diseases when their energy intakes are restricted. These life-prolonging benefits become evident when the diet provides enough food to prevent malnutrition and an energy intake of about 70% of normal; benefits decline as the age of starting the energy restriction is delayed. Exactly how energy restriction prolongs life remains unexplained, although gene activity appears to play a key role. The genetic activity of old mice differs from that of young mice, with some genes becoming more active with age and others less active. With an energy-restricted diet, many of the genetic activities of older mice revert to those of younger mice. These “slow-aging” genetic changes are apparent in as little as 1 month on an energyrestricted, but still nutritionally adequate, diet. The consequences of energy restriction in animals include a delay in the onset, or prevention, of chronic diseases such as cancer and atherosclerosis and age-related conditions such as neuron degeneration; prolonged growth and development; and improved blood glucose, insulin sensitivity, and blood lipids. In addition, energy metabolism slows and body temperature drops—indications of a reduced rate of oxygen consumption. Restricting energy intake in animals not only produces fewer free radicals, but also increases antioxidant activity and enhances DNA repair. Reducing oxidative stress may at least partially explain how restricting energy intake lengthens life expectancy. Interestingly, longevity appears to depend on restricting energy intake and not on energy balance or body composition. Genetically obese rats live longer when given a restricted diet, even though their body fat is similar to that of rats that are allowed to eat freely. Research on a variety of species—including mice, rats, monkeys, spiders, and fish—confirms the relationship between energy restriction and longevity. Applying the results of animal studies to human beings is problematic, however, and conducting studies on human beings raises numerous questions— beginning with how to define energy restriction. Does it mean eating less or just weighing less? Is it less than you want or less than the average? Does eating less have to result in weight loss? Does it matter whether weight loss results from more exercise or from less food, or whether weight loss is intentional or unintentional? Extreme starvation to extend life, like any extreme, is rarely, if ever, worth the price. Hunger is persistent when energy is restricted by 30%. Furthermore, using animal data to extrapolate to humans, researchers estimate that it would take 30 years of such energy-restricted dieting to increase life expectancy by less than 3 years. Moderation, on the other hand, may be valuable. Many of the physiological responses to energy restriction seen in animals also occur in people whose intakes are moderately restricted. When people cut back on their usual energy intake by 10 to 20%, body weight, body fat, inflammatory proteins, growth factors, and blood pressure drop, and blood lipids and insulin response improve— favorable changes for preventing chronic diseases such as some cancers, type 2 diabetes, hypertension, and heart disease. Some research suggests that fasting on alternative days may provide similar benefits.

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 103. How does stress affect the aging process? How do stress responses vary by sex? ANSWER: As people get older, each person becomes less and less like anyone else. The older people are, the more time has elapsed for such factors as nutrition, genetics, physical activity, and everyday stress to influence physical and psychological aging. Stress contributes to a variety of age-related conditions. Both physical stressors (such as alcohol abuse, other drug abuse, smoking, pain, and illness) and psychological stressors (such as exams, divorce, moving, and the death of a loved one) elicit the body’s stress response. The body responds to such stressors with an elaborate series of physiological reactions, as the nervous and hormonal systems bring about defensive readiness in every body part. These effects favor physical action—the classic fight-orflight response. Prolonged or severe stress can drain the body of its reserves and leave it weakened, aged, and vulnerable to illness, especially if physical action is not taken. As people age, they lose their ability to adapt to both external and internal disturbances. When disease strikes, the reduced ability to adapt makes the aging individual more vulnerable to death than a younger person. Strategies to preserve health forestall disease, disability, and death. Because the stress response is mediated by hormones, it differs between men and women. The fightor-flight response may be more typical of men than of women. Women’s reactions to stress more typically follow a pattern of “tend-and-befriend.” Women tend by nurturing and protecting themselves, their children, and other loved ones. These actions promote safety and reduce stress. Women befriend by creating and maintaining a social group that can help in the process. 104. Consider the economic and social changes that occur as people age. How do these changes affect nutrition status? ANSWER: Overall, older adults today have higher incomes than their cohorts of previous generations. Still, 9% of the people older than age 65 live in poverty; without the help of Social Security, it would be 40%. Factors such as living arrangements and income make significant differences in the food choices, eating habits, and nutrition status of older adults, especially those older than age 80. People of low socioeconomic means are likely to have inadequate food and nutrient intakes. Only about one third of eligible seniors participate in the Supplemental Nutrition Assistance Program (SNAP). Malnutrition is most likely to occur among those living alone, especially men; those with the least education; those living in federally funded housing (an indicator of low income); and those who have recently experienced a change in lifestyle (such as getting a divorce or becoming widowed). Adults who live alone do not necessarily make poor food choices, but they often consume too little food or not enough variety, especially of fruits and vegetables. Loneliness is directly related to nutritional inadequacies, especially of energy intake. Feeling lonely is also associated with a decline in activities of daily living and mobility as well as an increased risk of death. 105. Why is dehydration a common problem among older adults? ANSWER: Despite real fluid needs, many older people do not seem to feel thirsty or notice mouth dryness. Many nursing home employees say it is hard to persuade their elderly clients to drink enough water and fruit juices. Older adults may find it difficult and bothersome to get a drink or to get to a bathroom. Those who have lost bladder control may avoid drinking too much water. Dehydration is a common problem for many older adults. Total body water decreases as people age, so even mild stresses such as fever or hot weather can precipitate rapid dehydration in older adults. Dehydrated older adults seem to be more susceptible to urinary tract infections, pneumonia, pressure ulcers, and confusion and disorientation. To prevent dehydration, older adults need to drink at least six glasses of water or other beverages every day. Emphasizing foods with high-water content, such as melons and soups, can also be helpful. Page 21

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 106. How might nutrition prevent and/or treat cataracts and macular degeneration? ANSWER: Oxidative stress appears to play a significant role in the development of cataracts, but supplements of the antioxidant nutrients (vitamin C, vitamin E, and carotenoids) do not seem to prevent or slow the progression. By comparison, a healthy diet that includes plenty of fruits and vegetables rich in these antioxidant nutrients does seem to slow the progression or reduce the risk of developing cataracts. A word of caution: vitamin C supplements in high doses (1000 mg) and long duration (several years) may increase the risk of cataracts. One other diet-related factor may play a role in the development of cataracts— obesity. Obesity appears to be associated with cataracts, but its role has not been identified. Risk factors that typically accompany obesity, such as inactivity, diabetes, or hypertension, do not explain the association. The leading cause of visual loss among older people is age-related macular degeneration, a deterioration of the macular region of the retina. As with cataracts, risk factors for age-related macular degeneration include oxidative stress from sunlight. Preventive factors may include supplements of the omega-3 fatty acids, some B vitamins (folate, vitamin B6, and vitamin B12), antioxidants (vitamin C, vitamin E, and beta-carotene), zinc, and the carotenoids lutein and zeaxanthin.

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 107. Describe two types of arthritis that can benefit from dietary changes and/or from physical activity. ANSWER: The most common type of arthritis that disables older people is osteoarthritis, a painful deterioration of the cartilage in the joints. During movement, the ends of bones are normally protected from wear by cartilage and by small sacs of fluid that act as a lubricant. With age, cartilage begins to deteriorate, and the joints may become malformed and painful to move. Obesity is common among adults with arthritis. Weight loss may relieve some of the pain for overweight persons with osteoarthritis, partly because the joints affected are often weight-bearing joints that are stressed and irritated by having to carry excess pounds. Interestingly, though, weight loss often relieves much of the pain of arthritis in the hands as well, even though they are not weight-bearing joints. Importantly, walking and other weight-bearing exercises do not worsen arthritis. In fact, lowimpact aerobic activity and resistance strength training offer improvements in physical performance and pain relief, especially when accompanied by even modest weight loss. Another type of arthritis, rheumatoid arthritis, has possible links to diet through the immune system. In rheumatoid arthritis, the immune system mistakenly destroys bone and cartilage as if they were made of foreign tissue. The omega-3 fatty acids commonly found in fatty fish reduce joint tenderness and improve mobility in some people with rheumatoid arthritis. The same diet recommended for heart health—a Mediterranean-type diet low in saturated fat from meats and milk products and high in vegetables, olive oil, and omega-3 fats from fish—helps prevent or reduce the inflammation in the joints that makes arthritis so painful. Another possible link between nutrition and rheumatoid arthritis involves the oxidative damage to the membranes within joints that causes inflammation and swelling. The antioxidant vitamins C and E and the carotenoids defend against oxidation, and increased intakes of these nutrients may help prevent or relieve the pain of rheumatoid arthritis. Another form of arthritis, which most commonly affects men, is gout, a condition characterized by deposits of uric acid crystals in the joints. Uric acid derives from the breakdown of purines, primarily from those made by the body but also from those found in foods. Recommendations to lower uric acid levels and the risk of gout include limiting alcohol and excessive amounts of meat, seafood, and sugarsweetened beverages. For most people, however, such strategies are insufficient, and drugs are needed to control symptoms. Treatment for arthritis—dietary or otherwise—may help relieve discomfort and improve mobility, but it does not cure the condition. Traditional medical intervention for arthritis includes medication and surgery. Alternative therapies to treat arthritis abound, but none have proved safe and effective in scientific studies. Popular supplements—glucosamine, chondroitin, or a combination—may relieve pain and improve mobility as well as over-the-counter pain relievers, but mixed reports from studies emphasize the need for additional research. 108. How does obesity affect brain structure? ANSWER: Being overweight or obese may accelerate the onset and progression of brain shrinkage that naturally occurs as a person ages. Adults who are overweight or obese have significantly reduced white brain matter compared with those of normal weight. Brain scans indicate that the volume of white brain matter of overweight or obese adults is similar to those of normal weight adults who are 10 years older. In other words, the brain degeneration of an overweight 50-year-old adult is comparable to that of a 60year-old adult. Maintaining a healthy body weight and participating in regular physical activity may be the best way to slow the brain’s natural aging process and degeneration.

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Chapter 16- Life Cycle Nutrition: Adulthood and the Later Years 109. What are five strategies for growing old healthfully? ANSWER: • Choose nutrient-dense foods. • Be physically active. Walk, run, dance, swim, bike, or row for aerobic activity. Lift weights, do calisthenics, or pursue some other activity to tone, firm, and strengthen muscles. Practice balancing on one foot or doing simple movements with your eyes closed. Modify activities to suit changing abilities and preferences. • Maintain appropriate body weight. • Reduce stress—cultivate self-esteem, maintain a positive attitude, manage time wisely, know your limits, practice assertiveness, release tension, and take action. • For women, discuss with a physician the risks and benefits of estrogen-replacement therapy. • For people who smoke, discuss with a physician strategies and programs to help you quit. • Expect to enjoy sex, and learn new ways of enhancing it. • Use alcohol only moderately, if at all; use drugs only as prescribed. • Take care to prevent accidents. • Expect good vision and hearing throughout life; obtain glasses and hearing aids if necessary. • Take care of your teeth; obtain dentures if necessary. • Be alert to confusion as a disease symptom, and seek diagnosis. • Take medications as prescribed; see a physician before self-prescribing medicines or herbal remedies and a registered dietitian nutritionist before self-prescribing supplements. • Control depression through activities and friendships; seek professional help if necessary. • Drink six to eight glasses of water every day. • Practice mental skills. Keep on solving math problems and crossword puzzles, playing cards or other games, reading, writing, imagining, and creating. • Make financial plans early to ensure security. • Accept change. Work at recovering from losses; make new friends. • Cultivate spiritual health. Cherish personal values. Make life meaningful. • Go outside for sunshine and fresh air as often as possible. • Be socially active—play bridge, join an exercise or dance group, take a class, teach a class, eat with friends, volunteer time to help others. • Stay interested in life—pursue a hobby, spend time with grandchildren, take a trip, read, grow a garden, or go to the movies. • Enjoy life. 110. Why are the elderly especially vulnerable to adverse drug-nutrient interactions? ANSWER: As people age, their likelihood of taking medicines increases. Up to 90% of adults aged 65 years and older take at least one prescription medicine; almost 40% use five or more daily. They take a variety of over-the-counter medicines and dietary supplements, such as glucosamine, as well. Most often, older adults take multiple drugs and supplements for heart disease, but also to treat arthritis, respiratory problems, and gastrointestinal disorders. They often go to different doctors for each condition and receive different prescriptions from each. Furthermore, physiological changes associated with aging may alter drug metabolism and excretion, which may in turn, diminish drug effectiveness or create potential toxicities. For all these reasons, physicians need to “start low and go slow” when prescribing for older adults. To avoid harmful drug interactions, consumers need to inform all of their physicians and pharmacists of all the medicines being taken. These medicines enable people of all ages to enjoy better health, but they also bring side effects and risks. Page 24

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Chapter 17- Nutrition Care and Assessment 1. Depending on the patient population, estimates indicate that approximately malnourished. a. 20 to 50 b. 35 to 70 c. 45 to 80 d. 50 to 90

percent of hospitalized patients are

ANSWER: a 2. Which statement is true regarding malnutrition among hospitalized patients? a. Although common among chronic care patients, malnutrition is rare among acute care patients. b. Malnutrition among hospitalized patients is extremely rare and an indication of seriously flawed care. c. Only patients who are terminally ill and expected to die within months are at risk of malnutrition. d. Even acutely ill patients who are not malnourished during admission may become malnourished subsequently. ANSWER: d 3. Impaired nutrient digestion and absorption that affects nutritional status would most likely be caused by a. insufficient excretion of digestive enzymes b. anorexia due to illness c. prolonged immobilization d. use of diuretics

ANSWER: a 4. Changes in hydration, as well as diarrhea due to illness, affect nutrition status primarily by a. reducing nutrient and food intake b. altering metabolism and excretion c. impairing digestion and absorption d. impairing cognition

ANSWER: b 5. A patient who has had surgery for colostomy placement has been put on bowel rest and has only intravenous fluids for nutrition. In what way would these treatments affect this patient’s nutrition status? a. reduce food intake b. impair digestion c. alter nutrient excretion d. Impair absorption ANSWER: a

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Chapter 17- Nutrition Care and Assessment 6. Maisie Green is a frail, elderly widow who lives in a nursing home and has been confined to her bed for 4 months. What is most likely to increase her metabolic stress and her energy and protein needs? a. weakened immunity b. medications causing GI discomfort c. poor emotional health d. pressure sores ANSWER: d 7. Specific instructions regarding dietary management for a patient are known as “ a. clinical pathways b. nutrition care plans c. diet orders d. nutrition screenings

.”

ANSWER: c 8. Nutrition assessment and diagnosis followed by provision of nutrition care by a registered dietitian is termed “ a. medical nutrition therapy b. the nutrition care process c. a nutrition screening d. a medical history

.”

ANSWER: a 9. A nutrition care plan is . a. the client’s diet prescription ordered by the nurse b. the dietitian’s strategies for meeting an individual's nutritional needs c. the nurse’s documentation of how well the client is eating d. nutritional formulas showing minimum daily requirements ANSWER: b 10. In a health care facility, who holds the ultimate responsibility for ensuring that all the patient's nutritional needs are met? a. clinical dietitians b. physicians c. nurses d. pharmacists ANSWER: b

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Chapter 17- Nutrition Care and Assessment 11. Which health care professional is expected to have extensive knowledge about foods, nutrition, and health? a. physician b. registered dietitian c. nurse d. social worker ANSWER: b 12. A new patient is admitted to the rehabilitation unit. Who is most likely to visit the patient to compile a list of his or her food preferences? a. nurse b. physician c. dietitian d. dietetic technician ANSWER: d 13. The physician asks the staff to administer tube feedings. Who is most often responsible for doing this? a. the nurse b. the dietitian c. the dietetic technician d. the social worker ANSWER: a 14. Coordinated programs of treatment that merge the care plans of different health practitioners are called “ a. critical pathways b. clinical integrative plans c. diagnosis-related groups d. treatment plans

.”

ANSWER: a 15. Clinical judgments about actual or potential health problems that provide the basis for selecting appropriate nursing interventions are called “ .” a. potential diagnoses b. nursing diagnoses c. treatment objectives d. nursing goals ANSWER: b

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Chapter 17- Nutrition Care and Assessment 16. Which statement most accurately describes nutrition screening? a. Screenings should be conducted within 24 hours of patient’s admission. b. Screening questions are the same from facility to facility. c. Assessments must be conducted by physicians. d. Laboratory tests are not included as part of the screening process. ANSWER: a 17. What is the screening tool that is used in clinical facilities to detect the risk of malnutrition in adults over the age of 65? a. Subjective Global Assessment b. Patient Education Materials Assessment Tool c. Continuity Assessment and Record Evaluation d. Mini Nutritional Assessment ANSWER: d 18. A patient’s height, weight, and body mass index represent which type of data in the nutrition screening process? a. admission data b. anthropometric data c. functional assessment data d. laboratory test results ANSWER: b 19. General weakness and impaired mobility in a patient represents which type of data in the nutrition screening process? a. admission data b. anthropometric data c. functional assessment data d. laboratory test results ANSWER: c 20. An assessment procedure for identifying clients who are malnourished or at risk for malnutrition is referred to as a “____.” a. health questionnaire b. health history c. diet order d. nutrition screening ANSWER: d

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Chapter 17- Nutrition Care and Assessment 21. A nutritional assessment involves . a. collecting and analyzing health-related data to identify nutrition problems b. implementing a nutrition care plan c. identifying existing and potential psychological problems d. obtaining approval from insurance providers ANSWER: a 22. A registered dietitian performs a Subjective Global Assessment on a newly admitted hospital patient. The dietitian gives several “C” ratings for the assessment variables related to the patient’s medical history and physical examination. This most likely means that the patient is . a. obese and needs to lose weight b. well nourished c. at risk of malnutrition d. severely malnourished ANSWER: d 23. The neuropsychological problems assessed in the Mini Nutritional Assessment screening tool include a. dementia b. distorted body image perception c. anxiety d. schizophrenia

ANSWER: a 24. An individual with a body mass index of screening tool. a. less than 19 b. 19 to less than 21 c. 21 to less than 23 d. 23 or greater

would receive one point for BMI in the Mini Nutritional Assessment

ANSWER: a 25. Lee is a 78-year-old woman with mild loss of muscle mass, loss of about 7% of body weight over the past 6 months, and decreased food intake due to anorexia. Using the Subjective Global Assessment screening tool, she is most likely to be classified in which category? a. well nourished b. mild malnutrition c. moderate malnutrition d. severe malnutrition ANSWER: c

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Chapter 17- Nutrition Care and Assessment 26. An example of a behavioral–environmental diagnosis given following a nutrition assessment might be a. altered blood potassium levels b. inadequate energy intake

c. unintended weight gain d. disordered eating pattern ANSWER: d 27. What is a social factor that can affect food intake and therefore nutrition status? a. methamphetamine use b. religious beliefs c. mental illness d. prescription medications ANSWER: b 28. What is an example of food and nutrition history information that would be included as part of the nutrition assessment? a. dietary supplements usage b. high educational level c. recent weight changes d. low socioeconomic status ANSWER: c 29. What technique is most effective when using the 24-hour recall method to obtain food intake data? a. multiple-pass method b. direct observation c. use of a checklist d. free recall ANSWER: a 30. If a client is asked to recount everything eaten in a typical day, the assessor is using a. a food record b. a calorie count c. a 24-hour recall d. direct observation

to collect food intake data.

ANSWER: c

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Chapter 17- Nutrition Care and Assessment 31. A 24-hour recall is used to collect food intake data for one day. The client states that she didn't eat breakfast. She had a soft drink and an apple for lunch, and for dinner she had a slice of pizza. What is the best question the health care professional could ask next regarding this finding? a. “Is this typically a day’s food intake?” b. “What was on the slice of pizza?” c. “What kinds of foods do you like to eat?” d. “Are you on a busy schedule?” ANSWER: a 32. What is a limitation when food intake information is collected using the 24-hour dietary recall method? a. The process is time consuming. b. Clients often keep poor records. c. The method excludes recording of beverages. d. A 24-hour recall relies on an individual’s memory. ANSWER: d 33. What best describes a food record? a. a written survey of food consumed in the past year b. a written account of food consumed during several consecutive days c. direct observation of how much a person eats d. an interview discussing food intake in the last day ANSWER: b 34. Why might food frequency questionnaires be less accurate than 24-hour recalls for obtaining food intake data? a. The process examines long-term food intake b. Dietary supplements can’t be included. c. They typically list only common foods. d. It may be difficult to estimate average portion sizes of foods eaten less frequently. ANSWER: c 35. An extensive and accurate log of foods eaten over a period of several consecutive days or weeks is called “ a. a food-frequency checklist b. a food record

.”

c. direct observation d. 24-hour recall ANSWER: b

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Chapter 17- Nutrition Care and Assessment 36. Danny is undergoing a health assessment. What should the clinician do that would most likely result in an accurate assessment of Danny’s weight? a. Ask Danny how much he weighs. b. Use a scale that is calibrated and checked for accuracy. c. Measure Danny’s weight three times and take an average of the measurements. d. Use a bathroom scale to weigh Danny. ANSWER: b 37. Head circumference is used to a. monitor brain growth b. help detect overnutrition

c. evaluate muscle size d. calculate infant body mass index ANSWER: a 38. In children, a sharp drop in a previously steady growth pattern suggests a. malnutrition b. obesity c. a growth spurt d. a medical error

ANSWER: a 39. Which calculation is more effective in evaluating weight loss in an overweight person? a. usual body weight b. ideal body weight c. %Usual Body Weight d. %Ideal Body Weight ANSWER: c 40. Growth charts with BMI-for-age percentiles can be used to assess risk of underweight using the the cutoff to identify children who may be malnourished. a. 5th

percentile as

b. 10th c. 15th d. 20th ANSWER: a

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Chapter 17- Nutrition Care and Assessment 41. A BMI-for-age above the a. 25th b. 50th

percentile indicates that the child may be overweight.

c. 75th d. 85th ANSWER: d 42. Mrs. Falwell is 5 ft 4 in. and weighs 110 lb. During the interview, she mentions she has lost "a lot of weight" over the past 5 months. She usually weighs 135 lbs. What is her %UBW? a. 25 b. 81 c. 120 d. 123 ANSWER: b 43. What %Ideal Body Weight indicates a risk of moderate malnutrition? a. 90 to 100 b. 85 to 90 c. 80 to 85 d. 70 to 79 ANSWER: d 44. An individual who is at risk of mild malnutrition has a %Usual Body Weight of a. <75 b. 75 to 84 c. 85 to 95 d. >95

ANSWER: c 45. An individual who is at risk of moderate malnutrition has a %Usual Body Weight of a. <70 b. 70 to 75 c. 75 to 84

d. 85 to 90 ANSWER: c

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Chapter 17- Nutrition Care and Assessment 46. Fluid retention typically results in a. deceptively low lab values b. deceptively high lab values

c. unintentional weight loss d. unintentional muscle loss ANSWER: a 47. After blood is centrifuged to remove cells, the fluid that remains is called “ a. plasma b. serum c. electrolytes d. platelets

.”

ANSWER: a 48. Which protein is the most abundant serum protein? a. transferrin b. albumin c. transthyretin d. retinol-binding protein ANSWER: b 49. Which nutrition assessment marker is routinely monitored in hospital patients, but is not a sensitive indicator of nutrition status? a. serum albumin b. body mass index c. mean corpuscular volume d. plasma creatinine ANSWER: a 50. Which serum protein rises rapidly in response to inflammation or infection associated with critical illness? a. transferrin b. prealbumin c. albumin d. C-reactive protein ANSWER: d

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Chapter 17- Nutrition Care and Assessment 51. Which of the following biochemical tests has different ranges of normal values for males and females? a. hematocrit b. mean corpuscular volume c. mean corpuscular hemoglobin concentration d. white blood cell (WBC) count ANSWER: a 52. The half-life of albumin is approximately a. 12 hours b. 2 to 3 days c. 8 to 10 days d. 14 to 20 days

ANSWER: d 53. Where do clinical signs of malnutrition appear most rapidly? a. hair b. eyes c. urinary tract d. cardiovascular system ANSWER: a 54. What clinical effects of protein-energy malnutrition (PEM) would most likely be seen in an individual’s hair? a. hair falling out easily b. thick hair c. hair firm in scalp d. shiny hair ANSWER: a 55. Elevated levels of a. albumin b. creatine kinase

may indicate liver disease.

c. mean corpuscular volume d. alanine aminotransferase ANSWER: d

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Chapter 17- Nutrition Care and Assessment 56. Which test is primarily used for monitoring kidney function? a. glycated hemoglobin b. C-reactive protein c. blood urea nitrogen d. alanine aminotransferase ANSWER: c 57. Physical signs of fluid retention include a. dark-colored urine b. reduced skin tension c. abdominal distention d. thirst

ANSWER: c 58. Immunity against a specific antigen is called “ a. adaptive b. innate c. systemic d. complementary

immunity.”

ANSWER: a 59.

are large globular proteins produced by B cells that function as antibodies. a. Antigens b. Immunoglobulins c. Antibodies d. Lysozymes ANSWER: b

60. White blood cells that have the ability to engulf and destroy pathogens are known as “ a. phagocytes b. immunoglobulins

.”

c. lymphocytes d. lysozymes ANSWER: a

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Chapter 17- Nutrition Care and Assessment 61. A nonspecific response to illness or injury is called “ a. an allergy b. cell-mediated immunity

.“

c. humoral immunity d. inflammation ANSWER: d 62. Which type of cell releases proteins that damage parasites? a. basophils b. monocytes c. eosinophils d. neutrophils ANSWER: c 63. An example of an antigen is a(an) a. monocyte b. NK cell c. virus d. T cell

ANSWER: c 64. Which tissue is a type of lymphoid tissue? a. spleen b. lungs c. appendix d. brain ANSWER: a 65. A foreign antigen has entered the body and has elicited the immune response. A helper T cell binds to an antigen fragment on an antigen-presenting cell. What happens next? a. B cells produce more antibodies. b. A cytotoxic T cell destroys the antigen. c. Free antibodies attach to the antigens. d. A macrophage engulfs the target antigen. ANSWER: b Match each word or phrase with the most appropriate definition or explanation. a. food and nutrition history b. calorie counts c. Subjective Global Assessment d. diet order Page 13

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Chapter 17- Nutrition Care and Assessment e. critical pathways f. nutrition care plans g. food record h. edema i. PES statement j. food-frequency questionnaire k. 3.4 to 4.8 g/dL l. nutrition care process m. 200 to 360 mg/dL n. 20 to 40 mg/dL o. nutrition screening 66. specific instructions about dietary management ANSWER: d 67. detailed log of food eaten during a specified time period, usually several days ANSWER: g 68. written survey of foods regularly consumed during a specific period of time ANSWER: j 69. strategies for meeting an individual’s nutritional needs ANSWER: f 70. comprehensive record of a person’s food intake and dietary practices ANSWER: a 71. the estimation of food energy consumed by patients for one or more days ANSWER: b 72. the abnormal retention of fluid in body tissues ANSWER: h 73. assessment of health-related variables to identify patients who are malnourished or at risk for malnutrition ANSWER: o 74. systematic approach used by registered dietitians that includes assessing, diagnosing, intervening, monitoring, evaluating, and treating the patient's nutrition problems ANSWER: l 75. nutrition screening tool that primarily uses information pertinent to medical history and physical examination ANSWER: c 76. statement that describes a nutrition problem, its etiology or cause, and the signs/symptoms ANSWER: i Page 14

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Chapter 17- Nutrition Care and Assessment 77. coordinated programs of treatment that merge the care plans of different health practitioners ANSWER: e 78. acceptable laboratory range for albumin ANSWER: k 79. acceptable laboratory range for transferrin in an individual <60 years old ANSWER: m 80. acceptable laboratory range for prealbumin (transthyretin) ANSWER: n 81. Describe the effects of illness on nutrition status and list two examples of conditions associated with malnutrition. ANSWER: Illnesses and their treatments may lead to malnutrition by causing a reduction in food intake, interfering with digestion and absorption, or altering nutrient metabolism and excretion. For example, the nausea caused by some illnesses or treatments can diminish appetite and reduce food intake; similarly, an inflamed mouth or esophagus may cause discomfort when the patient consumes food. Some medications can cause anorexia or gastrointestinal (GI) discomfort or interfere with nutrient function and metabolism. Prolonged bed rest often results in pressure sores, which increase metabolic stress and raise protein and energy needs. 82. Discuss the role of nurses on the nutrition care team and list five nutrition-related nursing diagnoses. ANSWER: Nurses interact closely with patients and thus are in an ideal position to identify people who would benefit from nutrition services. Nurses may screen patients for nutrition problems and participate in nutrition and dietary assessments. Nurses also provide direct nutrition care, such as encouraging patients to eat, finding solutions to food-related problems, monitoring food intakes, and answering questions about special diets. As members of nutrition support teams, nurses are responsible for administering tube and intravenous feedings. In facilities that do not employ registered dietitians, nurses often assume responsibility for much of the nutrition care. Examples of nutrition-related nursing diagnoses include constipation, disturbed body image, impaired oral mucous membrane integrity, nausea, and risk for aspiration.

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Chapter 17- Nutrition Care and Assessment 83. Discuss the different types of historical data collected for a nutrition assessment. ANSWER: The medical history describes the patient’s current and past medical issues; this information is helpful because numerous medical problems and their treatments can interfere with food intake or require dietary changes. The medical history generally includes the family medical history as well; this information may reveal genetic susceptibilities for diseases that can potentially be prevented with dietary and lifestyle changes. Many different medications can have detrimental effects on nutrition status, and various components of foods and dietary supplements can interact with medications. Personal and social factors influence food choices as well as a person’s ability to manage health and nutrition problems. For example, cultural background or religious beliefs can affect food preferences, whereas financial concerns may restrict access to health care and nutritious foods. A food and nutrition history is a detailed account of a person’s dietary practices. It includes information about food intake, lifestyle habits, and other factors that affect food choices, such as food allergies or beliefs about nutrition and health. The procedure often includes an interview about recent food intake and a survey about usual food choices. The food and nutrition history may help the dietitian uncover current or potential nutrition problems or patterns of behavior that contribute to health problems. 84. List two advantages and two disadvantages for each of the four methods used for obtaining food intake data. ANSWER: The 24-hour dietary recall interviews are conducted after food is consumed; therefore, this method does not influence dietary choices. The required information is obtained quickly, but the process relies on memory, and food items that cause embarrassment (such as alcohol and desserts) may be omitted from the list of foods consumed. A food-frequency questionnaire is not affected by day-to-day or seasonal variability and is inexpensive to administer, but food lists often include common foods only, and therefore calculated nutrient intakes may not be accurate. The food record method tracks foods as they are consumed, which may improve the accuracy of food intake data; this process is useful for controlling intake because keeping records increases awareness of food choices. The disadvantages of the food record method are that underreporting and portion size errors are common, and the process is time consuming, with respondent burden being high. The direct observation method is advantageous since the process does not rely on memory and, nor does it influence food intake, but the process is labor-intensive and only possible in residential situations. 85. Describe the use of anthropometric measurements in infants and children. ANSWER: To evaluate growth patterns, the clinician takes periodic measurements of height (or length), weight, and head circumference and plots them on growth charts. The most commonly used growth charts compare height (or length) to age, weight to age, head circumference to age, weight to length, and BMI to age. Although individual growth patterns vary, a child’s growth will generally stay at about the same percentile throughout childhood; a sharp drop in a previously steady growth pattern suggests malnutrition. Growth patterns that fall below the 5th percentile indicate failure-to-thrive and may be cause for concern, although genetic influences must be considered when interpreting low values. Growth charts with BMI-for-age percentiles can be used to assess the risk of underweight and overweight in children over 2 years of age: the 5th and 85th percentiles, respectively, are used as cutoffs to identify children who may be malnourished or overweight.

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Chapter 17- Nutrition Care and Assessment 86. Explain why serum proteins are used as part of biochemical assessment measurements and list three examples. ANSWER: Serum protein levels can aid in the assessment of protein-energy status, but the levels may fluctuate for other reasons as well. Because serum proteins are synthesized in the liver, blood levels of these proteins can reflect liver function. Metabolic stress alters serum proteins because the liver responds by increasing its synthesis of some proteins and reducing the synthesis of others. Values are also influenced by hydration status, pregnancy, kidney function, zinc status, blood loss, and some medications. Because serum proteins are affected by so many factors, their values must be considered along with other data to evaluate health and nutrition status. Some examples of serum proteins include albumin, transferrin, Creactive protein and retinol-binding protein. 87. Describe clinical signs of malnutrition in an individual’s eyes, lips, skin, and nails. ANSWER: Signs of malnutrition tend to appear most often in parts of the body where cell replacement occurs at a rapid rate, such as the hair, skin, and digestive tract (including the mouth and tongue). The eyes may have pale membranes, spots, dryness, or redness in the corners. The lips may appear dry or cracked or may have sores in the corners. The skin manifests poor wound healing, it may be dry and rough and may bruise easily. The nails can be ridged, spoon-shaped, and pale. These clinical signs and symptoms manifest as a result of macronutrient and micronutrient deficiencies. 88. Describe the differences between fluid retention and dehydration. ANSWER: Fluid retention (also called “edema”) may be caused by PEM, severe infection or injury, and some medications. It can also result from heart failure, disorders of the liver or kidneys, and obstructions in the veins or lymphatic system. Physical signs of fluid retention include weight gain, facial puffiness, tissue swelling, abdominal distention, and tight-fitting shoes. Dehydration may be caused by vomiting, diarrhea, fever, excessive urination, blood loss, and wounds or burns (due to fluid loss through skin lesions). The risk of dehydration is especially high in older adults, who have a reduced thirst response and various other impairments in fluid regulation. Signs or symptoms include thirst, weight loss, dry skin or mouth, reduced skin tension, dark-colored urine, and low urine volume. 89. Describe how malnutrition impacts the body's immune response. ANSWER: Malnutrition affects all aspects of immunity, including both innate and adaptive immune defenses. For example, both protein-energy malnutrition (PEM) and vitamin A deficiency can result in damage to the skin and mucous membranes, allowing microorganisms to easily enter the body. Deficiencies of protein and various micronutrients can affect the synthesis of hydrolytic enzymes, complement, antibodies, and other proteins important for immune function. Cell-mediated immunity is impaired in numerous ways by both PEM and zinc deficiencies. Because PEM is usually associated with multiple micronutrient deficiencies, it has been difficult for researchers to separate out the influences of individual nutrients. Nevertheless, zinc, iron, and vitamin A deficiencies are among the most common micronutrient deficiencies worldwide, and a large body of research has demonstrated that each has a strong independent influence on immunity. Of note, correcting deficiencies of various micronutrients (especially zinc and vitamin A) in malnourished populations has been found to reduce the incidence and severity of illness.

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Chapter 17- Nutrition Care and Assessment 90. Discuss the undesirable impact of immune responses on nutrition status. ANSWER: The body’s immune function can sometimes create problems. Exaggerated or inappropriate immune reactions, referred to as “hypersensitivity,” can lead to physical discomfort or illness. Allergy is an example of an exaggerated response to an allergen, a harmless protein fragment that may be eaten or inhaled. As another example, the immune complexes formed from antigens and antibodies can cause damage to tissues if not readily cleared by phagocytes. Autoimmune diseases, including such familiar diseases as type 1 diabetes mellitus and pernicious anemia, develop when immune responses are mounted against the body’s own cells. Although the effects of the immune system are lifesaving when directed at harmful pathogens, they can be life-threatening when turned against the body.

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Chapter 18- Nutrition Intervention 1. What type of nutrition intervention provides referrals to local agencies and arranges transfer of nutrition care to another location? a. nutrition counseling b. coordination of nutrition care c. nutrition education d. nutrition delivery ANSWER: b 2. Which element of nutrition interventions would be accomplished while planning nutrition care? a. documenting the care plan in the medical record b. individualizing treatment as warranted c. consulting dietetics practice guidelines d. discussing the care plan with the patient ANSWER: c 3. The two interrelated components of nutrition intervention are a. monitoring and evaluation b. examining and supervision c. planning and implementation d. observation and modification

ANSWER: c 4. Mike needs to make long-term changes to his diet because of a chronic illness. What approach would be most successful in helping Mike implement long-term dietary changes? a. determining Mike’s readiness for change b. emphasizing what to avoid, rather than what to eat c. suggesting five to six changes at a time d. ensuring the new plan is totally different than mike’s usual diet ANSWER: a 5. Providing information about a modified diet is an example of a. food/nutrient delivery b. nutrition education c. nutrition counseling d. coordination of nutrition care

the following type of nutrition intervention.

ANSWER: b

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Chapter 18- Nutrition Intervention 6. Solving problems that interfere with the nutrition care plan is an example of what type of nutrition intervention.? a. food/nutrient delivery b. nutrition education c. nutrition counseling d. coordination of nutrition care ANSWER: c 7. Which statement describes an important benefit of follow-up care? a. It facilitates evaluation and any necessary modification of the nutrition care plan . b. It allows updating of basic patient data such as address and phone number. c. It is typically required by insurance companies to qualify for payment. d. It allows clinicians to sharpen their skills. ANSWER: a 8. Nutrition education allows patients to . a. evaluate the effectiveness of their nutrition care plan b. determine whether their health plan needs to be updated c. decide whether they need a referral to another health professional d. learn about the dietary factors that affect their particular medical condition ANSWER: d 9. A document or electronic file used to record a client's medical and social history, medical assessment, treatment, and results of therapy is a(n) . a. medical record b. informal record c. diagnosis d. nutrition care plan ANSWER: a 10. Electronic data systems used to document patient’s medical records are characterized by a. a lack of popularity among health care facilities b. reliance on handwritten chart notes c. flexibility in language used d. standardized templates

ANSWER: d

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Chapter 18- Nutrition Intervention 11. In medical records, what information is included in the A section of the ADIME documentation format? a. nutrition diagnoses b. expected outcomes c. relevant assessment results d. changes to the care plan ANSWER: c 12. The ADIME format for documenting nutrition care . a. closely reflects the steps of the nutrition care process b. is the oldest charting method for nutrition care used c. uses a “D” to stand for “diet prescription” d. focuses on subjective information ANSWER: a 13. What does the “S” stand for in the SOAP note charting format? a. symptom b. standard c. subjective d. selective ANSWER: c 14. Which part of the SOAP note would include recommendations for dietary changes? a. S b. O c. A d. P ANSWER: d 15. What data are relevant for inclusion in the O section of the SOAP note? a. the chief medical problem b. referrals to appropriate agencies c. the nutrition prescription d. anthropometric data ANSWER: d

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Chapter 18- Nutrition Intervention 16. Which section of the ADIME format would contain PES statements? a. A b. D c. I d. ME ANSWER: b 17. A dietitian is providing diet counseling for a patient with hyperlipidemia. She asks the patient to limit intake of fast foods, but the patient’s wife states that her husband mostly eats burgers and fries on weekends. In which section of the SOAP note will the wife’s input be recorded? a. S b. O c. A d. P ANSWER: a 18. The “P” of PES stands for a. problem b. prescription c. plan d. possible cause

ANSWER: a 19. The “I” of ADIME stands for a. intervention b. implementation

c. integration d. insurance ANSWER: a 20. In which section of ADIME would the treatment goals and expected outcomes be found? a. A b. D c. I d. ME ANSWER: c

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Chapter 18- Nutrition Intervention 21. The clinical dietitian uses a. resting metabolic rate b. actual body weight

and stress factor to estimate energy needs of patients with specific illnesses

c. usual body weight d. ideal body weight ANSWER: a 22. What is the most accurate method to determine resting metabolic rate? a. Harris–Benedict equation b. Mifflin–St. Jeor equation c. indirect calorimetry d. bomb calorimeter ANSWER: c 23. What is the most accurate method to determine energy needs in overweight or obese patients who are not critically ill? a. Harris–Benedict equation b. Mifflin–St. Jeor equation c. indirect calorimetry d. bomb calorimeter ANSWER: b 24. Use the Harris-Benedict equation (presented below) to estimate daily energy needs for a 32-year-old woman who is 165 cm tall and weighs 46 kg. Use a stress factor of 1.2. RMR = 655.1 + [9.563 × weight (kg)] + [1.85 × height (cm)]—[4.676 × age (years)] a. 1730 kcal b. 1860 kcal c. 2006 kcal d. 2130 kcal ANSWER: b 25. Health practitioners should monitor the patient’s food intake and the hospital stay. a. body weight b. height c. blood pressure d. albumin levels

, and reevaluate energy needs regularly during

ANSWER: a

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Chapter 18- Nutrition Intervention 26. The final result of indirect calorimetry is to determine the

a. amount of energy the patient needs to take in per 24 hours b. number of kcalories burned during a period of study c. factors associated with illness that contribute to high energy intake d. adjustments to make in the patient’s diet to improve carbohydrate intake ANSWER: b 27. Indirect calorimetry is ideal for which group of patients? a. bedridden patients b. children c. ambulatory patients d. obese patients ANSWER: a 28. What describes a disadvantage of using indirect calorimetry? a. It requires certification and advanced training. b. It causes pain for the patient. c. It is labor intensive. d. It requires at least 24 hours of test-time for accurate results. ANSWER: c 29. A quick way of estimating a person’s energy needs is to multiply medical condition. a. 24-hour kcalorie intake b. body weight

by a factor appropriate for the patient’s

c. waist circumference d. percent of body fat ANSWER: b 30. One of the main characteristics of a standard diet is that it a. results in reduced intake of total fat and saturated fat b. includes a limited number of foods c. meets the nutrient needs of healthy people d. is likely to cause food intolerances

ANSWER: c

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Chapter 18- Nutrition Intervention 31. When a regular diet fails to meet the nutrient needs of a client, a a. standard diet b. nutrition care plan

is used.

c. modified diet d. nursing diagnosis ANSWER: c 32. Difficulty swallowing is referred to as “ a. dysphagia b. dyspepsia c. dementia d. dermatitis

.”

ANSWER: a 33. Jackie is preparing to undergo a gastrointestinal test procedure in the hospital. What would be the most appropriate diet a day before the procedure? a. blenderized diet b. clear liquid diet c. high-kcalorie, high-protein diet d. low -odium diet ANSWER: b 34. Why are diets for dysphagia highly individualized? a. because of best practice standards b. because swallowing ability can fluctuate over time c. to challenge the patient to improve swallowing ability d. to eliminate patient boredom ANSWER: b 35. Which food can be included in a blenderized liquid diet? a. sausage b. raisins c. White rice d. almonds ANSWER: c

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Chapter 18- Nutrition Intervention 36. Liquid diets are often prescribed a. following oral or facial surgeries b. for individuals with edema

c. based on personal preference d. to assist with weight loss ANSWER: a 37. Which food can be included in a mechanically altered/soft-food diet? a. cereal bars b. canned pears c. pretzels d. granola ANSWER: b 38. Which food could be included in a clear liquid diet? a. cream of potato soup b. frozen juice bars c. ice cream d. orange juice ANSWER: b 39. After surgery, the physician ordered Tina to be put on a clear liquid diet. The first food Tina would receive could be ____. a. bread b. eggs c. flavored gelatin d. milk ANSWER: c 40. Use the Mifflin–St. Jeor equation to calculate an appropriate energy intake for a 30-year old male hospital patient who is 5 ft 9 in. tall and weighs 162 lb. Use 1.25 as the stress factor for this patient. The patient’s energy requirement is kcalories a. 1916 b. 2113 c. 2020 d. 2415 ANSWER: b

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Chapter 18- Nutrition Intervention 41. Which patient would most likely need a low-fiber diet? a. a patient in rehabilitation after a burn injury b. a patient who tolerates a clear liquid diet c. a patient who is getting ready for surgery d. a patient who has an allergy to wheat ANSWER: c 42. What food would most likely be restricted in a low-residue diet? a. fish b. squash c. mashed potatoes d. bananas ANSWER: b 43. Most foods included in a fat-restricted diet have less than a. 1 b. 1/2 c. 1/4 d. 1/10

gram of fat per serving.

ANSWER: a 44. For which client would diet progression be appropriate? a. Betty, who just had gallbladder surgery and is being discharged on a standard diet b. Jim, who has been on a clear liquid diet and now is ready to start eating solid foods again c. Susan, who has been diagnosed with celiac disease and must exclude gluten from her diet d. David, whose cancer has returned and has been transferred to hospice care ANSWER: b 45. The process of changing the client’s diet as per his/her tolerance to food is called “ a. a standard diet b. diet progression

.”

c. nutrition education d. a manual diet ANSWER: b

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Chapter 18- Nutrition Intervention 46. What food would most likely be included in a high-kcalorie, high-protein diet? a. cranberry juice b. pancakes c. coleslaw d. boiled potatoes ANSWER: b 47. Mrs. Greenbaum is suffering from kidney disease and experiencing edema. Which modified diet would be appropriate for her based on this information? a. fat-controlled diet b. low-sodium diet c. high-kcalorie, high-protein diet d. liquid diet ANSWER: b 48. Which food would be permitted on a fiber-restricted diet? a. whole-wheat bread b. chunky peanut butter c. plain yogurt d. winter squash ANSWER: c 49. A sodium-controlled diet is often used to prevent fluid retention and may be recommended for the treatment of a. hyperglycemia b. congestive heart failure c. cancer d. hyperthyroidism

ANSWER: b 50. In most cases, on a low-sodium diet, the sodium level is restricted to a. 250 to 500 b. 500 to 1000 c. 2000 to 3000

mg per day.

d. 4000 to 5000 ANSWER: c

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Chapter 18- Nutrition Intervention 51. Mr. Whitaker is 5 ft 8 in. tall and currently weighs 145 lb (usual weight around 175 lb) and has been diagnosed with esophageal cancer. His hematocrit is 28% and his albumin level is 3.1 g/dL. Which diet would assist in improving his nutrition status? a. low-sodium diet b. fat-restricted diet c. high-kcalorie, high-protein diet d. lactose-free diet ANSWER: c 52. Delivery of nutrient solutions directly into the vein is called “ a. enteral nutrition b. modified nutrition c. parenteral nutrition d. tube feeding

.”

ANSWER: c 53. In which case would a tube feeding be preferred over parenteral nutrition? a. if the patient has an infection b. if the patient needs extra calories c. if the GI tract is functioning normally d. if the patient is deficient in vitamin A ANSWER: c 54. A nurse is reading new orders written in the patient chart. The order reads, "NPO," which means that the patient will receive ____. a. only beverages and medications b. only medications c. nothing by mouth d. all foods orally ANSWER: c 55. Which patient would most likely have an order to be NPO? a. a patient who had knee surgery yesterday b. a patient preparing for a gastrointestinal procedure c. a patient who is 85 years old d. a patient who is obese ANSWER: b

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Chapter 18- Nutrition Intervention 56. Your client is prescribed a high-kcalorie, high-protein diet. Out of the recommended 3200 kcales, 38% is provided from fat sources. How many grams of fat will the client receive on this diet? a. 115 grams b. 135 grams c. 143 grams d. 151 grams ANSWER: b 57. A lactose-intolerant patient is provided a full-liquid diet as a transition between liquids and solid foods. Which of the following foods would not be appropriate for this patient: a. cream soup b. ginger ale c. fruit ice d. soft drinks ANSWER: a 58. A client has just been admitted to your unit at 11:30 PM on a Saturday. He states that he is hungry and wants something to eat. You note that he is on a fat-restricted diet, but have questions regarding what exactly is allowed. Your best resource at this time of night is the . a. diet manual b. client’s physician c. client’s dietitian d. nursing supervisor ANSWER: a 59. What is a benefit of using a selective menu? a. Patients can decide whether or not to follow their diet plans. b. Patients become more familiar with the foods permitted on their particular diet. c. The foodservice department saves money because fewer foods are served. d. Risks associated with noncompliance are reduced. ANSWER: b 60. The nurse is preparing one of her patients for lunchtime. She opens the tray and sees the patient's pureed food. The nurse should . a. tell the patient, “I hope you know what this is. ... It all looks like mush to me” b. ask visitors to leave, as they are distracting the patient c. ask the patient if he needs help with his meal d. turn off the lights and turn on the television ANSWER: c

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Chapter 18- Nutrition Intervention 61. What information is included in a diet manual? a. calorie counts for patients recovering from surgery b. the exact items to avoid when a patient is NPO c. preparation methods to include or exclude in modified diets d. food choices that the patient is most likely to eat ANSWER: c 62. What intervention would most likely help to improve intake for a hospitalized patient at mealtime? a. suggesting foods that require little effort to eat. b. turning down the lights in the room. c. placing the patient’s bed in the highest position. d. selecting all foods for the patient from his menu. ANSWER: a 63. A positive skin-prick test result correctly identifies an allergen about a. 50 to 60% b. 60 to 70% c. 70 to 80% d. 80 to 90%

of the time.

ANSWER: a 64. A negative skin-prick test result . a. is typically incorrect b. indicates that the test substance is not the cause of allergy c. is valid for physical but not psychological symptoms d. is rarely clinically meaningful ANSWER: b 65. Blood antibody testing for food allergies . a. is the most accurate method b. predicts lack of allergy better than actual allergy c. should be accompanied by other diagnostic tests to confirm the food allergy d. is rarely clinically meaningful ANSWER: c

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Chapter 18- Nutrition Intervention 66. What refers to a systemic (whole-body) reaction characterized by breathing difficulty and low blood pressure? a. hives b. oral allergy syndrome c. anaphylaxis d. acute gastrointestinal response ANSWER: c 67. Because allergic responses may persist after allergens are removed from the diet, . a. elimination testing is no longer used b. patients must be cautioned to be scrupulously careful with their diets c. patients are generally inaccurate in identifying foods to which they are allergic d. an elemental formula diet may be needed to stabilize the patient before foods are reintroduced ANSWER: d 68. Elemental formula diets . a. contain no intact proteins b. contain only one type of protein c. are used to provoke allergic responses d. help identify “safe” foods ANSWER: a 69. When properly performed, a. oral food challenges b. skin testing c. blood antibody testing d. food elimination diets

is(are) the gold standard for diagnosis of food allergies.

ANSWER: a 70. Breaded meats and vegetables are known to be a hidden source of a. eggs b. milk

c. peanuts d. shellfish ANSWER: a Match each word or phrase with the most appropriate definition or explanation. a. Modified diet b. Selective menu c. Hives d. Standard diet e. Mechanically altered diet Page 14

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Chapter 18- Nutrition Intervention f. Clear liquid diet g. Diet manual h. Tube feedings i. Anaphylaxis j. Fiber-restricted diet k. Parenteral nutrition l. Sodium-controlled diet m. Blenderized liquid diet n. Nonselective menu o. Dysphagia 71. diet that includes all foods and meets the nutrient needs of healthy people ANSWER: d 72. diet adjusted in consistency, amount of calories or nutrients, or by the inclusion or elimination of certain foods ANSWER: a 73. difficulty swallowing ANSWER: o 74. liquid formulas delivered through a tube placed in the stomach or intestine ANSWER: h 75. provision of nutrients through a vein, bypassing the intestine ANSWER: k 76. menu with two or more choices in some or all categories ANSWER: b 77. book that specifies the foods allowed and/or restricted on modified diets ANSWER: g 78. menu that only lists preselected food items ANSWER: n 79. raised, swollen patches of skin or mucous membranes ANSWER: c 80. modified-texture diet for people with difficulty swallowing or oral hypersensitivity ANSWER: e 81. a severe allergic reaction that may lead to shock ANSWER: i

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Chapter 18- Nutrition Intervention 82. diet for preparation for bowel surgery, colonoscopy, or acute gastrointestinal illnesses or as a transition diet after intravenous feedings ANSWER: f 83. diet for acute phases of intestinal disorders or to reduce fecal output before surgery ANSWER: j 84. diet for prevention or correction of fluid retention ANSWER: l 85. diet for patients who cannot chew, swallow, or tolerate solid foods ANSWER: m 86. Describe the importance of instituting follow-up care after nutrition education. ANSWER: For optimal results, dietitians should monitor the patient’s progress and periodically evaluate the effectiveness of the nutrition care plan. Doing so usually involves comparing relevant outcome measures (such as the results of blood tests) with initial values and meeting with the patient to learn whether the plan has been satisfactory from the patient’s point of view. Such follow-up efforts can reveal whether the care plan needs to be revised or updated, as is often the case when a person’s medical condition or situation changes. (For example, after a woman delivers a baby, she may need instructions on how to feed her infant or, if she is breastfeeding, how to modify her diet to support lactation). If a follow-up meeting with a dietitian is not possible, a dietetic technician or other qualified health practitioner should provide additional guidance and nutrition education. 87. List the types of modified diets that alter food texture and consistency and explain the appropriate uses of each type. ANSWER: Modified diets that alter food texture or consistency are often used for those who need assistance with the process of eating or for those who require procedures that affect how food is eaten or digested. Mechanically altered diets, such as pureed and soft food diets are for people with swallowing difficulties, poor tongue control, or oral hypersensitivity. They are appropriate for those with limited chewing abilities or swallowing impairments. Blenderized liquid diets are for people who cannot chew, swallow easily, or tolerate solid foods. Clear liquid diets are for preparation for bowel surgery or colonoscopy, for acute GI disturbances, or as a transition diet after intravenous feeding. 88. Compare and contrast tube feeding and parenteral nutrition. ANSWER: Tube feedings consist of nutritionally complete formulas that can be delivered through a tube placed directly into the stomach or intestine. Tube feedings are preferred to parenteral nutrition if the GI tract is functioning normally. A person’s medical condition sometimes prohibits the use of the GI tract to deliver nutrients. If the person is malnourished and the GI tract cannot be used for a significant period of time, parenteral nutrition, in which nutrients are supplied intravenously, can meet nutritional needs.

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Chapter 18- Nutrition Intervention 89. Discuss the advantages of selective menus and methods used to improve patient satisfaction with foodservice. ANSWER: Most hospitals provide selective menus from which patients can select their meals. The use of selective menus allows patients to choose foods they prefer and are most likely to eat. If a patient is following a modified diet, the menu includes only foods that are permitted on that diet. An advantage of this system is that patients following modified diets can become familiar with the foods permitted on their particular diet. To improve patient satisfaction with foodservice as well as patients’ perceptions of their overall hospital experience, many hospitals are moving toward a room service cook-to-order system similar to what an individual might experience in a hotel. In these facilities, the menus list more food choices than usual and include more fresh foods, seasonal ingredients, and local specialties. Entrées are prepared as they are ordered, and food delivery hours are expanded to better accommodate patients’ varied schedules. 90. List three common food allergies, and discuss the challenges in managing each. ANSWER: Eggs and egg proteins are common ingredients in many recipes and processed foods. People with egg allergy should avoid eggs from all birds to prevent cross-reactivity. Because vaccines for influenza, rabies, and yellow fever are prepared using egg embryos, people with egg allergies need to check with their physicians before being vaccinated. Milk and the proteins derived from milk are common ingredients in many prepared and packaged foods. In addition, individuals with milk allergies need to avoid milk from all animals because of the potential for cross-reactivity. Obtaining sufficient calcium and vitamin D from nonmilk sources may be difficult, and supplementation is often warranted. A milk allergy may be difficult to differentiate from lactose intolerance because both conditions can produce gastrointestinal symptoms. Some people with peanut allergies have severe reactions, including anaphylaxis, to even the smallest quantities of peanuts. Although peanut allergy is not necessarily associated with other nut allergies, patients may be advised to avoid all nuts (and seeds such as sunflower seeds) because of potential contamination from food-processing equipment. People with peanut allergies may also react to lupine flour (produced from seeds of the lupine plant), which is sometimes used as a wheat flour additive in Europe and Australia.

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 1. What federal organization is responsible for approving sales of new medications and inspecting facilities where drugs are manufactured? a. Department of Health and Human Services (DHHS) b. Food and Drug Administration (FDA) c. United States Department of Agriculture (USDA) d. Centers for Disease Control and Prevention (CDC) ANSWER: b 2. Prescription drugs are given over-the-counter (OTC) status when . a. 20 years have passed since the drug was first released b. they are considered safe enough for self-medication c. the bioavailability of the drug is similar to that of a generic preparation d. their mechanism of effective action outweighs their adverse side effects ANSWER: b 3. To gain FDA approval, a generic drug must . a. be less expensive than the original drug b. have a different route of administration than the original drug c. have a similar name as the brand-name drug d. contain the same active ingredients as the original drug ANSWER: d 4. The nurse is administering a medication via injection to the patient’s hip. Therefore, the patient is receiving the drug ____. a. transdermally b. intramuscularly c. sublingually d. orally ANSWER: b 5. What is the purpose of the FDA’s MedWatch program? a. to monitor the need for new medications, especially those for rare illnesses b. to identify and monitor the use of prescription drugs that can be abused or misused c. to set the prices for prescription medications d. to encourage health care professionals and consumers to report problems with medications ANSWER: d

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 6. Most drugs are commonly administered through which route? a. orally b. sublingually c. transdermally d. by injection ANSWER: a 7. Loss of drug potency associated with metabolism by liver or intestinal enzymes is referred to as “ a. hepatic degradation b. first-pass elimination c. enzymatic elimination d. unavoidable loss

.”

ANSWER: b 8. Any preventable event that causes inappropriate drug use or patient harm due to mistakes made by the health professional, patient, or caregiver is known as a(n) . a. diet-drug interaction b. adverse reaction c. drug-drug interaction d. medication error ANSWER: d 9. What is a policy that has been developed to reduce the risk of mistakes when administering medications? a. bar codes on medications and patient ID bracelets b. increased off-label medication use c. mandatory reporting of side effects d. monitored drug disposal in pharmacies ANSWER: a 10. On medication orders, which of the following terms is considered accurate? a. 7.0 b. .70 c. 0.7 d. .77 ANSWER: c

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 11. Which medical abbreviation can be mistaken for “every day”? a. TWA b. TIW c. TID d. QOD ANSWER: d 12. What is a prohibited term in clinical documentation and has to be spelled out? a. IU b. mg c. unit d. 0.1 mL ANSWER: a 13. Why are the elderly more vulnerable to adverse effects from medications than other populations? a. impaired function of the liver or kidneys b. inability to afford multiple medications c. the focus on older adults in clinical trials d. susceptibility to acute infections ANSWER: a 14. Which intervention would most likely reduce the risk of adverse effects from medications? a. advising patients to take the drugs on a continuous schedule. b. telling the patient to write down side effects after finishing the prescription. c. encouraging a patient to call the physician or nurse prior to taking each dose of the medication. d. obtaining a list of all prescription and over-the-counter drugs and herbal supplements the patient is taking. ANSWER: d 15. Drugs may alter a. food intake b. enzyme action

by interfering with taste or smell.

c. nutrient absorption d. nutrient excretion ANSWER: a

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 16. Drugs may alter by changing the acidity of the digestive tract. a. food intake b. motivation to take the drug c. nutrient absorption d. nutrient excretion ANSWER: c 17. Food substances and drugs may interact and cause toxicity by a. increasing side effects of the drug b. causing diarrhea and vomiting c. damaging mucosal cells d. interfering with the sense of smell

ANSWER: a 18. Components of charbroiled meats may increase the metabolism of a. tetracycline b. warfarin c. amphetamine d. phenobarbital

ANSWER: b 19. Bile acid binders may also bind to a. water-soluble vitamins b. trace minerals c. fat-soluble vitamins d. protein analogues

ANSWER: c 20. Which of the following foods will improve absorption of a lipophilic drug? a. steamed carrots b. plain baked potato c. mashed avocado d. boiled cabbage ANSWER: c

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 21. Excretion of calcium and potassium may be increased by some a. diuretics b. antihistamines

c. antidepressants d. psychotropics ANSWER: a 22. Aspirin works faster when it is taken a. with meals b. on an empty stomach c. immediately upon awakening d. just prior to bed

ANSWER: b 23. Which type of medication would most likely cause nutrient malabsorption because of damage to the gastrointestinal tract? a. anticonvulsants b. antineoplastics c. antivirals d. antihypertensives ANSWER: b 24. Which central nervous system–targeting drug is affected by grapefruit juice? a. carbamazepine b. haloperidol c. lorazepam d. risperidone ANSWER: a 25. Drugs classified as antiemetics can improve food intake by a. preventing vomiting b. promoting sleep c. increasing electrolyte losses d. binding to calcium

ANSWER: a

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 26. Methotrexate resembles a. iron b. folate

in structure and competes with it for the enzyme that converts it to its active form.

c. phosphorus d. calcium ANSWER: b 27. Mr. White has been prescribed corticosteroids. He should expect a. suppression of appetite b. weight loss c. reduced depression d. increased appetite

ANSWER: d 28. Mr. Ahmed has bladder cancer. His appetite, intake, and weight have declined over the past few weeks. The doctor prescribes to increase his intake. a. methotrexate b. megestrol acetate c. amphetamines d. liver enzymes ANSWER: b 29. A possible side effect of some antibiotics, such as ciprofloxacin, is a. dry mouth b. reduced calcium absorption c. reduced iron absorption d. enhanced tumor growth

ANSWER: b 30. The amount of lithium reabsorbed in the kidneys is similar to the amount of a. sodium b. folate c. magnesium d. phosphorus

that is reabsorbed.

ANSWER: a

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 31. Betty has been prescribed an antiulcer agent. Her physician will monitor Betty’s a. iron status b. GI comfort

for side effects.

c. renal function d. sodium excretion ANSWER: a 32. A person who takes a monoamine oxidase inhibitor (MAOI) and consumes food that contains tyramine could suffer from ____. a. hearing loss b. peripheral edema c. hallucinations d. severe headache ANSWER: d 33. Glenn has been on corticosteroids for many years. This long-term use may cause a. weight loss b. osteoporosis c. hypoglycemia d. appetite suppression

ANSWER: b 34. Altered excretion of potassium, magnesium, thiamin, and calcium are side effects associated with the use of a. narcotics b. antihypertensives c. diuretics d. laxatives

ANSWER: c 35. Dietary and herbal supplements that can interact with warfarin metabolism include a. ginseng b. vitamin D c. vitamin C d. echinacea

ANSWER: a

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 36. A patient who is taking an MAO inhibitor should avoid which lunchtime entrée? a. Reuben sandwich b. split pea soup c. lettuce salad with ranch dressing d. pork chops with steamed carrots ANSWER: a 37. Mrs. Appleton has been diagnosed with depression and her physician has prescribed a monoamine oxidase inhibitor. He instructs her to avoid consuming large amounts of tyramine. Which food should be safe for Mrs. Appleton’s diet? a. aged cheese b. oranges c. tofu d. sausage ANSWER: b 38. Ms. Holmes is taking an MAO inhibitor. She is at the food court and needs to pick the best meal. Which food would contain the largest amount of tyramine? a. chocolate b. scrambled eggs c. hot dogs d. cheddar cheese ANSWER: d 39. The scientific name for black cohosh is a. Cimicifuga racemosa b. Tanacetum parthenium c. Zingiber officinale d. Serenoa repens

ANSWER: a 40. What describes a potential adverse effect of using St. John’s wort? a. skin photosensitivity b. heartburn c. liver damage d. weight gain ANSWER: a

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 41. Which herb is correctly paired with its common use among consumers? a. feverfew—treatment of mild-to-moderate depression b. black cohosh—relief of menopausal symptoms c. saw palmetto—prevention of migraine headaches d. ginger—wound healing (topical use) ANSWER: b 42. Which herbal preparation may be taken to reduce blood clotting? a. St. John’s wort b. garlic c. ginseng d. valerian ANSWER: b 43. Which herbal preparation may be taken to treat erectile dysfunction? a. saw palmetto b. feverfew c. ginseng d. yohimbe ANSWER: d 44. Which herbal preparation has been associated with the occurrence of mouth and tongue sores? a. saw palmetto b. feverfew c. ginseng d. yohimbe ANSWER: b 45. Consumers rarely find listed on supplement labels. a. adverse effects of herbs b. the name of the manufacturer c. ambiguous statements about health benefits d. incorrect information about herb species or potency ANSWER: a

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 46. In a university study that evaluated the authenticity of 44 single-herb supplements, to contain a completely different plant species than was listed on the label. a. 12% b. 32% c. 49% d. 61%

of the products were found

ANSWER: b 47. Garlic, ginkgo, and ginseng have been shown to have an interaction with which type of drug? a. anticoagulants b. immunosuppressants c. antiarrhythmics d. diuretics ANSWER: a 48. When goldenseal is used with anticoagulants, for which side effect is the patient at risk? a. hypotension b. cardiac arrhythmias c. blood clots d. aortic aneurysm ANSWER: c 49. What best explains why older adults are at higher risk of drug interactions with herbal supplements? a. Older adults are more likely to take three or more prescription medications at a time. b. The bodies of older adults cannot process herbal supplements at all. c. Older adults do not always understand how to buy the correct supplements for what they need. d. The herbal supplements provided to older adults are more likely to have fillers and toxic agents. ANSWER: a 50. What are the most common adverse effects of herbal supplements? a. diarrhea, nausea, and vomiting b. liver damage c. renal failure d. seizures and heart palpitations ANSWER: a

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 51. Physicians who refer patients for complementary therapies while continuing to provide standard treatments are practicing what is known as medicine. a. integrative b. complementary c. alternative d. conventional ANSWER: a 52. Homeopathic and naturopathic medicinal treatments are examples of “ a. mind–body interventions b. manual healing methods c. alternative systems of medical practice d. pharmacological treatments

ANSWER: c 53. An example of a mind–body intervention is a. Ayurveda b. faith healing c. ozone therapy d. homeopathy

ANSWER: b 54. The complementary/alternative approach that proposes that a person’s natural “life force” can foster self-healing is called “ .” a. chiropractic b. homeopathy c. biofeedback d. naturopathic medicine ANSWER: d 55. Which method is based on the theory that “like cures like?” a. chiropractic b. homeopathy c. biofeedback d. naturopathic medicine ANSWER: b

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products Emma Wiseman is an 85-year-old widow and retired elementary school teacher. She lives alone, and her closest relatives live about an hour away. She has a medical history of breast cancer, hypertension, and osteoporosis. Emma currently takes six medications. She has been having difficulty opening her medication bottles and decided to put all of her pills into one container. After doing this she realizes that some of them look the same and she is unsure which medication she should take with her dinner. 56. An important thing Emma should do is to . a. take any pill b. contact her pharmacist c. stop her medications d. purchase OTC medications instead ANSWER: b 57. Emma reports that she has had decreased appetite and weight loss over the past 3 days. She may be suffering from ____. a. a medication error b. medication side effects c. bacterial reaction d. cross-reactivity ANSWER: b 58. Upon further examination, one of Emma's medications is identified as an herbal supplement that may treat dementia and memory deficits. This medication is most likely . a. garlic b. ginger c. gingko d. ginseng ANSWER: c 59. This situation may have been prevented by identifying Emma as a. part of a low-risk group b. one who takes multiple medications

c. one who needs herbal products d. one who should consider alternative medicine ANSWER: b

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 60. Which condition and its medication/treatment could cause Emma to have mouth sores? a. cancer b. osteoporosis c. depression d. hypertension ANSWER: a Ralph Mitchell is a 53-year-old male. He is happily married with three children and has his own business. Today, he is having his yearly physical. He lists the following medications on his "Patient History" paperwork: aspirin, lovastatin, hydrochlorothiazide, warfarin, garlic, and vitamin C. 61. Upon reviewing his medications, we can assume that Ralph most likely suffers from . a. obesity b. diabetes c. osteoporosis d. cardiovascular disease ANSWER: d 62. Which of Ralph's medications is an over-the-counter (OTC) drug? a. aspirin b. lovastatin c. warfarin d. hydrochlorothiazide ANSWER: a 63. Given the medications he is taking, Ralph needs to control his intake of a. chocolate b. charbroiled meats

c. baked chicken d. applesauce ANSWER: b 64. Which of Ralph's medications requires a prescription? a. aspirin b. lovastatin c. garlic d. vitamin C ANSWER: b

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 65. Ralph shouldn’t drink a. water b. milk

c. grapefruit juice d. orange juice ANSWER: c Match each word or phrase with the most appropriate definition or explanation. a. Herbal supplements b. National Center for Complementary and Alternative Medicine c. Megestrol acetate d. Prescription drugs e. Isoniazid f. Food and Drug Administration g. Cortisol h. Drug-drug interactions i. Over-the-counter drugs j. Diet-drug interactions k. Generic drugs l. Antineoplastic m. Ayurveda n. Tyramine o. Medical error 66. medications given to treat serious conditions that may cause adverse side effects ANSWER: d 67. any preventable action that causes inappropriate drug use or patient harm due to mistakes made by a health professional or patient ANSWER: o 68. agency responsible for approving sales of new medications and inspecting facilities where drugs are manufactured ANSWER: f 69. drugs that can be used safely and effectively without medical supervision ANSWER: i 70. process whereby substances in the diet alter the effectiveness of drugs and drugs may affect food intake or nutrient metabolism ANSWER: j 71. botanical products such as garlic and ginkgo ANSWER: a Page 14

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 72. drugs that can combat tumor growth ANSWER: l 73. an antituberculosis medication ANSWER: e 74. process whereby one drug alters the effects of another drug and the risk of side effects increases ANSWER: h 75. a steroid hormone secreted by the adrenal cortex ANSWER: g 76. agency whose mission is to investigate complementary and alternative therapies by funding well-designed scientific studies ANSWER: b 77. versions of brand-name drugs that can be sold after the patent protection of brand-name drugs expires ANSWER: k 78. a traditional medical system from India that promotes the use of diet, herbs, meditation, massage, and yoga for preventing and treating illness ANSWER: m 79. an appetite enhancer ANSWER: c 80. compound in some fermented/aged foods that can cause a sudden release of accumulated norepinephrine ANSWER: n 81. In what ways are over-the-counter and prescription medications different? ANSWER: Prescription drugs are usually given to treat serious conditions and may cause severe side effects. For these reasons, they are sold by prescription only, which ensures that a physician has evaluated the patient’s medical condition and determined that the benefits of using the medication outweigh the risks of incurring side effects. Over-the-counter (OTC) drugs are those that individuals can use safely and effectively without medical supervision. People use them to treat less serious illnesses that are easily self-diagnosed. Examples include aspirin to treat headaches or pain and antacids to combat acid reflux. The FDA regulates labels on OTC drugs to make sure they provide accurate information about the drugs’ appropriate uses and dosages and potential adverse effects. Prescription drugs considered safe enough for self- medication are often given OTC status, sometimes in smaller doses than are available by prescription.

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 82. Explain how policies are being improved in the health care community to reduce instances of medication errors. ANSWER: Several policies are helping to reduce medication errors. The bar codes currently used on medications and patient identification bracelets allow health practitioners to verify that the correct medication and dosage are administered: error messages alert personnel if the drug, dose, or timing of administration is inappropriate. In addition, a national education campaign aims to eliminate one of the most common but preventable sources of medication errors—the use of ambiguous medical abbreviations. Because such terms can be easily misread or misinterpreted, they should not be used in clinical documentation related to patient care in order to prevent medical errors. 83. Explain why some patients are at higher risk of adverse effects from medications than others. ANSWER: Health care professionals should be aware that some patients are more vulnerable than others to adverse effects from drugs. This category includes the populations that rarely participate in clinical trials that determine product safety: pregnant and lactating women, children, and people with medical conditions that are not the main focus of the study. In these groups, side effects may be discovered only after a drug has been marketed. Children may react in different ways to drugs than adults do if appropriate dosage for their age and size is not administered. Also, limited data are available on drug safety in older adults. Elderly people with chronic diseases that require multiple medications are especially susceptible to adverse effects due to drug-drug or drug-nutrient interactions. They are also more likely to have impaired function of the liver or kidneys—the two organs critical for metabolizing drugs and eliminating drugs from the body. 84. Provide examples of drug-induced side effects that can limit food intake. ANSWER: Drugs can produce side effects that impact various mechanisms of how the body takes in and uses nutrients, including by limiting food intake. Ways that drug interactions alter food intake include altering the appetite, interfering with taste or smell, inducing nausea or vomiting, interfering with oral functioning, or causing sores or inflammation in the mouth. 85. Explain how stomach acidity can affect drug absorption. ANSWER: Some drugs are absorbed better in an acidic environment, whereas others are absorbed better in alkaline conditions. For example, reduced stomach acidity (due to secretory disorders or antacid medications) may reduce the absorption of ketoconazole (Nizoral, an antifungal medication) and atazanavir (an antiretroviral medication), but increase the absorption of digoxin (Lanoxin, which treats heart failure) and alendronate (Fosamax, which treats osteoporosis). Some drugs are available in coated forms to resist the stomach’s acidity; these are referred to as “enteric-coated.” 86. How can metabolism be affected in relation to diet-drug interactions? ANSWER: Some food components alter the activities of enzymes that metabolize drugs or may counteract drug effects in other ways. Compounds in grapefruit juice (or whole grapefruit) have been found to inhibit or inactivate enzymes that metabolize a number of different drugs. As a result of the reduced enzyme action, blood concentrations of the drugs increase, leading to stronger physiological effects. The effect of grapefruit juice can last for a substantial period, possibly as long as several days after the juice is consumed; thus, the interaction cannot be avoided just by separating grapefruit juice consumption from drug administration.

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Chapter 19- Medications, Diet-Drug Interactions, and Herbal Products 87. What are some safety concerns associated with the use of herbal products? ANSWER: Consumers often assume that because plants are “natural,” herbal products must be harmless. Many herbal remedies have toxic effects, however. The most common adverse effects of herbs include diarrhea, nausea, and vomiting. The popular herbs chaparral, germander, green tea, kava, and pennyroyal can cause liver damage. Contamination of herbal products is another safety concern. Many products have been found to contain lead and other toxic metals in excessive amounts. Other contaminants frequently found in herbal supplements include molds, bacteria, and pesticides that have been banned for use on food crops. Adulteration of imported products is a serious concern; for example, chemical analyses have frequently identified the presence of synthetic drugs that were not declared on the label. Illnesses or fatalities sometimes result from the intentional or accidental substitution of one plant species for another. Some herbal products have been found to contain unlisted fillers made from rice, soybean, or wheat, which may pose a health risk for persons with allergies to these substances. 88. Describe how using herbal supplements to treat illnesses can cause safety concerns. ANSWER: When people self-medicate or ask the advice of unqualified people such as store clerks instead of seeking effective medical treatment, the consequences are sometimes serious and irreversible. Purchasing an herbal remedy may be less stressful than a visit to the doctor, but it may delay getting appropriate treatment and allow an illness to progress. Although retailers are not legally permitted to provide medical advice, sellers of herbal products routinely make improper claims that the products are able to treat, prevent, or cure specific illnesses. Patients are often unaware that herbal products may be unsafe or can interact with prescription and over-the-counter medications. 89. Briefly describe the concept of traditional Chinese medicine (TCM). ANSWER: TCM includes a large number of folk practices that originated in China. TCM is based on the theory that the body has pathways (called “meridians”) that conduct energy (called “qi”). The interrupted flow of qi is believed to cause illness. TCM practices allegedly improve the flow of qi and includes acupuncture, qi gong, herbal remedies, dietary practices, and massage. 90. Describe a manipulative or body-based therapy. Include a discussion of its effectiveness and validity. ANSWER: Massage therapy is the manipulation of muscle and connective tissue to improve muscle function, reduce pain, and promote relaxation. Massage therapists may also apply heat or cold and give advice about exercises that may improve muscle tone and range of motion. Massage is often integrated into conventional physical therapy, although some massage therapists may incorrectly suggest that massage is a valid treatment for a wide range of medical conditions.

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Chapter 20- Enteral Nutrition Support 1. Lora, age 57, is undergoing chemotherapy and radiation for cancer and will soon have surgery. She is in need of

oral supplementation to help improve her nutritional status prior to the surgery. What might be done to help her accept oral supplements? a. Allow her to try several formulations to find one she likes. b. Warn her that her surgery will have to be delayed if she does not accept them. c. Give her a trial of tube feeding so that she will prefer the oral supplements. d. Acknowledge that they taste terrible but tell her they are better than the alternative. ANSWER: a 2. Alan has been diagnosed with cancer and needs oral supplements to prevent weight loss. What oral supplement

that can be purchased over-the-counter should be recommended for Alan? a. Special K b. Nutrisystem c. SlimFast d. Ensure ANSWER: d 3. What is a good guideline for serving oral supplements to hospitalized patients? a. Serve beverages in the can they come in, so that the patient can recognize them. b. Serve beverages as cold as possible to minimize the often-unpleasant taste. c. Serve the supplements attractively in a glass on a plate, which may be more appealing to patients. d. Serve the same flavor every day so that the patient will get used to them. ANSWER: c 4. Which feature is essential for the administration of enteral nutrition? a. a functional gastrointestinal tract b. a good appetite c. good peripheral venous access d. minimal nutritional needs ANSWER: a 5. An enteral formula that contains intact proteins and polysaccharides is a(n) a. standard

formula.

b. elemental c. modular d. hydrolyzed ANSWER: a Page 1

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Chapter 20- Enteral Nutrition Support 6. Which condition or treatment may indicate the need for tube feedings? a. obesity b. mechanical ventilation c. systemic infection d. potassium depletion ANSWER: b 7. Standard formulas are used for clients who a. require specific nutrient combinations

b. are able to digest and absorb nutrients without difficulty c. are severely malnourished d. require intravenous feedings ANSWER: b 8. If a patient is going to be tube-fed for longer than a. 1 week

, a gastrostomy or jejunostomy may be necessary.

b. 4 weeks c. 2 months d. 6 months ANSWER: b 9. In which patient should gastric feedings be avoided? a. a pediatric patient b. a patient at risk of aspiration c. a patient with extremely high nutrient requirements d. a patient with severe malnutrition ANSWER: b 10. An opening in the abdomen through which a feeding tube can be passed to the stomach is called a(n) a. ileostomy

b. endoscopic jejunostomy c. gastrostomy d. duodenostomy ANSWER: c

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Chapter 20- Enteral Nutrition Support 11. A(n)

feeding tube placement may be preferred for infants because it allows normal breathing. a. nasoduodenal b. nasogastric c. orogastric d. nasoenteric ANSWER: c

12. Which feeding tube placement may require a surgical procedure? a. nasogastric b. nasojejunal c. enterostomy d. nasoduodenal ANSWER: c 13. The type of feeding tube that requires the most difficult insertion procedure is a(n) a. orogastric

tube.

b. nasoduodenal c. nasojejunal d. jejunostomy ANSWER: d 14. Mr. Heiman has suffered a stroke and now has dysphagia (difficulty swallowing). He is 5 ft 8 in. tall and weighs

127 lb. The most appropriate method of nutrition support for him would be a. gastrostomy feedings b. nasojejunal feedings c. liquid supplements d. orogastric feedings

ANSWER: a 15. Which tube feeding route is most appropriate for patients requiring long-term nutrition support? a. enterostomy b. nasoenteric c. nasogastric d. orogastric ANSWER: a

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Chapter 20- Enteral Nutrition Support 16. A disadvantage of transnasal tube placement is that

a. it is not an effective means for tube feeding b. the tube can be easily pulled out c. the tube is inserted through the skin d. it requires surgical placement ANSWER: b 17. Standard formulas are also referred to as a. polymeric

formulas.

b. MCT c. elemental d. modular ANSWER: a 18. Elemental formulas are also called a. polymeric

formulas.

b. specialty c. hydrolyzed d. disease-specific ANSWER: c 19. The protein content of enteral formulas is usually a. 2 to 10 b. 12 to 20 c. 22 to 30 d. 32 to 40

percent of total kcalories.

ANSWER: b 20. The fat content of enteral formulas is usually a. 5 to 10

percent of total kcalories.

b. 15 to 30 c. 35 to 50 d. 55 to 60 ANSWER: b

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Chapter 20- Enteral Nutrition Support 21. What is a carbohydrate source used in many standard formulas? a. aldose b. maltodextrin c. amylopectin d. cellulose ANSWER: b 22. Most enteral formulas have energy density of a. 1.0 to 2.0

kcalories per milliliter of fluid.

b. 2.0 to 3.0 c. 3.0 to 4.0 d. 4.0 to 5.0 ANSWER: a 23. A formula with an osmolality greater than that of blood serum is known as a(n) a. isotonic

formula.

b. hypertonic c. enteral d. complete ANSWER: b 24. A patient with fluid, electrolyte, and protein restrictions would most likely need which type of formula? a. carbohydrate-modified b. high-kcalorie c. renal or hepatic insufficiency d. standard formula with moderate fiber content ANSWER: c 25. The vast majority of patients commonly use which type of enteral formula? a. standard b. hydrolyzed c. specialized d. modular ANSWER: a

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Chapter 20- Enteral Nutrition Support 26. A health care provider is preparing to administer a tube feeding to a patient with a nasogastric tube. To best reduce

the risk of formula contamination, the caregiver should perform which step first? a. Clean the lid of the can with an alcohol wipe. b. Warm the can in a pan of hot water. c. Pour the contents of the can into a clean container. d. Label the can with the date and time of its opening. ANSWER: a 27. What can happen when liquid medications are infused along with enteral feedings? a. The osmolality can increase substantially and may contribute to diarrhea. b. Fluid overload can occur owing to the additional need for water flushes. c. Risk of aspiration increases owing to the need for additional water flushes. d. The medication can more easily reach toxic levels in the body. ANSWER: a 28. Proper sterile techniques should be used during preparation and delivery of formulas to protect patients from a. receiving the wrong formula

b. exposure to foodborne illness c. malnutrition d. dehydration ANSWER: b 29. Health care facilities have protocols for handling food products and formulas based on the potential hazards and

critical control points in food preparation, which are called a. HACCP systems b. Joint Commission mandates c. MSDS requirements d. AHA standards

ANSWER: a 30. What is a characteristic of an open feeding system? a. A greater variety of formulas can be used. b. The formula must be transferred from its original packaging to a feeding container. c. An aseptic technique is not necessary. d. This system costs more initially. ANSWER: b

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Chapter 20- Enteral Nutrition Support 31. What is a characteristic of a closed feeding system? a. The formula can hang for a longer period of time. b. It is more expensive in the long run. c. Aseptic technique is not necessary. d. It requires far more nursing time. ANSWER: a 32. Open containers of formula that are unused should be disposed of within a. 6 to 8

hours.

b. 8 to 12 c. 12 to 24 d. 24 to 48 ANSWER: d 33. When an open feeding system is used, the nurse should hang no more than a(n) a. 6 b. 8 c. 12 d. 16

-hour supply.

ANSWER: b 34. A gastric secretion sample typically has a pH of a. 5 or lower

b. 6 to 7 c. 8 to 9 d. 10 or higher ANSWER: a 35. A respiratory secretion sample typically has a pH of a. 3 or lower

b. 4 c. 5 d. 6 or higher ANSWER: d

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Chapter 20- Enteral Nutrition Support 36. To reduce the risk of aspiration, the patient’s upper body is elevated to a

-degree angle during the feeding.

a. 5 to 10 b. 15 to 30 c. 30 to 45 d. 45 to 60 ANSWER: c 37. Intermittent tube feedings are best tolerated when they are administered over a. 5 to 10 minutes

b. 30 to 45 minutes c. 1 to 2 hours d. 4 to 6 hours ANSWER: b 38. Iris has an order for continuous tube feedings through her nasogastric tube. She is to receive 2500 mL of formula

on a continuous basis over 24 hours. At what hourly rate should the health care provider set the infusion pump? a. 25 mL b. 58 mL c. 104 mL d. 250 mL ANSWER: c 39. The delivery of up to 500 mL of formula within 10 minutes is termed a(n) a. minimal residual feeding

b. intermittent feeding c. bolus feeding d. a continuous drip ANSWER: c 40. Intermittent feeding using the gravity drip method is suitable for the delivery of no more than how much formula

over 30 minutes? a. 100 mL b. 200 mL c. 300 mL d. 400 mL ANSWER: d

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Chapter 20- Enteral Nutrition Support 41. A patient who does not tolerate a bolus feeding would most likely develop what symptoms? a. abdominal discomfort and nausea b. headache and blurred vision c. confusion and anxiety d. constipation and edema ANSWER: a 42. Which tube feeding delivery method is administered every 3 to 4 hours using a syringe? a. continuous feedings b. bolus feedings c. sustainable feedings d. cyclic feedings ANSWER: b 43. Tom is a 15-year-old who is eating some food but must also receive enteral feedings for malnutrition associated

with Crohn's disease. To help Tom carry on normal activities, the health care team might try a. continuous feedings b. intermittent feedings c. a neon-colored feeding tube

d. brightly colored formulas ANSWER: b 44. Mr. Simpson is receiving formula intermittently six times a day. He needs 1500 mL every 24 hours. How many

milliliters of formula is Mr. Simpson receiving at each feeding? a. 120 b. 250 c. 333 d. 900 ANSWER: b 45. Why are bolus feedings used only in patients who are not critically ill? a. Bolus feedings restrict the patient’s movements for long periods of time. b. Risk of aspiration is greater than with other delivery methods. c. Bolus feedings wouldn’t be adequate to meet the patient’s nutrition needs in this situation. d. Bolus feedings require the use of an infusion pump. ANSWER: b

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Chapter 20- Enteral Nutrition Support 46. For what purpose would a nurse measure the gastric residual volume in a patient’s feeding tube? a. to check that the stomach is emptying properly b. to ensure that the patient is receiving adequate water c. to prevent dumping syndrome and diarrhea d. to ensure that medications have been digested ANSWER: a 47. Typically, adults require a. 5 to 8

mL per kilogram of body weight of water daily.

b. 10 to 12 c. 15 to 20 d. 30 to 40 ANSWER: d 48. Samuel is an 88-year-old patient with a gastrostomy tube. The health care provider knows that Samuel will not

always recognize thirst, even though he may need extra water. To evaluate Samuel’s hydration status, the provider will check his . a. white blood cell count b. respiratory rate c. blood urea nitrogen d. waist circumference ANSWER: c 49. A nurse determines that his patient’s jejunostomy tube is clogged. What is a possible cause? a. using liquid medications b. using a very viscous energy-dense formula c. excessive water flushing d. using a low-fiber formula ANSWER: b 50. What is a potential metabolic complication of tube feedings? a. elevated heart rate b. hyperglycemia c. increased vitamin C levels d. redness and irritation at the tube insertion site ANSWER: b

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Chapter 20- Enteral Nutrition Support 51. How often should the feeding tube placement be checked if the patient is on intermittent feedings? a. before each feeding is initiated b. after each feeding c. every 6 hours d. every 12 hours ANSWER: a 52. How often should the feeding tube be flushed if the patient is on continuous feedings? a. every 4 hours b. every 8 hours c. every 12 hours d. daily ANSWER: a 53. A patient with a jejunostomy tube has developed an infection around the tube’s insertion site. What measure would

most likely correct this situation? a. Using a small-bore tube. b. Ensuring that medication doses are appropriate. c. Applying a protective antibiotic dressing. d. Elevating the head of bed during and after feeding. ANSWER: c 54. Nausea, vomiting, and cramps in a patient with a feeding tube are most likely caused by a. an inappropriate size feeding tube

b. inadequate fiber intake c. a lack of exercise d. delayed stomach emptying ANSWER: d 55. In the United States, phenylketonuria (PKU) affects approximately 1 out of a. 5000 b. 12,700 c. 34,500 d. 150,000

births annually.

ANSWER: b

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Chapter 20- Enteral Nutrition Support 56. The only current treatment for phenylketonuria (PKU) is a diet that

a. restricts phenylalanine and tyrosine b. supplies tyrosine and valine c. supplies valine and restricts phenylalanine d. supplies tyrosine and restricts phenylalanine ANSWER: d 57. Nondietary therapies can treat some inborn errors of metabolism. In some cases, the missing protein is infused,

such as in the case of a. PKU b. cystic fibrosis c. hemophilia d. galactosemia

ANSWER: c 58. A patient who requires 3000 kcal per day is receiving a standard formula that provides 1.5 kcal per milliliter

continuously over 24 hours. How many milliliters of formula will the patient receive each hour? a. 50 mL per hour b. 83 mL per hour c. 125 mL per hour d. 150 mL per hour ANSWER: b 59. The main focus of the dietary treatment for galactosemia is the a. exclusion of galactose

b. provision of galactose c. exclusion of protein d. provision of essential fatty acids ANSWER: a 60. Kristina is a 4-year-old with galactosemia. Her caregivers must ensure adequate intake of a. vitamin C

b. calcium c. vitamin E d. potassium ANSWER: b

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Chapter 20- Enteral Nutrition Support 61. A patient requires 1800 kcal per day and is receiving a standard formula that provides 1.2 kcal per milliliter in eight

intermittent feedings daily. Calculate the volume of formula required at each feeding. a. 100 mL b. 155 mL c. 188 mL d. 208 mL ANSWER: c 62. Elemental enteral formulas provide fat from medium-chain triglycerides (MCTs). Which of the following is false

regarding MCTs? a. They contain fatty acids that are 6 to 12 carbons long. b. They do not require digestion. c. They can be absorbed in the absence of lipase or bile. d. They require pancreatic lipase and bile for digestion and absorption. ANSWER: d 63. Which type of enteral feeding should be avoided in patients at high risk of aspiration? a. Nasogastric feedings b. Nasojejunal feedings c. Nasoduodenal feedings d. Jejunostomy feedings ANSWER: a 64. What is the diameter (in millimeters) for a 18 French feeding tube? a. 9 mm b. 6 mm c. 3 mm d. 2 mm ANSWER: b 65. A patient has a procedure in. which an opening into the gastrointestinal tract is made through the abdominal wall for

administering enteral feeding. What is this procedure called? a. Orogastric tube placement b. Nasogastric tube placement c. Gastric decompression d. Enterostomy ANSWER: d

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Chapter 20- Enteral Nutrition Support

66–69. Short Case Study Questions Maureen Grey is a 75-year-old nursing home patient. She has been obtaining her nutrition via tube feeding for over 3 years. She is admitted to Good Valley Hospital with a diagnosis of dehydration with weight loss (8 lb) in 1 month. 66. What may have caused Maureen to become dehydrated? a. dysphagia b. food allergy c. tube feeding rate d. diarrhea ANSWER: d 67. Which type of tube feeding did Maureen most likely have when she was in the nursing home? a. nasogastric b. orogastric c. gastrostomy d. double lumen ANSWER: c

68. Ten days after being admitted to the hospital, Maureen develops gastroparesis and a fistula. What would be a

better way to feed Maureen at this point? a. Orogastric feeding b. Nasogastric feeding c. Jejunostomy feeding d. Nasoduodenal feeding ANSWER: c

69. While reviewing the nursing home's medical record, the nurse discovers that the doctor has prescribed phenytoin for Maureen, a medication that requires the tube feeding to be . a. stopped for an hour before and after medication administration b. increased by 25 mL every hour following medication administration c. diluted with 100 mL of water to facilitate medication dissolution d. administered as a bolus within 2 hours of medication administration ANSWER: a

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Chapter 20- Enteral Nutrition Support 70. Differentiate among standard formulas, elemental formulas, and specialized formulas. ANSWER: Most enteral formulas are categorized according to their macronutrient sources. Standard formulas,

also called “polymeric formulas,” are provided to individuals who can digest and absorb nutrients without difficulty. They contain intact proteins extracted from milk or soybeans or a combination of such proteins. Carbohydrate sources include hydrolyzed cornstarch, glucose polymers, and sugars. A few formulas, called “blenderized formulas,” are produced from whole foods such as chicken, vegetables, fruits, and oils, along with some added vitamins and minerals. Elemental formulas, also called “hydrolyzed formulas,” “chemically defined formulas,” or “monomeric formulas,” are prescribed for patients who have compromised digestive or absorptive functions. Elemental formulas contain proteins and carbohydrates that have been partially or fully broken down to fragments that require little (if any) digestion. The formulas are often low in fat and provide fat from medium-chain triglycerides (MCTs) to ease digestion and absorption. Specialized formulas, also called “diseasespecific formulas” or “specialty formulas,” are intended to meet the nutrient needs of patients with particular illnesses. Products have been developed for individuals with liver, kidney, and lung diseases; glucose intolerance; severe wounds; and metabolic stress. Specialized formulas are generally expensive, and their effectiveness is controversial. Match each word or phrase with the most appropriate definition or explanation. a. enteral nutrition b. phenylketonuria c. hypertonic formula d. modular formulas e. isotonic formula f. transnasal g. elemental formulas h. enterostomy i. parenteral nutrition j. standard formulas k. continuous feeding l. intermittent feeding m. bolus feeding n. galactosemia o. inborn error of metabolism p. mutation 71. a heritable change in the DNA sequence of a gene ANSWER: p 72. enteral formulas that contain single macronutrients ANSWER: d Page 15

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Chapter 20- Enteral Nutrition Support 73. enteral formulas that contain partially or fully hydrolyzed proteins and carbohydrates ANSWER: g 74. general-purpose enteral formulas that contain intact proteins and polysaccharides ANSWER: j 75. feeding tube inserted through the nose ANSWER: f 76. provision of nutrients through the GI tract ANSWER: a 77. inherited disorder that affects conversion of the essential amino acid phenylalanine to the amino ANSWER: b 78. an opening into the GI tract through which a feeding tube can be passed ANSWER: h 79. an inherited trait that causes a deficiency or the absence of a protein that has a critical metabolic role ANSWER: o 80. slow delivery of formula at a constant rate over an 8- to 24-hour period ANSWER: k 81. formula with an osmolality greater than that of blood serum ANSWER: c 82. intravenous provision of nutrients that bypasses the gastrointestinal tract ANSWER: i 83. formula with an osmolality similar to that of blood serum ANSWER: e 84. delivery of about 250 to 400 mL of formula over 30 to 45 minutes ANSWER: l 85. delivery of about 250 to 500 mL of formula in less than 15 minutes ANSWER: m 86. inherited disorder that affects galactose metabolism ANSWER: n

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Chapter 20- Enteral Nutrition Support 87. Explain how health care professionals select the appropriate enteral formula for an individual patient. ANSWER: The formula is selected after careful assessment of the patient’s medical problems, fluid and nutrition

status, and ability to digest and absorb nutrients. Although the vast majority of patients can use standard formulas, a person with a functional but impaired GI tract may require an elemental formula. As with patients consuming regular diets, the tube-fed patient may require adjustments in nutrient and energy intakes. For example, patients with diabetes may need to control carbohydrate intake, criticalcare patients may have high protein and energy requirements, and patients with chronic kidney disease may need to limit their intakes of protein and several minerals. High nutrient needs must be met using the volume of formula a patient can tolerate. If fluids need to be restricted, the formula should have adequate nutrient and energy densities to provide the required nutrients in the volume prescribed. Formulas that provide fiber may be helpful for managing problems such as diarrhea, constipation, and hyperglycemia. Nearly all formulas are lactose-free and glutenfree, and can accommodate the needs of patients with lactose intolerance or gluten sensitivity. 88. Describe the factors to consider when selecting a feeding route for a patient who needs tube feedings. ANSWER: Transnasal access is usually preferred when the tube-feeding duration is expected to be less than 4

weeks and enterostomies are often appropriate when tube feedings are planned for longer periods. Gastric feedings (nasogastric and gastrostomy routes) are preferred whenever possible. These feedings are more easily tolerated and less complicated to deliver than intestinal feedings because the stomach controls the rate at which nutrients enter the intestine. Gastric feedings are not possible if patients have gastric obstructions, motility disorders that impair stomach emptying, or inadequate stomach volume due to prior gastric surgery. Gastric feedings are often avoided in patients at high risk of aspiration. Aspiration pneumonia may result. Although clinicians frequently administer nasoduodenal or nasojejunal feedings to reduce the likelihood of aspiration, clinical studies have not found an increased incidence of pneumonia in patients who receive gastric feedings. 89. Explain how mechanical complications can develop with tube feedings. How are these complications corrected? ANSWER: Mechanical problems include clogged feeding tubes, malfunctioning feeding pumps, and feeding tubes

that become dislodged after placement. The feeding tube itself may be a physical irritant and may warrant a change to a different type of tubing or a different feeding route. Transnasal routes are associated with a number of side effects, such as dry mouth from increased mouth breathing and reduced salivary secretions, sinus or middle ear infections due to blocked sinuses or eustachian tubes, and injury to GI tissues. In ostomy patients, leakages of GI secretions sometimes develop at tube insertion sites. These can be corrected by ensuring that the tube size is appropriate and by flushing tubing with water before and after giving formula. Remedies to unclog feeding tubes include flushes with warm water or solutions that contain pancreatic enzymes and sodium bicarbonate. The pharmacist can be consulted for more options.

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Chapter 20- Enteral Nutrition Support 90. Discuss medical nutrition therapy for galactosemia and possible long-term complications of this disorder. ANSWER: Patients with galactosemia must consume a galactose-restricted diet. The diet is much simpler than the

diet for PKU because galactose is not an essential nutrient and is not in a metabolic pathway that produces a required substance. In addition, dietary galactose is obtained primarily from lactose, so the main focus of dietary treatment is the exclusion of milk and milk products. Other foods that contain galactose in substantial amounts, such as organ meats and some legumes, fruits, and vegetables, must also be avoided or restricted. Prepared foods and medications that include lactose as an additive must be avoided as well. Galactosemia patients or their caregivers are generally given food lists that identify common sources of galactose. Although the early introduction of a galactose-restricted diet can eliminate the acute toxic effects of galactosemia, complications of the disease can develop despite an individual’s compliance with diet therapy. For instance, many patients may experience difficulties with language, abstract thinking, and visual perception. Ovarian failure and cataracts are common. The reasons for these long-term complications are not fully understood.

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Chapter 21- Parenteral Nutrition Support 1. Delivery of nutrient solutions directly into the vein is called a. standard nutrition b. enteral nutrition

c. parenteral nutrition d. tube feeding ANSWER: c 2. Parenteral nutrition would most likely be contraindicated in which condition? a. paralytic ileus b. GI bleeding c. severe hyperglycemia d. intractable vomiting ANSWER: c 3. The large-diameter central veins are located near the a. extremities b. heart c. liver d. lungs

ANSWER: b 4. Redness, swelling, and tenderness at the infusion site of a vein is described as a. hematoma b. phlebitis c. infiltration d. nerve damage

ANSWER: b 5. Peripheral parenteral nutrition is most often used in patients who require nutrition support for less than a. 2 weeks b. 6 weeks

c. 3 months d. 6 months ANSWER: a

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Chapter 21- Parenteral Nutrition Support 6. The small-diameter veins that are used for peripheral parenteral nutrition carry blood from the a. heart b. limbs

c. kidneys d. brain ANSWER: b 7. A 21-year-old athlete who has a nonfunctional gastrointestinal tract is scheduled for major gastric surgery in 3 weeks. His energy and nutrient needs are higher than those of the average person his age, but his fluid intake is restricted. What would be the preferred method of feeding for this patient in order to keep him well nourished until surgery? a. clear liquids b. peripheral parenteral nutrition c. total parenteral nutrition d. mechanically soft diet ANSWER: c 8. Which statement regarding peripheral insertion of central catheters is false? a. It is lower in cost b. It is less invasive c. It enters the circulation at the basilica vein d. It enters the circulation at the right subclavian vein ANSWER: d 9. The movement of water across biological membranes is known as a. osmosis b. peripheral transport

c. diffusion d. absorption ANSWER: a 10. Osmolality refers to milliosmoles of ions and molecules per a. liter of solution (mOsm/L) b. kilogram of solvent (mOsm/kg) c. kilogram of solution (mOsm/kg) d. liter of solvent (mOsm/L) ANSWER: b

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Chapter 21- Parenteral Nutrition Support 11. Osmolarity refers to milliosmoles of ions and molecules per a. liter of solution (mOsm/L) b. kilogram of solvent (mOsm/kg)

c. kilogram of solution (mOsm/kg) d. liter of solvent (mOsm/L) ANSWER: a 12. Osmolality is usually derived by using . a. equations that account for the nutrients and electrolytes b. the weights of the nutrients and solution c. an instrument called an osmometer d. an instrument called a spectrometer ANSWER: c 13. What is an advantage of total parenteral nutrition? a. Nutrient concentrations do not need to be limited. b. It accesses only peripheral veins. c. Patients who require only brief support (7 to 10 days) can use it. d. It is less invasive. ANSWER: a 14. To prevent phlebitis, the osmolarity of parenteral solutions used for peripheral parenteral nutrition is generally kept below milliosmoles per liter. a. 300 b. 600 c. 900 d. 1200 ANSWER: c 15. The use of peripheral parenteral nutrition is not recommended in a patient with a. a partially functioning GI tract b. low pain tolerance c. weak peripheral veins d. a swallowing disorder

ANSWER: c

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Chapter 21- Parenteral Nutrition Support 16. Which form of glucose is typically used in parenteral solutions? a. dextrose b. fructose c. lactose d. galactose ANSWER: a 17. Traditionally, central catheters enter the circulation at the the tip of the catheter lying close to the heart. a. brachial b. right subclavian

vein and are threaded into the superior vena cava with

c. basilic d. cephalic ANSWER: b 18. How much energy does dextrose provide? a. 3.4 kcal/g b. 4.0 kcal/g c. 4.4 kcal/g d. 5.0 kcal/g ANSWER: a 19. Dextrose concentrations of a. 10 b. 30 c. 50 d. 70

percent or lower can be used for peripheral parenteral nutrition solutions.

ANSWER: a 20. The protein in a total parenteral nutrition solution is primarily in the form of a. amino acids b. protein hydrolysate c. short-chain fatty acids d. intact protein

ANSWER: a

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Chapter 21- Parenteral Nutrition Support 21. A physician writes an order for a patient to receive lipid emulsions via total parenteral nutrition twice a week. The purpose of this order to supply lipids is mainly to . a. provide essential fatty acids b. provide nonessential amino acids c. provide essential minerals d. suppress the immune response ANSWER: a 22. Which type of oil most commonly makes up the triglycerides in lipid emulsions? a. corn oil b. sunflower oil c. soybean oil d. coconut oil ANSWER: c 23. Which macronutrient is usually the main source of energy in parenteral nutrition? a. carbohydrate b. protein c. fat d. amino acids ANSWER: a 24. Caution should be taken when administering parenteral lipids to people with which condition? a. hypertriglyceridemia b. hyperglycemia c. diabetes d. kidney failure ANSWER: a 25. Which trace mineral is typically excluded from parenteral solutions because it alters the stability of the other ingredients in the solution? a. zinc b. copper c. iron d. selenium ANSWER: c

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Chapter 21- Parenteral Nutrition Support 26. Which vitamin is omitted from parenteral solutions prescribed for patients on warfarin therapy? a. C b. D c. E d. K ANSWER: d 27. How many grams of amino acids would be provided to a client receiving 2000 mL of a 5% amino acid solution? a. 50 b. 100 c. 200 d. 400 ANSWER: b 28. How many kcalories are provided by 3 L of a 5% dextrose solution? a. 150 b. 510 c. 600 d. 660 ANSWER: b 29. The energy content of 2 L of a parenteral solution that contains 22% dextrose and 15% amino acids supplemented kcalories with 300 mL of a 10% lipid emulsion is a. 1696 b. 2696 c. 3696 d. 4696 ANSWER: b 30. The approximate osmolarity of a 1-L solution that contains 35 g of amino acids, 200 g of dextrose, 20 g of lipids from a 20% fat emulsion, and 150 mEq and mmol of electrolytes would be mOsm/L. a. 1039.4 b. 1339.2 c. 1514.2 d. 1729.4 ANSWER: c

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Chapter 21- Parenteral Nutrition Support 31. Approximately how many liters of fluids will be required by a stable adult patient weighing 81 kg? a. 1.4 to 2.2 L b. 2.4 to 3.2 L c. 3.2 to 4.0 L d. 4.0 to 4.4 L ANSWER: b 32. The administration of a second solution using a separate port is called a a. Y-connector b. piggyback c. double-lumen tube d. distal port

ANSWER: b 33. To prevent bacterial contamination and maintain stability, parenteral solutions are a. warmed to room temperature prior to infusion b. exposed to light c. pasteurized d. compounded in the pharmacy under aseptic conditions

ANSWER: d 34. A 3-in-1 solution that contains amino acids, lipids, and dextrose is also called a a. hydrolyzed solution b. total nutrient admixture

c. elemental suspension d. isotonic solution ANSWER: b 35. Although the administration of 3-in-1 solutions is simpler because only one infusion pump is required, what can occur when lipid emulsions have been added? a. The solution is too dense to use in a central vein. b. The solution causes platelet aggregation. c. The solution often becomes contaminated. d. The solution can form large lipid droplets. ANSWER: d

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Chapter 21- Parenteral Nutrition Support 36. Daily fluid needs range from a. 5 to 15 b. 15 to 25

mL per kilogram of body weight in most stable patients.

c. 30 to 40 d. 35 to 45 ANSWER: c 37. Why are few medications added to parenteral solutions? a. to avoid potential drug-nutrient interactions b. because too many can destabilize the dextrose c. because they are unnecessary if the solution is properly balanced d. because it is not possible to do so ANSWER: a 38. One major benefit of cyclic infusion of total parenteral nutrition is a. maintenance of high insulin levels b. increase in fat stores c. more freedom of movement during the day d. achievement of a negative nitrogen balance

ANSWER: c 39. Cyclic parenteral nutrition is administered over a. 3 to 6 b. 6 to 8 c. 8 to 14 d. 12 to 18

hours per day.

ANSWER: c 40. Which condition describes a metabolic complication of parenteral nutrition? a. hypoglycemia b. phlebitis c. air embolism d. sepsis ANSWER: b

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Chapter 21- Parenteral Nutrition Support 41. Which type of parenteral nutrition provided at night allows patients to participate in routine activities during the day? a. continuous b. cyclic c. peripheral d. piggyback ANSWER: b 42. The health care team has just ordered total parenteral nutrition for Mr. Calabria. He is a 58-year-old man who is suffering from intractable diarrhea. Before Mr. Calabria starts TPN, what procedure should be performed? a. X-ray to confirm catheter placement b. body mass index assessment c. calcium balance d. hand grip strength ANSWER: a 43. What best describes the role of the nurse on the nutrition support team? a. diagnosing nutrition problems b. recommending the appropriate diet c. performing direct patient care d. recommending appropriate drug therapy ANSWER: c 44. A 12-year-old patient is being weaned off of total parenteral nutrition. In addition to total parenteral nutrition, he is on a soft diet. The patient is 5 ft 2 in. tall and weighs 110 lb. His energy needs are estimated to be approximately 2100 kcal/day. His kcalorie count reveals he is consuming 1700 kcal/day. Which intervention is appropriate at this time? a. Discontinue TPN. b. Double his oral feedings. c. Consider enteral feedings. d. Increase TPN to provide an additional 1100 kcal. ANSWER: a 45. Before parenteral nutrition is discontinued, oral intake, tube feeding, or a combination of both should provide at least percent of the estimated energy needs. a. 40 to 50 b. 55 to 60 c. 60 to 75 d. 90 to 95 ANSWER: c

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Chapter 21- Parenteral Nutrition Support 46. A patient on total parenteral nutrition for longer than a few gallstone formation. a. hours b. days c. weeks d. months

is at risk for “sludge” buildup in the gallbladder and

ANSWER: c 47. A female patient who is on long-term parenteral nutrition is at risk for a. type 1 diabetes b. osteoporosis c. liver cancer d. heart disease

ANSWER: b 48. Liver enzymes should be monitored a. hourly b. daily c. weekly d. every 2 weeks

during parenteral support.

ANSWER: c 49. Refeeding syndrome is characterized by fluid and electrolyte imbalances and a. systemic infection b. hypothyroidism

c. severe weight loss d. hyperglycemia ANSWER: d 50. How often should the fluid intake and output of a patient on total parenteral nutrition be checked? a. before starting b. every 4 to 8 hours c. daily d. once a week ANSWER: c

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Chapter 21- Parenteral Nutrition Support 51. Which condition describes a catheter-related complication of parenteral nutrition? a. refeeding syndrome b. gallbladder disease c. air embolism d. nutrient deficiencies ANSWER: c 52. In which situation would home total parenteral nutrition be an appropriate means for maintaining adequate nutrition status? a. an individual with dysphagia b. an individual with chronic intestinal obstruction c. an individual with head and neck cancer d. an individual with neurological impairment affecting the esophagus ANSWER: b 53. Shawna is on home total parenteral nutrition and is having trouble adjusting to the changes in her life. Which organization does the text recommend as a good source of support and information for her? a. Oley Foundation b. P-CAN c. Livestrong d. ACS ANSWER: a 54. The enteral formula used for home nutrition is most often influenced by cost and a. taste b. availability c. efficiency of administration d. appearance

ANSWER: b 55. When refrigerated, ready-made parenteral solutions may be stable for a. 1 week b. 10 days c. 2 weeks d. 3 weeks

ANSWER: a

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Chapter 21- Parenteral Nutrition Support 56. One of the greatest concerns of patients who use home nutrition support is the a. inability to consume meals with friends b. appearance of the tube

c. risks of the tube becoming clogged d. inability to choose the type and amount of formula delivered ANSWER: a 57. A patient should be fully informed of a treatment’s benefits and risks in a fair and honest manner. If the patient agrees to the proposed treatment, it is referred to as . a. autonomy b. informed consent c. beneficence d. distributive justice ANSWER: b 58. The potential good that can come from a proposed treatment is referred to as a. autonomy b. informed consent c. beneficence d. distributive justice

ANSWER: c 59. When providers consider whether provision of health care for one patient would unfairly limit the care of other patients, is being considered. a. autonomy b. informed consent c. beneficence d. distributive justice ANSWER: d 60. Which statement is true of Terri’s Law? a. It allows hospitals to withdraw life-sustaining treatment against the wishes of the family. b. It allowed the governor to order hospitals to withdraw life-sustaining treatment against the wishes of the family, but was found unconstitutional. c. It allows hospitals to continue life-sustaining treatment against the wishes of the family. d. It allowed the governor to intervene and act against a family’s wishes in order to continue life-sustaining treatment, but was found unconstitutional. ANSWER: d

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Chapter 21- Parenteral Nutrition Support 61. The do-not-resuscitate (DNR) order is most often used in patients for whom a. death is expected and inevitable b. treatment is excessively costly and not reimbursable

c. organ procurement is in progress d. families have requested it ANSWER: a Questions 62-64 Short Case-study

Devon Young is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Devon to the medical-surgical unit for evaluation of reported symptoms of poor appetite, constipation, nausea, and vomiting for 3 days. 62. Upon admission, what diet is most appropriate for Devon until he receives further testing? a. nothing by mouth b. low sodium c. low fiber d. high protein/high kcalorie ANSWER: a 63. Devon will need intestinal surgery and will be receiving nothing by mouth for 15 to 20 days. How can his medical team meet his nutritional needs during this time? a. regular diet b. elemental formula c. enteral nutrition d. parenteral nutrition ANSWER: d 64. After surgery, Devon remains on ventilator support but his gut function is improving. The doctor should initiate a. a soft diet b. a clear liquid diet c. elemental tube feeding d. PPN

ANSWER: c

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Chapter 21- Parenteral Nutrition Support Questions 65–68 Short Case Study Elena Hayes is a 64-year-old realtor. She has been admitted to the local medical center six times in the past 3 months with severe pancreatitis. Elena has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support. She is being transferred to a subacute nursing facility for therapy. 65. Upon admission, Elena tells her nurse that she has a lot of fear with regard to nutrition support because she experienced a “vein blowout” at a previous admission. What is the most likely cause of this incident? a. high glucose in the TPN b. low amino acids in the TPN c. low vitamin K in the PPN d. high osmolarity of the PPN ANSWER: d 66. The registered dietitian completing Elena's initial assessment should expect which result? a. high albumin b. weight loss c. high iron d. low insulin ANSWER: b 67. The nutrition support team decides to increase the kcal in Ms. Hayes's total parenteral nutrition slowly to prevent ____. a. hypoglycemia b. an elevated white blood cell count c. refeeding syndrome d. weight gain ANSWER: c 68. Laboratory values indicate that Elena’s blood glucose is extremely high. Which nutrient component of her total parenteral nutrition must be adjusted? a. water b. dextrose c. amino acids d. chromium ANSWER: b

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Chapter 21- Parenteral Nutrition Support 69. Compare and contrast peripheral parenteral nutrition and total parenteral nutrition. ANSWER: In peripheral parenteral nutrition, nutrients are delivered using only the peripheral veins. The peripheral veins can be damaged by overly concentrated solutions. To prevent complications, the osmolarity of PPN is kept below 900 mOsm per liter, a concentration that limits the amounts of energy and protein the solution can provide. PPN is most often used in patients who require short-term nutrition support and who do not have high nutrient needs or fluid restrictions. With TPN, most patients meet their nutrient needs using the larger, central veins, where blood volume is greater and nutrient concentrations do not need to be limited. This method can reliably provide all of a person’s nutrient requirements. Because the central veins carry a large volume of blood, the parenteral solutions are rapidly diluted; thus, patients with high nutrient needs or fluid restrictions can receive the nutrient-dense solutions they require. TPN is also preferred for patients who require long-term parenteral nutrition. 70. Define refeeding syndrome. Why does it occur and how can it be prevented? ANSWER: Severely malnourished patients who are aggressively fed may develop refeeding syndrome, characterized by fluid and electrolyte imbalances and hyperglycemia. These effects occur because dextrose infusions raise levels of circulating insulin, which promotes anabolic processes that quickly remove phosphate, potassium, and magnesium from the blood. The altered electrolyte levels can lead to fluid retention and life-threatening changes in various organ systems. Heart failure and respiratory failure are possible consequences. Refeeding syndrome generally develops within 2 weeks after beginning parenteral infusions. The patients at highest risk are those who have experienced chronic malnutrition or substantial weight loss. Symptoms include edema, cardiac arrhythmias, muscle weakness, and fatigue. To prevent refeeding syndrome, health practitioners may provide only half of the patient’s energy requirement when they initiate nutrition support and gradually advance the dose over several days while monitoring (and possibly correcting) electrolyte levels. 71. Discuss possible metabolic complications associated with parenteral nutrition and suggest ways to correct such complications. ANSWER: With parenteral nutrition, hyperglycemia most often occurs in patients who are glucose-intolerant, receiving excessive energy or dextrose, undergoing severe metabolic stress, or receiving corticosteroid medications. It can be prevented by providing insulin along with parenteral solutions, avoiding overfeeding or overly rapid infusion rates, and restricting the amount of dextrose in the solution. Although uncommon, hypoglycemia sometimes occurs when parenteral nutrition is interrupted or discontinued or if excessive insulin is given. In patients at risk, such as young infants, feedings may be tapered over several hours before discontinuation. Another option is to infuse a dextrose solution at the same time that parenteral nutrition is interrupted or stopped. Hypertriglyceridemia may result from dextrose overfeeding or overly rapid infusions of lipid emulsion. Patients at risk include those with severe infection, liver disease, kidney failure, or hyperglycemia and those using immunosuppressant or corticosteroid medications. If blood triglyceride levels exceed 400 mg/dL, lipid infusions should be reduced or stopped.

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Chapter 21- Parenteral Nutrition Support 72. Discuss the quality-of-life issues that need to be addressed with patients receiving long-term nutrition support at home. ANSWER: Although home nutrition support can help to improve health and extend life, users of these services and their families may struggle with the lifestyle adjustments required. In addition to the high costs of nutrition support, home infusions are often time-consuming and inconvenient. Activities and work schedules must be planned around feedings. Extra planning is necessary and precautions must be taken when a person wants to travel or participate in sports activities. Explaining one’s medical needs to friends and acquaintances may be embarrassing. Among physical difficulties, people receiving nocturnal feedings often cite disturbed sleep as a major problem. Disruptions may be due to multiple nighttime bathroom visits, noisy infusion pumps, or difficulty finding a comfortable sleeping position when “hooked up.” People using parenteral support sometimes prefer infusing solutions during the day to improve their sleeping patterns. Among social issues, the inability to consume meals with family and friends is often a great concern. Many individuals miss the enjoyment, comfort, and socialization they previously experienced from food and mealtimes. Joining friends at restaurants and attending certain types of social events may become a source of stress for individuals who cannot consume food. 73. Discuss the use of carbohydrates in parenteral nutrition. ANSWER: Glucose is the main source of energy in parenteral solutions. It is provided in the form of dextrose monohydrate, in which each glucose molecule is associated with a single water molecule. Dextrose monohydrate provides 3.4 kcal/g, slightly less than pure glucose, which provides 4 kcal/g. Commercial dextrose solutions are available in concentrations between 2.5 and 70%; concentrations higher than 10% are usually used only in TPN solutions. Match each word or phrase with the most appropriate definition or explanation. a. peripheral veins b. central veins c. peripheral parenteral nutrition d. total parenteral nutrition e. osmolarity f. osmolality g. piggyback h. total nutrient admixture i. 2-in-1 solution j. continuous parenteral nutrition k. cyclic parenteral nutrition l. refeeding syndrome m. durable power of attorney n. advance directive o. 396 p. 720 q. 578 74. kcalories in 360 mL of a 10% lipid emulsion ANSWER: o Page 16

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Chapter 21- Parenteral Nutrition Support 75. energy content of 1 L of a parenteral solution that contains 17% dextrose ANSWER: q 76. type of nutrition support in which the nutrient concentrations do not need to be limited ANSWER: d 77. administration of a second solution using a separate port in an intravenous catheter ANSWER: g 78. continuous administration of parenteral solution over 24 hours ANSWER: j 79. refers to the concentration of solutes per kilogram of water ANSWER: f 80. small-diameter veins that carry blood from the arms and legs ANSWER: a 81. large-diameter veins close to the heart ANSWER: b 82. parenteral solution that contains dextrose, amino acids, and lipids ANSWER: h 83. kcalories in 360 mL of a 20% lipid emulsion ANSWER: p 84. administration of a parenteral solution over an 8- to 14-hour period ANSWER: k 85. type of nutrition support that usually has a maximum of 900 mOsm/L ANSWER: c 86. parenteral solution that contains dextrose and amino acids, and excludes lipids ANSWER: i 87. refers to the concentration of solutes per liter of solution ANSWER: e 88. exhibited by severely malnourished patients who are fed aggressively; characterized by fluid and electrolyte imbalances ANSWER: l 89. legal document that gives legal authority to another to make medical decisions in the event of incapacitation ANSWER: m

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Chapter 21- Parenteral Nutrition Support 90. written or oral instruction regarding one's preferences for medical treatment to be used in the event that a person becomes incapacitated ANSWER: n

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Chapter 22- Metabolic and Respiratory Stress 1. A disruption in the body's chemical environment due to the effects of disease or injury that threatens its normal and healthy functioning is called stress. a. metabolic b. severe c. physiological d. dysfunctional ANSWER: a 2. In response to metabolic and respiratory stress, the body experiences a. hypometabolism b. a breakdown of muscle mass c. a decrease in carbon dioxide in the blood d. only minor complications

ANSWER: b 3. What effect does an increase in the release of catecholamines have on the body? a. sodium excretion from the kidneys b. glycogen breakdown in the liver c. storage of fatty acids in the adipose cells d. water reabsorption in the kidneys ANSWER: b 4. Long-term use of pharmaceutical forms of cortisol (cortisone, prednisone) results in a. thickening of the skin b. dehydration c. hypothyroidism d. early osteoporosis

ANSWER: d 5. Which hormone(s) is/are referred to as the “fight-or-flight” hormone(s)? a. catecholamines b. glucagon c. cortisol d. aldosterone ANSWER: a

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Chapter 22- Metabolic and Respiratory Stress 6. The inflammatory response begins with the . a. removal of cellular debris by immune cells b. dilation of arterioles and capillaries at the site of injury c. destruction of microorganisms by phagocytes d. release of inflammatory mediators from damaged tissue ANSWER: b 7. Which hormones promote glycogen breakdown in the liver? a. catecholamines and antidiuretic hormone b. catecholamines and glucagon c. cortisol and aldosterone d. aldosterone and catecholamines ANSWER: b 8. What is a metabolic effect of hormones released during the stress response? a. glycogenesis b. gluconeogenesis c. lipogenesis d. protein synthesis ANSWER: b 9. Effects of elevated cortisol levels during prolonged stress include a. impaired wound healing b. increased protein synthesis c. increased risk of hypoglycemia d. improved immune response

ANSWER: a 10. Chemical mediators that control the inflammatory process are released from a. the central nervous system, including the brain and spinal cord b. damaged tissues, blood vessels, and activated immune cells

c. the adrenal and pituitary glands d. adipose and muscle tissue ANSWER: b

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Chapter 22- Metabolic and Respiratory Stress 11.

is/are considered the best clinical indicator of acute-phase inflammation response a. C-reactive protein b. Hepcidin c. Prealbumin d. Eicosanoids ANSWER: a

12. Cytokines are proteins that help regulate a. immune system b. oxygen c. hormonal d. GI tract

development and activity.

ANSWER: a 13. Which substance is the precursor for the eicosanoids? a. amino acids b. fatty acids c. thiamin d. vitamin D ANSWER: b 14. What is a function of C-reactive protein? a. regulating blood pressure b. regulating iron metabolism c. producing and releasing histamine d. binding dead or dying cells to activate certain immune responses ANSWER: d 15. Which substance is an acute-phase protein produced by the liver? a. glucagon b. hepcidin c. aldosterone d. eicosanoids ANSWER: b

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Chapter 22- Metabolic and Respiratory Stress 16. Which acute-phase protein is involved in iron metabolism? a. prothrombin b. complement proteins c. C-reactive protein d. hepcidin ANSWER: d 17. The accumulation of pus is known as a. erysipelas b. impetigo c. an abscess d. cellulitis

ANSWER: c 18. The complication that results from rapid overfeeding of an acutely stressed patient is a. hypotension b. refeeding syndrome c. ketoacidosis d. tachycardia

ANSWER: b 19. Complications that result from refeeding syndrome include a. hyperglycemia b. weight gain c. hypoxemia d. hypovolemia

ANSWER: a 20. When determining the resting metabolic rate, a patient’s energy needs would generally be increased by which condition? a. receiving intravenous fluids b. having open wounds c. being bedridden d. having a nasogastric tube ANSWER: b

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Chapter 22- Metabolic and Respiratory Stress 21. Brandon is critically ill and is in the ICU. How many kcalories must be factored to determine Brandon’s daily energy needs? a. 15 to 20 kcal/kg body weight b. 25 to 30 kcal/kg body weight c. 30 to 35 kcal/kg body weight d. 35 to 38 kcal/kg body weight ANSWER: b 22. An estimate of the daily energy needs of a 70-kg man who is critically ill would be a. 1050 to 1400 b. 1750 to 2100 c. 2450 to 2800 d. 3150 to 3500

kcalories.

ANSWER: b 23. How many grams of protein would a 120-lb woman require after major physiological stress? a. 65 to 109 grams b. 82 to 95 grams c. 156 to 173 grams d. 144 to 240 grams ANSWER: a 24. What is the suggested kcalorie intake for hypocaloric feedings for critically ill obese patients? a. 5 to 8 kcal/kg actual body weight b. 8 to 10 kcal/kg actual body weight c. 11 to 14 kcal/kg actual body weight d. 15 to 18 kcal/kg actual body weight ANSWER: c 25. Which nonessential amino acids are sometimes supplemented in patients undergoing metabolic stress? a. aspartic acid and arginine b. arginine and glutamine c. glycine and glutamine d. alanine and glycine ANSWER: b

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Chapter 22- Metabolic and Respiratory Stress 26. When parenteral nutrition is necessary for critically ill patients, dextrose is limited to body weight per minute to prevent hyperglycemia. a. 3 b. 5 c. 10 d. 15

milligrams per kilogram of

ANSWER: b 27. Which classification of burns involves both the epidermis and dermis and is characterized by redness, swelling, and blistering? a. 1st degree b. 2nd degree c. 3rd degree d. 4th degree ANSWER: b 28. Which classification of burns destroys both the epidermis and dermis and may also damage underlying tissues? a. 1st degree b. 2nd degree c. 3rd degree d. 4th degree ANSWER: c 29. Burn size in adults is often estimated by dividing the body into 11 parts, with each part representing about percent of the total body surface area (TBSA). a. 9 b. 12 c. 15 d. 19 ANSWER: a 30. Protein intake should average a. 10 b. 15 c. 25 d. 30

percent of total calories for clients with burns greater than 10% of TBSA.

ANSWER: c

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Chapter 22- Metabolic and Respiratory Stress 31. Dave has 2nd-degree burns on his back torso, left arm, and left leg. This represents about a. 27 b. 36

percent of his TBSA.

c. 45 d. 72 ANSWER: c 32. For acutely ill patients with a functional GI tract, enteral feedings started in the first are associated with fewer complications and shorter hospital stays. a. 12 to 24 b. 24 to 48 c. 48 to 72

hours after hospitalizations

d. 72 to 96 ANSWER: b 33. Calculate the resting metabolic rate (RMR) for this patient (Hint: Hypocaloric feedings are recommended for critically ill obese patients) a. 1141 to 1241 kcal/day b. 1441 to 1834 kcal/day c. 1821 to 1934 kcal/day d. 1941 to 2041 kcal/day ANSWER: b 34. What would be the stress factor for acute kidney injury in this patient? a. 1.1 b. 1.2 c. 1.3 d. 1.4 ANSWER: c 35. Using the appropriate stress factor and the RMR for this patient, determine his energy intake? a. 1873 to 2384 kcal/day b. 1933 to 2084 kcal/day c. 2003 to 2230 kcal/day d. 2430 to 2533 kcal/day ANSWER: a

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Chapter 22- Metabolic and Respiratory Stress 36. Which condition is characterized by persistent inflammation and excessive secretions of mucus in the main airways of the lungs? a. asthma b. chronic bronchitis c. emphysema d. pneumonia ANSWER: b 37. What best describes why weight loss and malnutrition occur in the presence of chronic respiratory diseases? a. Damaged lung tissues use more vitamins and minerals. b. Excessive carbon dioxide in the blood causes a person to sleep more. c. Labored breathing raises energy needs. d. Hypoxemia causes the body to excrete excess glycogen. ANSWER: c 38. The primary risk factor for chronic obstructive pulmonary disease (COPD) is a. smoking b. vehicle exhaust c. genetic factors d. pollution from coal-fired power plants

ANSWER: a 39. What percentage of persons with COPD are affected by malnutrition? a. 20 b. 40 c. 60 d. 80 ANSWER: c 40. Patients with acute respiratory distress syndrome (ARDS) may require weight daily. a. 0.5 to 1.0 b. 1.0 to 1.5 c. 1.5 to 2.0 d. 2.0 to 2.5

grams of protein per kilogram body

ANSWER: c

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Chapter 22- Metabolic and Respiratory Stress 41. Shortness of breath is also referred to as a. cyanosis b. hypercapnia

c. dyspnea d. hypoxia ANSWER: c 42. A patient with chronic COPD might benefit from which recommendation to help increase food intake? a. eating large meals b. consuming liquids with meals rather than between meals c. eating quickly d. using supplemental oxygen at mealtimes ANSWER: d 43. What metabolic effect is most commonly seen with inhaled corticosteroids? a. altered taste sensation b. hypokalemia c. hyperphosphatemia d. exacerbated muscle loss ANSWER: d 44. Enteral formulas specifically for patients with COPD often contain more a. carbohydrates b. potassium c. iron d. fat

than standard formulas.

ANSWER: d 45. A patient has severe respiratory failure and is unable to eat much. The nurse notices a decrease in body weight and severe generalized weakness. The dietitian recommends . a. a change to parenteral nutrition support b. a change to a nutrient-dense enteral formula c. that they continue with the current diet order d. a change to a carbohydrate-rich enteral formula ANSWER: b

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Chapter 22- Metabolic and Respiratory Stress 46. A patient with severe respiratory failure and on fluid restrictions would require nutrient-dense enteral formulas of kcal/mL. a. 0.5 to 1.0 b. 1.0 to 1.2 c. 1.2 to 1.5 d. 1.5 to 2.0 ANSWER: d 47. To decrease the risk of aspiration in patients with respiratory failure who need nutrition support, the health care provider should . a. utilize gastric feedings b. utilize intestinal feeding c. decrease the amount of free water in the tube feeding d. select a formula enriched with vitamins A, C, and E ANSWER: b 48. Which symptom is associated with systemic inflammatory response syndrome (SIRS)? a. abnormal body temperature b. reduced heart rates c. abnormal red blood cell counts d. reduced respiratory rates ANSWER: a 49. Multiple organ dysfunction syndrome (MODS) most often affects the kidneys, lungs, and a. brain b. heart c. liver d. stomach

ANSWER: c 50. What effects are most commonly seen when MODS causes lung failure? a. bacterial translocation b. inability to maintain optimal gas exchange c. inability to maintain electrolyte balance d. increased oxygen saturation ANSWER: b

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Chapter 22- Metabolic and Respiratory Stress 51. In what way do blood transfusions contribute to development of MODS? a. Blood transfusions are immunosuppressive. b. Transfusion reactions cause severe muscle loss. c. Blood transfusions raise the patient’s temperature. d. The transfusion process requires more energy. ANSWER: a 52. The principle infection associated with MODS is a. gastroenteritis b. acute kidney infection c. a pressure ulcer d. pneumonia

ANSWER: d 53. Patients who have SIRS that persists for more than a. 4 hours b. 1 day c. 48 hours d. 3 days

are more likely to develop MODS.

ANSWER: d 54. In what way does advancing age contribute to development of MODS? a. Older adults do not understand what measures to take to prevent MODS. b. Older adults take more medications that can cause side effects that lead to MODS. c. Older adults are prone to infection because of increased skin thickening. d. Older adults are less able to deal with the stress of critical illness. ANSWER: d 55. Which of the following factors does NOT influence risk of MODS? a. malnutrition b. severity of tissue injury c. age under 20 years d. obesity ANSWER: c

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Chapter 22- Metabolic and Respiratory Stress 56. Which treatment is most often used to manage MODS? a. surgery b. mechanical ventilation c. induced hypothermia d. membrane oxygenation ANSWER: b 57. Support of heart and blood vessel function during treatment of MODS is characterized by a. medications to maintain normal body temperature b. fluid resuscitation c. central venous access to administer antibiotics d. mechanical ventilation

ANSWER: a 58. Nutrition support as part of treatment for MODS a. promotes weight gain b. reduces obesity c. prevents excessive wasting d. eliminates infection

ANSWER: c 59-63. Case Study Questions Forty-three-year-old Joseph Delgado is an electrician for a utility company. His medical history is unremarkable, with no problems. He is admitted to the ICU (intensive care unit) with severe electrical burns to his hands, arms, and chest (20 to 30% of body surface area). 59. What is the main nutritional goal for Joseph? a. Increase intake to 75% of meals. b. Increase tyrosine production. c. Promote gluconeogenesis d. Achieve nitrogen balance and minimize tissue losses. ANSWER: d 60. The most appropriate way to meet Joseph's nutritional needs is via a. tube feedings b. parenteral nutrition

c. a high-kcalorie/high-protein diet with six small meals/day d. a high-kcalorie/high-protein diet with three large meals/day ANSWER: c

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Chapter 22- Metabolic and Respiratory Stress 61. The registered dietitian is completing her initial assessment for Mr. Delgado. When estimating his energy needs she selects for his stress factor. a. 1.0 b. 1.4 c. 1.8 d. 2.2 ANSWER: b 62. The nurse orders a nutrition consult because of Joseph's poor intake. What is UNLIKELY to be related to his low intake? a. pain b. sedation c. feeding problems d. positive nitrogen balance ANSWER: d 63. Having burns increases Joseph's risk for what condition? a. osteoporosis b. intestinal ileus c. bronchitis d. overhydration ANSWER: b Match each word or phrase with the most appropriate definition or explanation. a. metabolic stress b. respiratory stress c. wasting d. multiple organ dysfunction syndrome e. phagocytes f. mast cells g. inflammatory response h. acute-phase response i. systemic inflammatory response syndrome (SIRS) j. shock k. chronic obstructive pulmonary disease l. acute respiratory distress syndrome (ARDS) m. hypoxemia n. hypercapnia o. Hypoxia p. sepsis Page 13

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Chapter 22- Metabolic and Respiratory Stress q. dyspnea 64. shortness of breath ANSWER: q 65. whole-body inflammatory response caused by infection ANSWER: p 66. progressive dysfunction of two or more organ systems that develops in critically ill patients; often results in death ANSWER: d 67. nonspecific responses of the immune system to infection or injury ANSWER: g 68. a severe reduction in blood flow that deprives the body's tissues of oxygen and nutrients ANSWER: j 69. cells within connective tissue that produce and release histamine ANSWER: f 70. a disruption in the body's chemical environment due to the effects of disease or injury; characterized by changes in metabolic rate, heart rate and blood pressure, hormonal status, and nutrient metabolism ANSWER: a 71. abnormal gas exchange between the air and blood, resulting in lower oxygen and higher carbon dioxide levels ANSWER: b 72. changes in body chemistry resulting from infection, inflammation, or injury; characterized by alterations in plasma proteins ANSWER: h 73. low amount of oxygen in body tissues ANSWER: o 74. group of lung diseases characterized by persistent obstructed airflow through the lungs and airways ANSWER: k 75. the breakdown of lean tissue that results from disease or malnutrition ANSWER: c 76. a whole-body response to illness or trauma; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and abnormal body temperature ANSWER: i 77. immune cells that have the ability to engulf and destroy antigens ANSWER: e

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Chapter 22- Metabolic and Respiratory Stress 78. Respiratory failure triggered by severe lung injury that causes dyspnea and pulmonary edema and requires mechanical ventilation ANSWER: l 79. insufficient oxygen in the blood ANSWER: m 80. excessive carbon dioxide in the blood ANSWER: n 81. Describe the factors associated with hormonal responses to severe stress. ANSWER: The stress response is mediated by several hormones, which are released into the blood soon after the onset of injury. The catecholamines stimulate heart muscle, raise blood pressure, and increase metabolic rate. Epinephrine also promotes glucagon secretion from the pancreas, prompting the release of nutrients from storage. The steroid hormone cortisol enhances muscle protein degradation, raising amino acid levels in the blood and making amino acids available for conversion to glucose. All of these hormones have similar effects on glucose and fat metabolism, causing the breakdown of glycogen, the production of glucose from amino acids, and the breakdown of triglycerides in adipose tissue. Thus, the combined effects of these hormones contribute to hyperglycemia, which often accompanies critical illness. Two other hormones induced by stress, aldosterone and antidiuretic hormone, help to maintain blood volume by stimulating the kidneys to reabsorb more sodium and water, respectively. Cortisol’s effects can be detrimental when stress is prolonged. In excess, cortisol causes the depletion of protein in muscle, bone, connective tissue, and the skin. It impairs wound healing, so high cortisol levels may be especially dangerous for a patient with severe injuries. Because cortisol inhibits protein synthesis, consuming more protein cannot easily reverse tissue losses. Excess cortisol also leads to insulin resistance, contributing to hyperglycemia, and suppresses immune responses, increasing susceptibility to infection. 82. Describe the acute inflammatory process in response to an injury or illness. ANSWER: The inflammatory response begins with the dilation of arterioles and capillaries at the site of injury, which increases blood flow to the affected area. The capillaries within the damaged tissue become more permeable, allowing some blood plasma to escape into the tissue and cause local edema. The various changes in blood vessels attract immune cells that can destroy foreign agents and clear cellular debris. Among the first cells to arrive are the phagocytes, which slip through gaps between the endothelial cells that form the blood vessel walls. The phagocytes engulf microorganisms and destroy them with reactive forms of oxygen and hydrolytic enzymes. When inflammation becomes chronic, these normally useful products of phagocytes can damage healthy tissue.

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Chapter 22- Metabolic and Respiratory Stress 83. Discuss the systemic effects of inflammation. ANSWER: The cytokines released during acute inflammation produce a number of systemic effects. Within hours after inflammation, infection, or severe injury, the liver steps up its production of certain plasma proteins, including C-reactive protein, complement proteins, hepcidin, blood-clotting proteins such as fibrinogen and prothrombin, and others. At the same time, plasma concentrations of albumin, iron, and zinc fall. The acute-phase response is accompanied by muscle catabolism to make amino acids available for glucose production, tissue repair, and immune protein synthesis; consequently, negative nitrogen balance (and wasting) frequently results. Other clinical features of the acute-phase response may include fever, an elevated metabolic rate, increased pulse rate and blood pressure, increased blood neutrophil levels, lethargy, and anorexia. If inflammation does not resolve, the continued production of pro-inflammatory cytokines may lead to the systemic inflammatory response syndrome (SIRS), which is diagnosed when the patient’s signs and symptoms include substantial increases in heart rate and respiratory rate, abnormal white blood cell counts, and/or fever. If these effects result from a severe infection, the condition is called “sepsis.” Complications associated with severe cases of SIRS or sepsis include fluid retention and tissue edema, low blood pressure, and impaired blood flow. If the reduction in blood flow is severe enough to deprive the body’s tissues of oxygen and nutrients, multiple organs may fail simultaneously. 84. Discuss the micronutrient needs in patients with metabolic stress, including the increased need for certain nutrients and their specific role in the healing process. ANSWER: Notable metabolic changes in patients undergoing metabolic stress include hypermetabolism, negative nitrogen balance, insulin resistance, and hyperglycemia. Hypermetabolism and negative nitrogen balance can lead to wasting, which may impair organ function and delay recovery. Hyperglycemia increases the risk of infection, which can lead to complications and higher mortality risk. Therefore, the principal goals of nutrition therapy are to preserve lean (muscle) tissue, maintain immune defenses, and promote healing. The amounts of protein and energy to provide during acute illness are controversial and still under investigation. Research results have been mixed, in part because various conditions are associated with metabolic stress and each patient’s situation is somewhat different. Moreover, protein and energy needs can vary substantially over the course of illness, requiring frequent reevaluation. The guidelines presented here are subject to change as new findings help to resolve the complex issues related to nutrient intakes and delivery methods. To help guide their decisions about treatment, clinicians need to closely observe patients’ responses to feedings and readjust nutrient intakes as necessary. 85. Explain the need for carbohydrate and fat intakes during acute stress. ANSWER: Most of the energy required is supplied by carbohydrate and fat. Carbohydrate is usually the main source of energy, providing about 50 to 60% of total energy requirements. When parenteral nutrition is necessary for critically ill patients, dextrose is limited to 5 mg/kg of body weight per minute to prevent hyperglycemia. In patients with severe hyperglycemia, fat may supply up to 50% of kcalories, although high fat intakes may suppress immune function and increase the risk of developing infections and hypertriglyceridemia. Patients with blood triglyceride levels above 500 mg/dL may require fat restriction.

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Chapter 22- Metabolic and Respiratory Stress 86. Explain how nutrition therapy is used in burn patients. ANSWER: The nutrition prescription for burn patients is typically a high-kcalorie, high-protein diet. Overfeeding must be avoided because it can result in hyperglycemia, fatty liver, and infectious complications. Ideally, energy needs should be measured using indirect calorimetry; alternatively, the energy requirement can be estimated. Some clinicians use predictive equations intended for burn patients, which may include factors for burn severity, number of days’ post-injury, ventilator use, or other relevant variables. The suggested protein intake is 1.5 to 2.0 g/kg of body weight; supplementation with glutamine and arginine may help to improve recovery. Micronutrient supplements are typically provided and may include high amounts of vitamin A, vitamin C, and zinc, which are thought to support immunity and promote wound healing. Fluid and electrolyte needs must be monitored carefully during the recovery period; the patient’s hydration status can be evaluated by monitoring urine output and serum electrolyte levels. 87. Describe factors that decrease food intake in patients with lung disease. ANSWER: Some medical problems upset the process of gas exchange between the air and blood and result in respiratory stress, which is characterized by a reduction in the blood’s oxygen supply and an increase in carbon dioxide levels. Excessive carbon dioxide in the blood may disturb the breathing pattern enough to interfere with food intake. Moreover, the labored breathing caused by many respiratory disorders entails a higher energy cost than normal breathing does, raising energy needs and further increasing carbon dioxide production. Lung diseases make physical activity difficult and can lead to muscle wasting. Weight loss and malnutrition, therefore, become dangerous outcomes of some types of respiratory illnesses. 88. Describe nutrition care for patients with respiratory failure; include estimation of energy needs and fluids for nutrition support. ANSWER: Patients with lung injuries or acute respiratory distress syndrome (ARDS) are frequently hypermetabolic and/or catabolic and at high risk of muscle wasting. The primary concerns are, therefore, to provide enough energy and protein to sustain muscle tissue and lung function without overtaxing the respiratory system. Fluid restrictions may be necessary to help correct pulmonary edema. As usual, when nutrition support is necessary, enteral nutrition is preferred over parenteral nutrition. Energy needs can be estimated using either indirect calorimetry or predictive equations; the body weight used in predictive equations may need to be corrected for pulmonary edema. Overfeeding should be avoided because it can cause excessive carbon dioxide production and worsen respiratory function. Protein requirements are increased in patients with lung inflammation or ARDS. For mild or moderate lung injury, protein recommendations range from 1.0 to 1.5 grams of protein per kilogram of body weight per day. Patients with ARDS may require 1.5 to 2.0 grams of protein per kilogram of body weight daily. Although most patients have normal fluid requirements, fluid status should be monitored daily to prevent fluid imbalances. Some patients may require fluid restriction to prevent edema in lung tissue, whereas others may become dehydrated because of diuretic therapy, an increase in bronchial secretions, or a low fluid intake. The presence of edema can make it difficult to assess whether a critically ill patient is maintaining weight.

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Chapter 22- Metabolic and Respiratory Stress 89. Discuss the factors that influence the development of multiple organ failure. ANSWER: Shock can impair numerous organ systems. The abnormal delivery of oxygen and nutrients to tissues and insufficient removal of wastes result in irreversible injury to cells and tissues. Although each organ system is affected differently, ultimately one or more organs may begin to fail. The failure of one organ may place excessive demands on another, causing the second to fail as well. The progression of systemic inflammatory response syndrome (SIRS) to multiple organ dysfunction syndrome (MODS) reflects the inability of the body’s defenses and medical treatments to counter the detrimental effects of a sustained and potent inflammatory response. Although the clinical course of MODS differs substantially among patients, the sequence of organ dysfunction often follows a similar pattern: first the lungs fail, then the heart, and finally the liver, kidneys, and GI tract. Other organs or systems may also become involved, and each additional failure reduces the likelihood of survival. 90. List the common therapies that are used to treat multiple organ failure and the function of each therapy. ANSWER: Once multiple organ dysfunction syndrome (MODS) has developed, extensive medical support is needed until the inflammatory response has abated. Unfortunately, aggressive treatments can have damaging effects of their own and may cause further injury to organs that are already weakened by illness. Health practitioners should, therefore, be aware of the adverse effects of aggressive therapies and remain alert to a patient’s responses to treatments. Mechanical ventilation is used to assist injured lungs and sustain gas exchange. Fluids and electrolytes are supplied to restore blood volume and maintain electrolyte balance. Medications help to sustain or increase cardiac output and maintain adequate blood pressure. Hemofiltration or dialysis helps to prevent the buildup of toxic metabolites in the blood. Antibiotic therapy may reverse or prevent infections. Enteral and parenteral nutrition support provide nutrients, help to prevent excessive wasting, and promote recovery.

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Chapter 23- Upper Gastrointestinal Disorders 1. A sign of oropharyngeal dysphagia is . a. a sensation of food “sticking” in the esophagus b. nasal regurgitation c. achalasia d. heartburn ANSWER: b 2. Sam has been diagnosed with esophageal dysphagia. This means that he has a. difficulty passing a bolus of food through the esophagus into the stomach b. coughing during swallowing c. an inability to initiate swallowing d. excessive secretion of saliva

ANSWER: a 3. Which condition would most likely be a cause of esophageal dysphagia? a. cleft palate b. muscular dystrophy c. stroke d. achalasia ANSWER: d 4. A degenerative nerve condition affecting the esophagus, characterized by impaired peristalsis and incomplete relaxation of the lower esophageal sphincter when swallowing, is called . a. achalasia b. achlorhydria c. hypochlorhydria d. stricture ANSWER: a 5. One of the most common complications from dysphagia is a. duodenal ulcers

b. esophageal spasm c. aspiration d. gastroesophageal reflux ANSWER: c

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Chapter 23- Upper Gastrointestinal Disorders 6. Which beverage is most appropriate for a client with dysphagia with a diet order for nectar-like liquids? a. water b. chicken broth c. iced tea d. tomato juice ANSWER: d 7. When evaluating dysphagia, peristalsis and sphincter pressure are measured by a. a manometer b. X-ray

c. echocardiography d. fluoroscopy ANSWER: a 8. An example of a strategy used by dietitians to encourage patients on mechanically altered diets to eat is to a. allow them to eat all desired foods b. prepare a person's favorite foods and foods with pleasant smells c. restrict all their favorite foods d. allow them to eat just one meal a day

ANSWER: b 9. What food should be avoided in Level 3 of the National Dysphagia Diet? a. clam chowder b. poached eggs c. canned fruit salad d. fruit yogurt ANSWER: a 10. The backward flow of acidic contents from the stomach into the esophagus is referred to as a. an esophageal stricture b. heartburn c. reflux

d. achalasia ANSWER: c

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Chapter 23- Upper Gastrointestinal Disorders 11. Eric has developed dysphagia after having a stroke. He requires mechanically altered foods that are easier to swallow. His caregiver is assisting him with eating so that he will not become malnourished. What strategy can the caregiver perform that would most likely help Eric to accept his mechanically altered foods? a. Substitute white vegetables for brightly colored ones. b. Serve the foods on an attractive plate to improve visual appeal c. Blend all foods and serve with a straw. d. Heavily season the foods with salt and pepper. ANSWER: b 12. Interventions that can help eliminate distress from gastroesophageal reflux disease (GERD) include a. lying down for 30 minutes after meals b. fluid intake with meals c. consuming small meals d. a pureed diet

ANSWER: c 13. Frequent reflux of highly acidic gastric fluids results in a. inflammation and scarring of the esophagus b. stomach ulcers c. decreased production of saliva d. an inability to use medications

ANSWER: a 14. A potential long-term consequence of chronic reflux and Barrett’s esophagus is a. esophageal cancer b. liver disease

c. peptic ulcer disease d. kidney failure ANSWER: a 15. The function of the lower esophageal sphincter is to a. direct food from the mouth to the esophagus b. protect the airway during swallowing

c. prevent backflow from the esophagus d. prevent backflow of acidic contents from the stomach ANSWER: d

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Chapter 23- Upper Gastrointestinal Disorders 16. Which food might be included on a Level 1 National Dysphagia Diet menu? a. pureed meat b. peanut butter c. cottage cheese d. chunky applesauce ANSWER: a 17. Thomas receives milk pudding with his breakfast. What type of a fluid is this under the National Dysphagia Guidelines? a. thin b. nectarlike c. honeylike d. spoon-thick ANSWER: d 18. Which increases the risk of GERD by increasing pressure in the stomach? a. chocolate b. wearing tight clothing c. diazepam d. cigarette smoking ANSWER: b 19. Pain or discomfort in the upper abdominal area is termed a. dysphagia b. dyspepsia c. epigastria d. achalasia

ANSWER: b 20. To minimize symptoms of dyspepsia, which might patients be advised to do? a. consume large meals b. eat only raw foods c. avoid highly spiced foods d. drink coffee rather than fruit juice ANSWER: c

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Chapter 23- Upper Gastrointestinal Disorders 21. Ellen is suffering from abdominal bloating. Avoiding which practice will most likely resolve some of her symptoms? a. drinking bottled water b. chewing gum c. taking estrogen d. eating chocolate ANSWER: b 22. Karen has intractable vomiting. Which type of a diet order would be most appropriate for her? a. gastric tube feeding b. intestinal tube feeding c. parenteral nutrition d. clear liquid ANSWER: c 23. A patient suffering from chronic nausea should eat a. a hot breakfast in the morning b. a tuna salad sandwich at lunch c. dry toast or crackers d. bagels with jalapeño cream cheese

ANSWER: c 24. The dietary management of acute gastritis includes a. avoiding antacids b. eating dry crackers c. increasing aspirin for pain d. avoiding alcohol

ANSWER: d 25. Peptic ulcer patients should avoid food consumption for at least a. 30 minutes b. 1 hour

before bedtime.

c. 2 hours d. 3 hours ANSWER: c

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Chapter 23- Upper Gastrointestinal Disorders 26. In what percentage of individuals with chronic Helicobacter pylori infection does a peptic ulcer actually develop? a. 5 to 15 b. 45 to 50 c. 60 to 65 d. 75 to 80 ANSWER: a 27. Gastroparesis most often develops as a consequence of what condition? a. cardiomyopathy b. Kawasaki disease c. diabetes d. hepatitis ANSWER: c 28. What is a potential side effect associated with antacids? a. hyperglycemia b. decreased absorption of fat c. decreased iron absorption d. decreased absorption of vitamin B6 ANSWER: c 29. An individual with gastritis and hypochlorhydria is most at risk of deficiency for what nutrient? a. vitamin C b. vitamin B12 c. sodium d. phosphorus ANSWER: b 30. Nutrition care and treatment of peptic ulcers includes a. quitting smoking b. consuming dry, starchy foods c. Increasing caffeine intake

d. eating meals 30 minutes before bedtime ANSWER: a

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Chapter 23- Upper Gastrointestinal Disorders 31. One of the primary goals of nutrition after gastrectomy is to a. promote healing of stomach tissue b. prevent dehydration

c. support nutrient excretion d. avoid peptic ulcer development ANSWER: a 32. In a partial gastrectomy, only part of the stomach is removed and the remaining portion is connected to the a. pyloric sphincter b. ileum c. duodenum or jejunum d. lower esophageal sphincter

ANSWER: c 33. What meets the guidelines for a postgastrectomy diet? a. unlimited liquids with meals b. unlimited simple sugar intake c. small, frequent meals and snacks d. unrestricted simple carbohydrate intake ANSWER: c 34. Dumping syndrome occurs when . a. nutrients are absorbed too quickly from the stomach b. fluids are transitioned too rapidly through the large intestine c. food and fluids are quickly emptied from the stomach into the small intestine d. food enters the stomach rapidly through the lower esophageal sphincter ANSWER: c 35. The postgastrectomy diet often includes a. fluid with meals b. refined carbohydrates

c. foods high in fat d. supplementation with calcium and vitamin D ANSWER: d

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Chapter 23- Upper Gastrointestinal Disorders 36. Anemia may develop after a gastrectomy because a. surgery alters vitamin B6 absorption

b. calcium-rich foods are avoided c. iron and vitamin B12 are absorbed poorly d. lactose is absorbed poorly ANSWER: c 37. Bacterial overgrowth, a common consequence of gastric surgeries, is caused by all of the following factors EXCEPT: a. reduced gastric acid secretion b. altered motility of intestinal contents c. changes in intestinal anatomy due to surgery d. deficiency of fat-soluble vitamins ANSWER: d 38. Austin is a 42-year-old obese male. He is researching surgical options to lose weight. Which type of bariatric surgery is fully reversible? a. gastric banding b. gastric bypass c. biliopancreatic diversion d. total gastrectomy ANSWER: a 39. Which beverage is recommended on a postgastrectomy diet? a. Water sweetened with Splenda b. 100% juice c. regular cola d. milkshake ANSWER: a 40. What are symptoms associated with early dumping syndrome? a. Anxiety and confusion b. Headache and dizziness c. Palpitations and weakness d. Flushing and sweating ANSWER: d

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Chapter 23- Upper Gastrointestinal Disorders 41. An obese individual is considered to be a candidate for bariatric surgery if he or she has a body mass index (BMI) greater than , regardless of whether there are any secondary obesity-associated health problems. a. 25 b. 30 c. 35 d. 40 ANSWER: d 42. Following bariatric surgery, what food would need to be avoided? a. shellfish b. ice cream c. popcorn d. coffee ANSWER: c 43. Long-term complications following bariatric surgery include a. peptic ulcer disease b. pressure ulcers c. heart failure d. bone disease

ANSWER: d 44. Amy is recovering from gastric bypass surgery and needs to learn new dietary habits. What intervention can best help Amy to promote weight loss and healing after surgery? a. eating three regular meals a day b. snacking throughout the day to feel satisfied c. consuming fluids with meals and snacks d. chewing food thoroughly ANSWER: d 45. To avoid dumping syndrome after bariatric surgery, a patient should a. consume liquids with meals b. avoid foods high in sugars c. avoid lying down for at least 30 minutes after eating d. choose foods that are high in starch

ANSWER: b

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Chapter 23- Upper Gastrointestinal Disorders 46. As plaque invades the space below the gumline of the teeth, a. toxic bacterial by-products b. calculus

can damage the tissues that hold the tooth in place.

c. caries d. salivary amylase ANSWER: a 47. What is a risk factor for the development of periodontal disease? a. wearing dentures b. tobacco smoking c. history of cardiovascular disease d. excessive salivation ANSWER: b 48. Why is a person with diabetes mellitus at higher risk for developing periodontal disease? a. impaired immune response b. increased rigidity of the collagen structure of tissues c. decreased dental plaque d. increased salivation ANSWER: a 49. Which of the following would most likely help to manage xerostomia? a. consuming foods with high fluid content, such as soup b. eating dry crackers to stimulate saliva c. avoiding wearing clothes that are too tight around the waist d. consuming coffee to stimulate saliva ANSWER: a 50. The inflammatory process induced by periodontal pathogens may a. slow the progression of rheumatoid arthritis b. decrease insulin resistance

c. improve immune responses d. accelerate the progression of atherosclerosis ANSWER: d

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Chapter 23- Upper Gastrointestinal Disorders 51–55. Short Case Study Questions A 73-year-old retired administrative assistant has had recurrent episodes of pneumonia with weight loss for the past 5 months. Her past medical history includes high cholesterol and diabetes. Currently, she is admitted to the hospital because of complications arising from a recent stroke. 51. The nurse documents that the patient has nasal regurgitation and a hoarse, wet voice. She most likely has . a. oropharyngeal dysphagia b. esophageal dysphagia c. achalasia d. strictures ANSWER: a

52. A possible cause of the patient's condition is a. stroke b. Achalasia c. emphysema

d. esophageal cancer ANSWER: a

53. The nurse suspects a swallowing problem and recommends an evaluation that involves direct visualization of the esophagus, which will most likely be performed by . a. a barium swallow test b. an endoscopy c. a neurological exam d. surgery ANSWER: b

54. On evaluation the patient is found to have chronic aspiration of food into her lungs. What may have caused the patient’s diagnosis to be delayed? a. respiratory infection b. abnormal cough reflex c. dehydration d. weight loss ANSWER: b

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Chapter 23- Upper Gastrointestinal Disorders

55. The patient is placed on a Level 2 Dysphagia Mechanically Altered diet for her swallowing problem. Which food would you expect her to have the most difficulty with? a. moist oatmeal b. baked potato with gravy c. rice d. canned peach slices ANSWER: c 56–60. Short Case Study Questions James Hammond is a 37-year-old business executive. He travels worldwide and has a very stressful schedule. He has been having chronic pain in his stomach for a month. After a recent trip he visits his physician after 5 days of nausea, vomiting, and blood in his stool and is diagnosed with severe gastritis. 56. Mr. Hammond’s gastritis may have been caused by . a. infection b. intake of acidic foods c. antibodies d. intake of high-fiber foods ANSWER: a 57. Mr. Hammond is prescribed a 2-week regimen of antibiotics and proton-pump inhibitors (PPIs). Based on this information, which is most likely to be the primary cause of his gastritis? a. intake of alcohol b. Helicobacter pylori c. radiation therapy d. bile reflux ANSWER: b 58. Which beverage should Mr. Hammond consume while being treated for gastritis? a. coffee b. tea c. cola d. noncarbonated water ANSWER: d

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Chapter 23- Upper Gastrointestinal Disorders

59. Mr. Hammond is placed on a. a mechanical soft diet b. a bland diet c. NPO (nothing by mouth)

for 24 to 48 hours to rest the stomach.

d. enteral nutrition support ANSWER: c

60. The doctor writes a prescription order for a(n) a. iron b. vitamin B12

supplement because of Mr. Hammond’s blood loss.

c. vitamin C d. folic acid ANSWER: a Matching Match each word or phrase with the most appropriate definition or explanation. a. oropharyngeal dysphagia b. esophageal dysphagia c. achalasia d. hiatal hernia e. Barrett’s esophagus f. proton-pump inhibitors g. histamine-2 receptor blockers h. dyspepsia i. Helicobacter pylori j. acute gastritis k. hypochlorhydria l. achlorhydria m. Pernicious anemia n. bariatric surgery o. atrophic gastritis p. gastrectomy q. gastroparesis r. dumping syndrome s. stricture t. xerostomia Page 13

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Chapter 23- Upper Gastrointestinal Disorders u. dental calculus v. peptic ulcer w. periodontal disease x. gingivitis y. Sjögren’s syndrome 61. upper portion of the stomach protrudes above the diaphragm ANSWER: d 62. drugs that suppress acid secretion by inhibiting receptors on acid-producing cells ANSWER: g 63. gastric tissue is acutely injured, often by the toxic effects of chemical substances or radiation treatment ANSWER: j 64. drugs that inhibit the enzyme that pumps hydrogen ions (protons) into the stomach ANSWER: f 65. an inability to transfer food from the mouth and pharynx to the esophagus; usually due to a neurological or muscular disorder ANSWER: a 66. an inability to move a food bolus through the esophagus; usually due to an obstruction or a motility ANSWER: b 67. the feeling of “indigestion”; refers to pain, bloating, or discomfort in the upper abdominal area ANSWER: h 68. chronic gastritis characterized by destruction of gastric mucosal tissue due to chronic inflammation ANSWER: o 69. abnormally low gastric acid secretions ANSWER: k 70. an esophageal disorder characterized by weakened peristalsis and impaired relaxation by the lower esophageal sphincter ANSWER: c 71. bacteria that colonize the gastric mucosa; a major cause of gastritis and peptic ulcer disease ANSWER: i 72. esophageal cells damaged by chronic reflux are replaced by cells that resemble those in the gastric or intestinal tissue ANSWER: e 73. dry mouth; due to a reduction in salivary secretions ANSWER: t Page 14

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Chapter 23- Upper Gastrointestinal Disorders 74. vitamin B12 deficiency that results from lack of intrinsic factor ANSWER: m 75. surgery that treats obesity ANSWER: n 76. disease that affects the connective tissue structures that support the teeth ANSWER: w 77. absence of gastric acid secretion ANSWER: l 78. inflammation of the gums, characterized by redness, swelling, and bleeding ANSWER: x 79. abnormal narrowing of a passageway ANSWER: s 80. delayed gastric emptying, most often because of diabetes or neurological disorders ANSWER: q 81. autoimmune disease characterized by the destruction of secretory glands, especially those that produce saliva and tears ANSWER: y 82. mineralized dental plaque, often associated with inflammation and bleeding ANSWER: u 83. surgery in which diseased portions of the stomach are removed ANSWER: p 84. symptoms that result from rapid stomach emptying: nausea, abdominal cramps, weakness, diarrhea, and hypoglycemia ANSWER: r 85. an open sore in the gastrointestinal mucosa ANSWER: v

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Chapter 23- Upper Gastrointestinal Disorders 86. Discuss the complications of dysphagia and explain how dietary interventions can help with dysphagia management. ANSWER: Health practitioners should be alert to the various complications that may accompany dysphagia. If the condition restricts food consumption, weight loss and malnutrition may develop. Individuals who cannot swallow liquids are at increased risk of dehydration. If aspiration occurs, it may cause choking, airway obstruction, or respiratory infections, including pneumonia. If a person lacks a normal cough reflex, aspiration is more difficult to diagnose and may go unnoticed. To compensate for swallowing difficulties, a person with dysphagia may need to consume foods and beverages that have been physically modified so that they are easier to swallow. Because a wide variety of defects can cause dysphagia, finding the best diet is often a challenge. Furthermore, a person’s swallowing ability can fluctuate over time, so the dietary plan needs frequent reassessment. The National Dysphagia Diet, developed in 2002 by a panel of dietitians, speech and language therapists, and a food scientist, has helped to standardize the nutrition care of dysphagia patients. After the appropriate dietary level is selected, the diet must be adjusted to suit the person’s swallowing abilities and tolerances. In many cases, the most appropriate foods may be determined only by trial and error. A consultation with a swallowing expert, such as a speech and language therapist, is often necessary. 87. Discuss the dietary interventions to help decrease nausea and vomiting. ANSWER: Sometimes nausea can be prevented or improved with dietary measures. To minimize stomach distention, patients should consume small meals and drink beverages between meals rather than during a meal. Dry, starchy foods such as toast, crackers, and pretzels may help to reduce nausea, whereas fatty or spicy foods and foods with strong odors may worsen symptoms. Foods that are cold or at room temperature may be better tolerated than hot foods. Individuals often have strong food aversions when nauseated, and food tolerances vary greatly. 88. Describe the potential complications of gastritis and dietary recommendations for control of the condition. ANSWER: The extensive tissue damage that develops in long-term gastritis may disrupt gastric secretory functions and increase the risk of cancer. When autoimmune disease is the cause of atrophic gastritis, it frequently leads to destruction of the stomach cells that produce hydrochloric acid and intrinsic factor. If hydrochloric acid secretions become abnormally low or absent, absorption of nonheme iron and vitamin B12 can be impaired, increasing the risk for deficiency. Lack of intrinsic factor can result in vitamin B12 malabsorption, which can lead to the vitamin B12–deficiency condition known as pernicious anemia. Possible consequences of pernicious anemia include macrocytic anemia and neurological damage. Dietary recommendations depend on an individual’s symptoms. In asymptomatic cases, no dietary adjustments are needed. If pain or discomfort is present, the patient should avoid foods and beverages that irritate the gut; these often include alcohol, coffee (including decaffeinated), cola beverages, spicy foods, and fried or fatty foods. If food consumption increases pain or causes nausea and vomiting, food intake should be avoided for 24 to 48 hours to rest the stomach. If hypochlorhydria or achlorhydria is present, supplementation with iron and vitamin B12 may be warranted.

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Chapter 23- Upper Gastrointestinal Disorders 89. Discuss the risk factors for periodontal disease and potential strategies for reducing risk. ANSWER: Dental plaque is the primary risk factor associated with periodontal disease, and the severity of disease is related to the amount of plaque present. Tobacco smoking is another factor, possibly because of its destructive effects on cellular immune responses. The likelihood of developing periodontal disease is increased if a person has a chronic illness that impairs immune status, such as diabetes mellitus or HIV infection. Other risk factors include stress, pregnancy, use of certain medications (including oral contraceptives, antiepileptic drugs, and anticancer drugs), and dental conditions that increase plaque accumulation, such as poorly aligned teeth or ill-fitting bridges. Strategies for reducing risk focus on improving oral hygiene (proper brushing and flossing) and encouraging smoking cessation. 90. Discuss the relationship between oral health and diabetes mellitus, atherosclerosis, and respiratory illnesses. ANSWER: Dental diseases may have adverse effects on health beyond their effects on teeth. The bacteria that reside on dental tissues can enter the bloodstream and travel to other tissues; therefore, they may be able to trigger immune responses or cause infections elsewhere in the body. The inflammatory process induced by periodontal pathogens may increase levels of cytokines and other mediators that accelerate the progression of atherosclerosis. In addition, periodontal bacteria may enter the bloodstream and contribute to the processes of arterial plaque formation or blood clotting. The chronic inflammation caused by periodontal disease can exacerbate insulin resistance and provoke events leading to type 2 diabetes. Severe periodontal disease has also been linked to poor glycemic control in persons with diabetes. Clinical studies suggest a link between pneumonia and poor oral health. In addition, dental treatment and improvements in oral health have been associated with significant reductions in respiratory diseases in institutionalized older adults.

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Chapter 24- Lower Gastrointestinal Disorders 1. In which organ of the gastrointestinal tract does digestion and absorption of nutrients primarily occur? a. stomach b. small intestine c. liver d. large intestine ANSWER: b 2. The risk of constipation is increased under what condition? a. increased food intake b. low-fiber diet c. increased intake of fluids d. High levels of physical activity ANSWER: b 3. The food that is most likely to produce gas is a. bananas b. dried beans and peas c. brown rice d. coffee

ANSWER: b 4. Consequences of severe diarrhea include a. weight gain b. dehydration and electrolyte imbalance c. neurological complications d. bacterial overgrowth

ANSWER: b 5. Medications that stimulate colonic contractions are called a. antispasmodic drugs b. cholinergic agonists

c. antiemetic medications d. prokinetic agents ANSWER: d

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Chapter 24- Lower Gastrointestinal Disorders 6. Antidiarrheal drugs . a. slow gastrointestinal motility or reduce intestinal secretions b. increase gastrointestinal motility or increase intestinal secretions c. slow gastrointestinal motility and may help fight infectious agents d. increase gastrointestinal motility and reduce intestinal secretions ANSWER: a 7. Mrs. Thomas has been suffering from diarrhea for the past 4 days. What should she be given as a snack to replace fluid and electrolytes? a. a commercial sports drink and saltine crackers b. low-fat milk and cookies c. iced-tea and a brownie d. regular coffee and a muffin ANSWER: a 8. Liana is 4 years old and suffering from diarrhea. Which food should her mother let her eat to thicken her stool? a. applesauce b. milk c. grape d. green beans ANSWER: a 9. In , unabsorbed nutrients or other substances attract water to the colon and increase fecal water content. a. osmotic diarrhea b. secretory diarrhea c. diarrhea associated with motility disorders d. inflammatory diarrhea ANSWER: a 10. What type of laxative may cause bloating and diarrhea? a. bulk-forming fiber agents b. osmotic laxatives with poorly absorbed salts c. chloride-channel activators d. stimulant or irritant laxatives ANSWER: b

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Chapter 24- Lower Gastrointestinal Disorders 11. Nutritional consequences of fat malabsorption include a. overnutrition and weight gain b. increase in essential amino acids

c. increased risk of bone loss d. decreased risk of kidney stone formation ANSWER: c 12. When calcium is unable to bind to oxalate in the small intestine a. enteric hyperoxaluria b. kidney stones c. hypercalcemia d. a decreased risk of osteoporosis

can result.

ANSWER: b 13. Medium-chain triglyceride (MCT) oil is commonly used in malabsorption syndromes because a. it is high in essential fatty acids b. its absorption occurs in the large intestine c. it does not require bile and lipase for absorption d. it provides all the essential amino acids

ANSWER: c 14. A condition classified as an intestinal disorder that can lead to malabsorption is a. giardiasis b. bile insufficiency c. cystic fibrosis d. deliac disease

ANSWER: d 15. Which food should be excluded from a 50-g fat-controlled diet? a. egg whites b. angel food cake c. starchy vegetables d. avocado ANSWER: d

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Chapter 24- Lower Gastrointestinal Disorders 16. Foods to avoid from the category of breads and cereals while on a fat-restricted diet include a. pancakes b. bagels

c. pretzels d. English muffins ANSWER: a 17. Which menu best meets the objectives of a fat-controlled diet for a patient with steatorrhea? a. tuna fish salad, crackers, ice cream, tea b. baked chicken, macaroni and cheese, biscuits, milk c. grilled chicken, plain baked potato, applesauce, tea d. sirloin steak, potato salad, broccoli au gratin, milk ANSWER: c 18. Which food would be the best dessert for a client on a fat-controlled diet? a. cookies b. ice cream c. cherry pie d. sherbet ANSWER: d 19. What condition would most likely lead to bacterial overgrowth in the gastrointestinal tract? a. gastroesophageal reflux b. diverticulosis c. dyspepsia d. celiac disease ANSWER: b 20. How does bacterial overgrowth sometimes lead to fat malabsorption? a. The bacteria dismantle the bile acids needed for fat emulsification. b. The bacteria compete for the sites that absorb fat. c. The bacteria cause the formation of soaps that disrupt the fat. d. The bacteria themselves consume the fat. ANSWER: a

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Chapter 24- Lower Gastrointestinal Disorders 21. Pancreatitis is defined as . a. production of a thick mucus that affects the pancreas b. an inflammatory disease of the pancreas c. ulceration along the wall of the pancreas d. excessive secretion of pancreatic enzymes ANSWER: b 22. Severe cases of acute pancreatitis could lead to what complication? a. liver disease b. systemic inflammatory response syndrome c. intestinal obstruction d. colon cancer ANSWER: b 23. Which nutrient has the greatest stimulating effect on pancreatic secretions? a. carbohydrates b. fat c. protein d. vitamins ANSWER: b 24. Which describes appropriate initial nutrition therapy for cases of mild-to-moderate acute pancreatitis? a. a full liquid diet b. Medium-chain triglyceride (MCT) oil and iron supplements c. a low-fiber diet d. NPO (nothing by mouth) ANSWER: d 25. What is the most frequent cause of chronic pancreatitis? a. celiac disease b. alcohol consumption c. liver disease d. cystic fibrosis ANSWER: b

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Chapter 24- Lower Gastrointestinal Disorders 26. Although all macronutrients are maldigested during chronic pancreatitis, the symptoms of typically the most severe. a. iron b. fat c. sodium d. protein

malabsorption are

ANSWER: b 27. What is a potential side effect of pancreatic enzyme replacements? a. fluid retention b. protein catabolism c. bloody stool d. constipation ANSWER: d 28. The most appropriate diet therapy for clients with cystic fibrosis is to a. reduce fat to less than 35 g/day b. limit kcalories to 1200 g/day c. replace pancreatic enzymes d. restrict sodium

ANSWER: c 29. The fat intake of patients with acute pancreatitis should be less than a. 30 b. 50 c. 70 d. 90

g/day.

ANSWER: b 30. The protein needs of patients with acute pancreatitis are between a. 1.0 and 1.2 b. 1.2 and 1.5 c. 1.5 and 1.7

g/kg of body weight per day.

d. 1.7 and 2.0 ANSWER: b

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Chapter 24- Lower Gastrointestinal Disorders 31. What causes malabsorption in patients with cystic fibrosis? a. lack of pancreatic enzymes reaching the small intestine b. abnormal structure of the small intestine c. hypometabolism due to labored breathing d. side effects of medications ANSWER: a 32. The protein fraction in wheat gluten that has toxic effects in celiac disease is called a. glutathione b. gliadin c. casein d. whey

ANSWER: b 33. Which food is a potential source of gluten? a. soy sauce b. buttermilk c. rice d. marshmallows ANSWER: a 34. An appropriate food for a patient with celiac disease is a. wheat bread sandwich b. oatmeal cookies c. vanilla egg custard d. cheese and rye crackers

ANSWER: c 35. Betsey, a patient with celiac disease, asks the dietitian whether she can include oats in her diet. How should the dietitian respond? a. Limit intake to about 1 cup dry rolled oats per day and monitor tolerance. b. Exclude regular oatmeal and oat bran from diet totally and eat only gluten-free oats. c. Consume oats freely because they don't contain gluten like wheat or barley. d. Compare labels and select oats in baked form or mixed with other grains. ANSWER: a

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Chapter 24- Lower Gastrointestinal Disorders 36. Ulcerative colitis involves which section(s) of the gastrointestinal tract? a. large intestine b. small intestine c. jejunum and rectum d. biliary tract ANSWER: a 37. What type of drug would most likely be prescribed for a patient with inflammatory bowel disease? a. antivirals b. antispasmodics c. immunosuppressants d. stool softeners ANSWER: c 38. Matthew has been diagnosed with ulcerative colitis. He should be aware of what complication? a. inflammation of the duodenum b. fistulas c. increased risk of cancer d. retroperitoneal abscess ANSWER: c 39. Severe exacerbations of inflammatory bowel disease would require which type of dietary intervention? a. high-kcalorie and high-protein diet b. lactose-free diet c. total parenteral nutrition d. clear liquid diet ANSWER: c 40. What is the malabsorption syndrome that results after surgery when the absorptive capacity of the remaining intestine is insufficient for meeting nutritional needs? a. celiac disease b. short bowel syndrome c. irritable bowel syndrome d. inflammatory bowel disease ANSWER: b

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Chapter 24- Lower Gastrointestinal Disorders 41. What is a potential nutritional consequence following resection of the ileum? a. sodium and chloride malabsorption b. reduced calcium, zinc, and vitamin B12 absorption c. lactose malabsorption d. reduced potassium and phosphorus absorption ANSWER: b 42. Individuals with gluten sensitivity develop a severe itchy rash called symptoms when they consume gluten-containing foods. a. dermatitis herpetiformis

but have few gastrointestinal

b. cutaneous celiac disease c. dermal dystrophy d. gluten dermatitis ANSWER: a 43. Which food item is a potential source of gluten? a. buttermilk b. cottage cheese c. chocolate milk d. cream cheese ANSWER: c 44. Appropriate nutrition therapy for irritable bowel syndrome would most likely include a. administering parenteral nutrition b. avoiding eating 3 hours before bedtime

c. increasing fluid intake with meals d. consuming a low-FODMAP diet ANSWER: d 45. In Western societies, diverticula occur most often in which location? a. the sigmoid colon b. at the ileocecal valve c. the transverse colon d. the ascending colon ANSWER: a

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Chapter 24- Lower Gastrointestinal Disorders 46. A surgical procedure that creates a stoma from the colon that remains after a colectomy is a(n) a. ileostomy b. colostomy

c. gastrostomy d. port ANSWER: b 47. People with ileostomies need to follow which nutrition practice? a. chew food thoroughly b. drink 4 to 6 cups of fluid per day c. take an antacid prior to meals d. check blood glucose levels frequently ANSWER: a 48. Which practice may increase gas formation in patients with ostomies? a. drinking carbonated beverages b. drinking buttermilk c. eating parsley d. eating yogurt ANSWER: a 49. Mallory has a colostomy and has been suffering from frequent diarrhea. What food would be most appropriate to help thicken stool output? a. ice cream b. green beans c. oatmeal d. dried apricots ANSWER: c 50. Intestinal bacteria can benefit our health by a. increasing bacterial overgrowth b. decreasing fatty acid production c. stimulating the immune system d. stimulating malabsorption

ANSWER: c

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Chapter 24- Lower Gastrointestinal Disorders 51. Which is a subdominant type of intestinal bacteria? a. Enterococci b. Bacteroides c. Eubacteria d. Clostridia ANSWER: a 52. Over a. 100 b. 500 c. 1000 d. 5000

different species of bacteria reside in the colon.

ANSWER: b 53. Researchers are interested in the effects of bacterial probiotics on gastrointestinal disorders and a. congenital heart disease b. prematurity

c. cancer d. renal failure ANSWER: c 54. A serving of usually provides enough probiotic bacteria to survive in sufficient numbers to influence bacterial populations in the large intestine. a. pickles b. sauerkraut c. yogurt d. beer ANSWER: c 55. Although adverse effects are rare, one concern related to probiotic bacteria is a. the increase in resistant strains

b. infection in immunocompromised individuals c. the association between probiotics and heart disease d. increased rates of contamination among products ANSWER: b

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Chapter 24- Lower Gastrointestinal Disorders 56. Three-year-old Jenny is on antibiotics for 10 days. In order to prevent complications, her mother was advised to add to her diet. a. fruit punch b. sugar-free gelatin c. saltines d. yogurt ANSWER: d 57. Which patient should be cautious about consuming probiotics? a. a person with diabetes b. a person with dementia c. a person receiving chemotherapy d. a person with influenza ANSWER: c 58. Research with probiotics has shown that certain strains may . a. shorten the duration of rotavirus-associated diarrhea in infants and children b. prevent the need for ostomies in some patients c. shorten the duration of exacerbations of Crohn’s disease d. prevent peptic ulcer development in older adults ANSWER: a 59–63. Short Case Study Questions Ms. Betty Bell is an 85-year old new resident to Lake Nursing Home. She has a history of osteoporosis, depression, and anorexia. Her nurse is informed that Ms. Bell has bennexperiencing constipation for the past 10 days. 59. What could be a potential cause of Ms. Bell's constipation? a. osteoporosis b. a high-fiber diet c. low food intake d. high levels of physical activity ANSWER: c

60. Ms. Bell is given a diet order for a high-fiber diet to maintain normal bowel movements. What could prevent her intake of high-fiber foods (e.g., raw apples, salads)? a. low acid production b. lack of fiber enzymes c. poor dentition d. osteoporosis ANSWER: c

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Chapter 24- Lower Gastrointestinal Disorders

61. A potential side effect of a high-fiber diet when introduced abruptly is a. diarrhea b. diverticulosis c. flatulence

d. ostomy ANSWER: c

62. Ms. Bell is prescribed a fiber supplement to increase stool weight. Which of the following is an active ingredient in the fiber supplement? a. psyllium b. lactulose c. castor oil d. sorbitol ANSWER: a

63. On taking the fiber supplement Ms. Bell reports flatulence and abdominal pain. The dietitian recommends a lowFODMAP diet, which includes the following food. a. apples b. garlic c. wheat d. cucumber ANSWER: d 64–67. Short Case Study Questions Mr. Rogelio Martinez is a healthy 79-year-old, retired factory worker. His medical history includes diverticular disease, arthritis, and irregular bowel movements. His wife urges him to go to the emergency department of the local hospital after three episodes of blood in his stool. 64. Mr. Martinez is found to have infection in the diverticula. What will his immediate treatment include? a. antibiotics b. aspirin c. nonsteroidal anti-inflammatory drugs d. antidepressants ANSWER: a

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Chapter 24- Lower Gastrointestinal Disorders

65. What describes the diet progression for Mr. Martinez? a. NPO, clear liquid, high fiber, low residue b. NPO, high fiber, low residue, clear liquid c. high fiber, low residue, NPO, clear liquid d. NPO, clear liquid, low residue, adequate fiber ANSWER: d

66. Four weeks later, Mr. Martinez returns to the hospital for treatment of complications associated with diverticulitis and undergoes surgery to remove an extensive portion of his colon. The surgeon creates a passage through the abdominal wall into the colon through which dietary wastes can be eliminated. What is this procedure called? a. diverticulosis b. colostomy c. ileostomy d. gastric bypass ANSWER: b

67. A home health nurse visits Mr. Martinez and his wife. She reinforces the importance of consuming a. nuts, seeds, and corn b. salt liberally c. raw celery and carrots

d. wheat bran cereal ANSWER: b Matching Match each word or phrase with the most appropriate definition or explanation. a. bacterial overgrowth b. cystic fibrosis c. celiac disease d. dermatitis herpetiformis e. inflammatory bowel disease f. Crohn's disease g. ulcerative colitis h. short bowel syndrome i. intestinal adaptation j. Colectomy k. stoma Page 14

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Chapter 24- Lower Gastrointestinal Disorders l. colostomy m. ileostomy n. prebiotics o. lactulose p. probiotics q. Fistula r. steatorrhea 68. excessive fat in the stool due to fat malabsorption ANSWER: r 69. osmotic laxatives with poorly absorbed sugars ANSWER: o 70. condition characterized by an abnormal immune reaction to wheat gluten that causes severe intestinal damage and nutrient malabsorption ANSWER: c 71. removal of a portion or all of the colon ANSWER: j 72. chronic inflammatory disease of the gastrointestinal tract ANSWER: e 73. process of intestinal recovery after resection that leads to improved absorptive capacity ANSWER: i 74. live bacteria provided in foods and dietary supplements ANSWER: p 75. a surgically created passage through the intestinal wall into the ileum ANSWER: m 76. gluten-sensitive disorder characterized by a severe skin rash; gastrointestinal symptoms may be mild or absent ANSWER: d 77. surgically created opening in a body tissue or organ ANSWER: k 78. abnormal passage between body tissues or organs ANSWER: q 79. excessive bacterial colonization of the stomach and small intestine; may be caused by low gastric acidity, altered gastrointestinal motility, mucosal damage, or contamination ANSWER: a

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Chapter 24- Lower Gastrointestinal Disorders 80. inflammatory bowel disease that usually occurs in the lower portion of the small intestine and the colon; inflammation may pervade the entire intestinal wall ANSWER: f 81. a surgically created passage through the abdominal wall into the colon ANSWER: l 82. malabsorption syndrome following small intestine resection; results from insufficient absorptive capacity in the remaining intestine ANSWER: h 83. nondigestible substances in foods that stimulate the growth of nonpathogenic bacteria within the large intestine ANSWER: n 84. inherited disease involving exocrine glands, characterized by respiratory disease and pancreatic insufficiency ANSWER: b 85. inflammatory bowel disease that involves the colon; inflammation affects the mucosa and submucosa ANSWER: g 86. Discuss possible diet and lifestyle modifications for the treatment of constipation. ANSWER: In individuals with a low fiber intake, the primary treatment for constipation is a gradual increase in fiber intake to at least 20 to 25 g/day. High-fiber diets increase stool weight and fecal water content and promote a more rapid transit of materials through the colon. The transition to a high-fiber diet may be difficult for some people because it can increase intestinal gas, so high-fiber foods should be added gradually as tolerated. Fiber supplements such as methylcellulose (Citrucel), psyllium (Metamucil, Fiberall), and polycarbophil (Fiberlax) are also effective; these supplements can be mixed with beverages and taken daily. Unlike other fibers, methylcellulose and polycarbophil do not increase intestinal gas. Consuming adequate fluid enhances the effect of an increased fiber intake on stool frequency, and an appropriate fluid intake prevents excessive reabsorption of water from the colon, resulting in wetter stools. Consuming prunes or prune juice is often recommended because prunes contain compounds that have a mild laxative effect. Skipping breakfast is discouraged, as colonic motility is highest after a morning meal. Inactive individuals are generally encouraged to increase physical activity, although clinical studies have not confirmed that increasing exercise improves constipation symptoms.

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Chapter 24- Lower Gastrointestinal Disorders 87. What is cystic fibrosis, and how is nutrition therapy used to minimize its symptoms? ANSWER: Cystic fibrosis is the most common life-threatening genetic disorder among Caucasians. The condition is characterized by a mutation in the protein that regulates chloride transport across epithelial cell membranes. The abnormality alters the ion concentration and/or viscosity of exocrine secretions, causing a broad range of serious complications. Cystic fibrosis is characterized by abnormal chloride and sodium levels in exocrine secretions. These altered secretions ultimately disrupt the functioning of multiple tissues and organs. Common complications of cystic fibrosis involve the lungs, pancreas, and sweat glands. Energy requirements may range from 120 to 150% of Dietary Reference Intakes (DRI) values; however, intakes are often much lower than these levels. To achieve normal growth and appropriate weight, patients are encouraged to eat a high-kcalorie, high-protein, high-fat diet with about 20% of kcalories from protein and 35 to 40% from fat. Also recommended are consumption of frequent meals and snacks, and meal supplementation with milkshakes or oral supplements. Supplemental tube feedings can help to improve nutrition status if energy intakes are inadequate. Pancreatic enzyme replacement therapy is a central feature of cystic fibrosis treatment. Supplemental enzymes must be included with every meal or snack. Multi-vitamin/mineral and fat-soluble vitamin supplements are routinely recommended. The liberal use of table salt and salty foods is encouraged to make up for sodium losses in sweat. 88. Describe the use of oats in a gluten-free diet for celiac disease. ANSWER: The treatment for celiac disease is lifelong adherence to a gluten-free diet. Even minute amounts of gluten may cause symptoms in some people with celiac disease and therefore patients should practice utmost caution. Most oats grown in the United States are contaminated with wheat, barley, or rye. Oats are usually grown in rotation with other grains and may become contaminated during harvesting or processing. Some oat manufacturers now produce oats in dedicated facilities and test the products to ensure that they are gluten-free. Individuals who wish to include oats in their diet should purchase only uncontaminated gluten-free oats. 89. Explain the effects of short bowel syndrome. What consequences most often occur after small bowel surgery? ANSWER: Short bowel syndrome is the malabsorption syndrome that results when the absorptive capacity of the remaining intestine after surgery is insufficient for meeting nutritional needs. Without appropriate dietary adjustments, short bowel syndrome can result in fluid and electrolyte imbalances, and multiple nutrient deficiencies. Symptoms of short bowel syndrome include diarrhea, steatorrhea, dehydration, weight loss, and growth impairment in children. Generally, up to 50 percent of the small intestine can be resected without serious nutritional consequences. More extensive resections lead to generalized malabsorption, and patients may need lifelong parenteral nutrition to supplement oral intakes. Other problems that may develop include kidney stones and gallstones. Furthermore, loss of the ileocecal valve increases the likelihood that colonic bacteria may infiltrate the small intestine and cause bacterial overgrowth.

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Chapter 24- Lower Gastrointestinal Disorders 90. Discuss the causes of irritable bowel syndrome and how dietary modifications can be used for treatment. ANSWER: Although the causes of irritable bowel syndrome remain elusive, people with the disorder tend to have excessive colonic responses to meals, gastrointestinal (GI) hormones, and psychological stress. Intestinal transit may be accelerated leading to diarrhea or be delayed causing constipation. Many individuals exhibit hypersensitivity to a normal degree of intestinal distention and feel discomfort when experiencing normal meal transit or typical amounts of intestinal gas. Some patients show signs of low-grade intestinal inflammation and some may have had a bacterial infection that initiated their GI problems. Many patients have coexisting psychiatric disorders, such as anxiety and depression, which can exacerbate symptoms. Nutrition therapy aims to identify food intolerances that may worsen symptoms and help patients establish dietary patterns that ensure nutrient adequacy. The foods that aggravate symptoms vary considerably among patients and tolerances are best determined by trial and error. Examples of problematic foods include gas-producing foods, wheat and other grains, milk products, caffeinecontaining beverages, and carbonated beverages. Some individuals have less discomfort when they consume small frequent meals instead of larger ones. Supplementation with psyllium (Metamucil or Fiberall) may help to improve constipation and possibly other symptoms.

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Chapter 25- Liver Disease and Gallstones 1. The most metabolically active organ is the a. heart b. brain

c. liver d. stomach ANSWER: c 2. Which blood vessel is responsible for returning blood to the heart from the liver? a. hepatic artery b. hepatic vein c. GI tract vein d. portal vein ANSWER: b 3. Liver inflammation associated with fatty liver disease is known as a. hepatomegaly b. steatohepatitis c. steatorrhea d. hepatic encephalopathy

ANSWER: b 4. Laboratory tests indicators associated with fatty liver include a. decreased creatinine and ammonia b. elevated blood urea nitrogen and low bilirubin c. decreased white blood cells and high albumin d. elevated alanine and aspartate aminotransferases

ANSWER: d 5. The primary treatment for fatty liver is . a. eliminating causative factors that are responsible for the fatty liver disease b. surgically resecting the damaged portions of the liver c. administering anti-inflammatory drugs d. administering frequent transfusions of packed red blood cells ANSWER: a

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Chapter 25- Liver Disease and Gallstones 6. The normal range for bilirubin in the bloodstream is a. 0 to 2.0 b. 3.4 to 4.8

mg/dL.

c. 15 to 45 d. > 55 ANSWER: a 7. What percentage of U.S. adults is estimated to be affected by fatty liver? a. 5 b. 10 c. 15 d. 24 ANSWER: d 8. A number of herbal remedies are reported to cause hepatitis, including a. St. John’s wort b. ma huang c. echinacea d. ginseng

ANSWER: b 9. When foodservice workers do not follow good hygiene practices, which strain of hepatitis virus can be transmitted? a. hepatitis A virus b. hepatitis B virus c. hepatitis C virus d. hepatitis D virus ANSWER: a 10. The characteristic yellowing of the skin associated with jaundice is caused by the accumulation of a. bilirubin b. bile

in the blood.

c. triglycerides d. alkaline phosphatase ANSWER: a

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Chapter 25- Liver Disease and Gallstones 11. What diet recommendation is most appropriate for a patient with hepatitis who is experiencing abdominal discomfort? a. regular diet b. small frequent meals c. high-kcalorie tube feedings d. NPO (nothing by mouth) ANSWER: b 12. Hepatitis B has infected as much as a. less than 10% b. one-quarter c. one-third d. one-half

of the world’s population.

ANSWER: d 13. The blood vessel that conducts nutrient-rich blood from the digestive tract to the liver is the a. hepatic portal vein b. hepatic vein

c. hepatic artery d. gastrointestinal tract veins ANSWER: a 14. Outbreaks of hepatitis a. A b. B c. C d. D

are often associated with natural disasters such as floods.

ANSWER: a 15. Patients with fat malabsorption who are experiencing steatorrhea should limit fat intake to less than total kcalories. a. 10 b. 20 c. 30

percent of

d. 40 ANSWER: c

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Chapter 25- Liver Disease and Gallstones 16. Diets for persons with cirrhosis should include a. 0.5 to 0.8 b. 0.8 to 1.0 c. 1.0 to 1.5 d. 1.5 to 1.9

grams of protein per kilogram of body weight each day.

ANSWER: c 17. One of the two most common causes of cirrhosis in the United States is a. bile duct blockage b. heart disease c. environmental toxins d. hepatitis C infection

ANSWER: d 18. Normal blood ammonia levels are a. 15 to 45 b. 45 to 60 c. 60 to 75 d. >75

µg/dL.

ANSWER: a 19. If bile obstruction occurs with cirrhosis, the patient will most likely develop a. hypertension b. pruritus c. diaphoresis d. urinary retention

ANSWER: b 20. The hepatic portal vein and hepatic arteries together supply approximately a. 100 b. 500 c. 900 d. 1500

mL of blood each minute to the liver.

ANSWER: d

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Chapter 25- Liver Disease and Gallstones 21. In a cirrhotic liver, portal hypertension is the result of a. increased pressure in the hepatic artery b. increased pressure in the hepatic portal vein

c. jaundice caused by excessive bilirubin d. extended blood-clotting time ANSWER: b 22. When blood flow through the hepatic portal vein is obstructed, the diverted blood travels through enlarged or newly formed vessels in the gastrointestinal tract called . a. ascites b. collaterals c. bypass d. varices ANSWER: b 23. Mild hepatic encephalopathy is characterized by clinical symptoms, including: a. forgetfulness and personality changes b. shortened attention span and impaired mental abilities c. inappropriate behavior and slurred speech d. staggering gait and muscle rigidity ANSWER: b 24. Within 10 years after the onset of cirrhosis, approximately a. 10 b. 35 c. 50 d. 80

percent of patients will develop ascites.

ANSWER: c 25. What condition is thought to play a key role in hepatic encephalopathy? a. elevated blood ammonia levels b. prolonged plasma prothrombin time c. decreased levels of alkaline phosphatase d. increased blood urea nitrogen levels ANSWER: a

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Chapter 25- Liver Disease and Gallstones 26. Branched-chain amino acids may be supplemented in the diets of patients with hepatic encephalopathy because they ____. a. increase the synthesis of albumin b. reduce bilirubin levels c. may improve neurological functioning d. prevent a false positive test for occult blood in stool ANSWER: c 27. Which nutritional intervention should be encouraged for a client with cirrhosis and steatorrhea? a. increasing intake of polyunsaturated fat b. reducing kcalorie intake by 20% c. limiting vitamin B intake d. limiting fat intake and using medium-chain triglyceride (MCT) oil. ANSWER: d 28. A patient with ascites should decrease the intake of a. sodium b. potassium c. calcium d. magnesium

in his diet.

ANSWER: a 29. John has severe ascites due to advanced cirrhosis. He is scheduled to undergo a procedure that will use a surgical puncture to draw excess fluid out of his abdomen. What is this procedure called? a. shock-wave lithotripsy b. paracentesis c. peritoneovenous shunt d. peristenotic aspiration ANSWER: b 30. Vitamin a. C b. A

status may be affected by steatorrhea related to liver damage.

c. B12 d. B6 ANSWER: b

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Chapter 25- Liver Disease and Gallstones 31. In patients with cirrhosis, the restricted blood flow within the liver stimulates the release of which leads to a greater volume of portal blood. a. vasodilators b. bile acids c. insulin d. pancreatic enzymes

in nearby arterioles,

ANSWER: a 32. Which clinical serum test may be normal or low in patients with liver disease? a. ammonia b. bilirubin c. blood urea nitrogen d. alanine aminotransferase ANSWER: c 33. Which type of medication would most likely be administered to a patient with cirrhosis to control ascites? a. diuretics b. anti-inflammatories c. antibiotics d. pancreatic enzyme supplements ANSWER: a 34. The blood loss associated with ruptured varices in patients with cirrhosis is a. rarely serious b. common but rarely clinically important c. less problematic given current treatment regimens d. exacerbated by the liver’s reduced production of clotting factors

ANSWER: d 35. Which clinical feature is associated with severe hepatic encephalopathy? a. somnolence b. shortened attention span c. slight tremor d. mood changes ANSWER: a

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Chapter 25- Liver Disease and Gallstones 36. What type of dietary interaction has been seen with the appetite stimulants dronabinol? a. Licorice root interferes with its effects. b. It potentiates the effects of alcohol. c. Grapefruit juice can raise its concentrations. d. Its effectiveness may be reduced by calcium and magnesium supplements. ANSWER: b 37. Patients with stable cirrhosis usually require a. 5 to 15 b. 15 to 20 c. 25 to 40 d. 45 to 50

kcal/kg of body weight of energy per day.

ANSWER: c 38. A patient has severe liver damage that has led to reduced serum levels of branched-chain amino acids (BCAAs). What are the three essential BCAAs for which the patient should receive supplements? a. leucine, isoleucine, and valine b. proline, tyrosine, and leucine c. phenylalanine, tryptophan, and glutamine d. cysteine, methionine, and valine ANSWER: a 39. Advanced cirrhosis is usually associated with malnutrition. It can disrupt functions of which of the following organs? a. heart, spleen, and pancreas b. kidney, lungs, and brain c. gallbladder, heart, and appendix d. colon, stomach, and rectum ANSWER: b 40. Isabella is being evaluated for liver transplant surgery. The dietitian finds it difficult to assess her anthropometric values in order to evaluate nutritional needs because . a. she may have edema or ascites b. her intake may be inadequate due to esophageal varices c. she is receiving nutrients via parenteral nutrition d. she is suffering from steatorrhea ANSWER: a

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Chapter 25- Liver Disease and Gallstones 41. Elizabeth had a liver transplant 2 weeks ago. She is on immunosuppressive therapy. What side effect of these medications might interfere with her nutrition status? a. steatorrhea b. orthostatic hypotension c. gastroesophageal reflux d. abdominal pain ANSWER: d 42. In what ways do immunosuppressant drugs given after liver transplant impact nutrition? a. by increasing sodium excretion b. by causing gastroparesis c. by causing abdominal pain and mouth sores d. by altering calcium absorption ANSWER: c 43. The dietitian evaluates a patient whose status is post–liver transplant. In addition to a high-kcalorie, high-protein diet, the nutrition education plan should include information on . a. food safety b. blood glucose monitoring c. portion control d. hepatitis information ANSWER: a 44. The 5-year survival rate for patients who have undergone liver transplantation may be as high as a. 50 to 60 b. 65 to 70 c. 75 to 80 d. 85 to 90

percent.

ANSWER: d 45. The majority of gallstones are composed primarily of a. cholesterol b. bile pigment c. chloride salts d. uric acid

ANSWER: a

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Chapter 25- Liver Disease and Gallstones 46. Pigment gallstones are made up primarily of which substance? a. the calcium salt of bilirubin b. excess pancreatic enzymes c. phospholipids d. inorganic salts ANSWER: a 47. Black pigment gallstones are caused primarily by a. bacterial infection b. collections of concentrated bile c. excessive red blood cell breakdown d. rapid weight loss following gastric bypass

ANSWER: c 48. Which ethnic group is at much higher risk of developing cholesterol gallstones than any other? a. Asian American b. Native Hawaiian/Pacific Islander c. African American d. Native American ANSWER: d 49. Recurrence rates after pharmacologic dissolution of stones are as high as treatment. a. 10 to 20 b. 30 to 50 c. 55 to 60 d. 70 to 75

percent within 3 to 5 years after

ANSWER: b 50. The nonsurgical procedure that uses high-amplitude sound waves to fragment gallstones or kidney stones is called ______. a. colectomy b. lithotripsy c. cholecystectomy d. cholecystitis ANSWER: b

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Chapter 25- Liver Disease and Gallstones 51. Pharmacological management of gallstones with ursodeoxycholic acid may require continued treatment for the cholesterol crystals dissolve. a. 3 to 6 weeks b. 6 to 10 weeks c. 3 to 6 months d. 6 to 18 months

, until

ANSWER: d 52. A patient who has undergone cholecystectomy is at risk for intestine. a. constipation b. dyspepsia c. diarrhea d. jaundice

owing to an increased amount of bile in the large

ANSWER: c 53. Where does erythropoiesis take place? a. in the stomach b. in the small intestines c. in the bone marrow d. in the large intestine ANSWER: c 54. One of the role of stem cells in the bone marrow is a. to differentiate into red blood cells b. to secrete erythropoietin c. to aid in the production of additional vitamin B12 d. to carry hemoglobin and oxygen to body tissues ANSWER: a 55. A type of anemia that results in premature destruction of red blood cells (RBCs) is RBC lifespan and fewer RBCs. a. aplastic anemia b. anemia of chronic disease c. macrocytic anemia d. hemolytic anemia

, which results in shortened

ANSWER: d

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Chapter 25- Liver Disease and Gallstones 56. The most common type of anemia affecting those with long-term illness is a. aplastic anemia b. macrocytic anemia

c. anemia of chronic disease d. iron-deficiency anemia ANSWER: c 57. Which type of anemia is characterized by failure of stem cells to develop into RBCs and may be due to immune disease, viruses, drugs and toxins, or genetic defects? a. aplastic anemia b. macrocytic anemia c. hemolytic anemia d. thalassemia ANSWER: a 58. Which test is used to study abnormalities in red blood cells, including their numbers and shapes? a. peripheral blood smear b. hemoglobin c. mean corpuscular volume d. hematocrit ANSWER: a 59. A patient presents with megaloblastic anemia, which is characterized by large immature red blood cells. Which are the two nutrient deficiencies that cause this type of anemia? a. vitamin C and D b. vitamins E and K c. folate and vitamin B12 d. biotin and niacin ANSWER: c 60. Serum levels of the transport form of iron (i.e., transferrin) is altered in both iron-deficiency anemia and anemia of chronic disease. What will lab tests for serum transferrin typically reflect in these two anemias, respectively? a. Low; low b. High; low c. High; high d. Low; high ANSWER: b

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Chapter 25- Liver Disease and Gallstones 61. A patient is informed that she has microcytic hypochromic anemia. What will be the characteristics of the blood cells that are “microcytic and hypochromic”? a. blood cells are large and purplish in color b. blood cells are immature and red in color c. blood cells are small and pale in color d. blood cells are small and bright red in color ANSWER: c Veronica Riley-O’Brien is a 30-year-old African-American woman and a mother of two young boys (Tyler, 4 years old, and Ethan, 1 month old). Veronica is 5 ft 4 in. tall and weighs 126 lb. She is quite healthy except for a 3-year history of hypertriglyceridemia. Lately, she is having difficulty sleeping because of pain in her abdomen and back. She calls her doctor this morning because the pain has intensified. 62. Riley-O’Brien is diagnosed with gallstones. In addition to abdominal pain, what other symptom might she experience? a. edema b. confusion c. headache d. vomiting ANSWER: d 63. What is a complication of gallstones that can lead to infection? a. cirrhosis b. ascites c. edema d. cholecystitis ANSWER: d 64. Which factor places Ms. Riley-O’Brien most at risk for gallstones? a. African American race b. relatively young age c. recent pregnancy d. normal weight ANSWER: c 65. In addition to the risk posed by her recent pregnancy, what other risk factor does Ms. Riley-O’Brien have that increases her risk for gallstones? a. young age b. African-American ethnicity c. normal weight d. high triglyceride level ANSWER: d Page 13

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Chapter 25- Liver Disease and Gallstones 66. An appropriate treatment for Ms. Riley-O’Brien based on current symptoms would be a. hormone replacement b. a low-fat/low-cholesterol diet

c. laparoscopic cholecystectomy d. cholesterol-lowering medications ANSWER: c Match each word or phrase with the most appropriate definition or explanation. a. jaundice b. portal hypertension c. collaterals d. varices e. hepatic encephalopathy f. gallstones g. cholelithiasis h. biliary sludge i. cholecystitis j. cholecystectomy k. hepatitis l. sinusoids m. fatty liver n. ascites o. paracentesis p. cirrhosis q. laparoscopy r. hepatic coma 67. formation of gallstones ANSWER: g 68. abnormal accumulation of fluid in the abdominal cavity ANSWER: n 69. advanced stage of liver disease in which extensive scarring replaces healthy liver tissue ANSWER: p 70. elevated blood pressure in the portal vein often caused by obstructed blood flow through the liver ANSWER: b 71. inflammation of the gallbladder ANSWER: i

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Chapter 25- Liver Disease and Gallstones 72. crystalline deposits that form in the gallbladder primarily from cholesterol ANSWER: f 73. accumulation of triglycerides in the liver ANSWER: m 74. abnormally dilated blood vessels ANSWER: d 75. a semisolid mass made up of mucus, cholesterol crystals, and bilirubin granules ANSWER: h 76. removal of excess fluid with a surgical puncture and aspirator ANSWER: o 77. inflammation of the liver ANSWER: k 78. condition characterized by altered neurological functioning, including personality changes, reduced mental abilities, and disturbances in motor function due to elevated ammonia levels ANSWER: e 79. the small capillary-like passages that carry blood through liver tissue ANSWER: l 80. yellow discoloration of skin and eyes due to an accumulation of bilirubin ANSWER: a 81. blood vessels that enlarge in order to allow an alternate pathway for diverted blood ANSWER: c 82. surgical removal of the gallbladder ANSWER: j 83. a procedure that uses small incisions and video camera ANSWER: q 84. loss of consciousness resulting from severe liver disease ANSWER: r

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Chapter 25- Liver Disease and Gallstones 85. Identify the etiology of the three common strains of the hepatitis virus. Describe the treatments and medical nutrition therapy for hepatitis. ANSWER: Hepatitis A virus (HAV) is primarily spread via fecal–oral transmission, which usually involves the ingestion of foods or beverages that have been contaminated with fecal material. HAV infection usually resolves within a few months and does not cause chronic infection or permanent liver damage. Hepatitis B virus (HBV) is transmitted by infected blood or needles, by sexual contact with an infected person, and from mother to infant during childbirth. Hepatitis C virus (HCV) is spread via infected blood or needles but is not readily spread by sexual contact or childbirth. Hepatitis is treated with supportive care, such as bed rest (if necessary) and an appropriate diet. Hepatitis patients should avoid substances that irritate the liver, such as alcohol, drugs, and dietary supplements that cause liver damage. HAV infection usually resolves without the use of medications. Antiviral agents may be used to treat HBV and HCV infections; examples include lamivudine and ribavirin, which block viral replication, and interferon alfa, which both inhibits viral replication and enhances immune responses. Nonviral forms of hepatitis may be treated with anti-inflammatory and immunosuppressant drugs. Hospitalization is not required for hepatitis unless other medical conditions or complications hamper recovery. 86. Explain how cirrhosis leads to portal hypertension, esophageal varices, and ascites. ANSWER: The scarred tissue of a cirrhotic liver impedes the flow of blood, three-fourths of which is supplied by the hepatic portal vein. The restricted blood flow within the liver stimulates the release of vasodilators (and therefore increases blood flow) in nearby arterioles, leading to a greater volume of portal blood. The increased portal blood coupled with resistance to blood flow within the liver causes a rise in blood pressure within the hepatic portal vein, called portal hypertension. As portal pressure builds, some of these collaterals can become enlarged and engorged with blood, forming varices. The varices that develop in the esophagus and stomach are vulnerable to rupture because they have thin walls and often bulge into the lumen. If ruptured, they can cause massive bleeding that is sometimes fatal. The blood loss is exacerbated by the liver’s reduced production of blood-clotting factors. Within 10 years of disease onset, about 50% of cirrhosis patients develop ascites, a large accumulation of fluid in the abdominal cavity. Ascites is primarily a consequence of portal hypertension, sodium and water retention in the kidneys, and reduced albumin synthesis in the diseased liver. As a result of portal hypertension, the distorted blood flow elsewhere in the body alters kidney function, leading to sodium and water retention and an accumulation of body fluid. The elevated pressure within the liver’s small blood vessels causes fluid to leak into lymphatic vessels and ultimately into the abdominal cavity. The movement of water into the abdomen is exacerbated by low levels of serum albumin, a protein that helps to retain fluid in blood vessels.

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Chapter 25- Liver Disease and Gallstones 87. Explain the importance of adequate nutrition support for patients before and following a liver transplant. ANSWER: Advanced liver disease is usually associated with malnutrition, which can increase the risk of complications following a liver transplant. Evaluating nutrition status in transplant candidates can be difficult, because liver dysfunction and malnutrition often have similar metabolic effects. In addition, the presence of edema or ascites can alter anthropometric values and mask weight loss. Correcting malnutrition prior to transplant surgery can help to speed recovery after the surgery. The stress associated with transplant surgery increases protein and energy requirements. High-kcalorie, highprotein snacks and oral supplements can help the transplant patient meet postsurgical needs. Vitamin and mineral supplementation is also an integral part of nutrition care. To help transplant patients avoid developing foodborne illnesses, health practitioners should provide information about food safety measures, such as cooking foods adequately, washing fresh produce, and avoiding foods that may be contaminated. 88. List the complications of gallstones that are not well managed or treated. ANSWER: If a gallstone remains lodged in the cystic duct, it can obstruct bile flow to the duodenum and cause cholecystitis—distention and inflammation of the gallbladder. Cholecystitis can lead to infection or to more severe complications, including perforation of the gallbladder, peritonitis, and fistulas. If gallstones obstruct the common bile duct, they can block bile flow from the liver, resulting in jaundice or damage to liver tissue. An impacted stone within the bile ducts may lead to infection and bacterial cholangitis, which causes severe pain, sepsis, and fever and is often a medical emergency. Gallstones can block the pancreatic duct as well—a primary cause of acute pancreatitis. Because these complications are potentially dangerous, individuals should seek medical attention if gallstone pain does not resolve over time or if fever, jaundice, or persistent nausea and vomiting develop. 89. Discuss the types of blood-related drug-nutrient interactions and anemias that can occur as a result of medication use. List some examples of the effects of medications and resulting anemia. ANSWER: Anemia is among the adverse effects that may result from medication use. Various medications can disrupt nutrient metabolism, impair blood coagulation and erythropoiesis, or increase red blood cell destruction. Because the life span of red blood cells is about 120 days, the long-term use of such medications is more likely to result in anemia than short-term use. Anticoagulants, which are prescribed specifically to reduce blood clotting, sometimes lead to excessive bleeding. The anticoagulant effects may be augmented if several of these drugs are used simultaneously. The slow, chronic bleeding that sometimes develops may go unnoticed until excessive blood loss has occurred. Many classes of drugs are associated with aplastic anemia, the anemia that occurs when the bone marrow fails to produce adequate numbers of blood cells. The categories of drugs that can inhibit erythropoiesis include antibiotics, anticancer agents, anticonvulsants, antihistamines, anti-inflammatory drugs, and diuretics. Aplastic anemia can also be caused by viral infections, exposure to toxins, and genetic defects. Some patients may develop hemolytic anemia as a result of drug interactions with red blood cells. For example, a drug may bind to the red blood cell membrane and elicit an antibody response that destroys the cell. Drugs that may cause this response include cephalosporin and fludarabine. Withdrawal of these drugs can eventually reverse the anemia, and sometimes medications are given to suppress the immune response.

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Chapter 26- Diabetes Mellitus 1. The renal threshold is described as

a. a decrease in erythropoietin production because of insulin imbalance b. nutrient depletion in the renal tubules caused from deficient insulin c. hemoglobin’s exposure to glucose within the kidneys d. the concentration at which the kidneys begin to pass glucose into the urine ANSWER: d 2. About a. 7 b. 17 c. 24 d. 37

percent of persons with diabetes are unaware that they have it.

ANSWER: c 3. The pancreatic hormone that promotes gluconeogenesis in the liver is a. glycogen b. estrogen c. glucagon d. leptin

ANSWER: c 4. What best describes polydipsia? a. excessive thirst b. excessive urination c. increased glucose in the urine d. excessive hunger ANSWER: a 5. Glycosuria usually occurs when plasma glucose concentration exceeds a. 140 b. 160 c. 180 d. 200

mg/dL.

ANSWER: d

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Chapter 26- Diabetes Mellitus 6. A blood glucose level between 100 and 125 mg/dL after an 8-hour fast would be classified as a. impaired fasting glucose b. hypoglycemia

c. impaired glucose tolerance d. normal fasting glucose ANSWER: a 7. A fasting blood glucose level above a. 90 b. 100 c. 116 d. 126

mg/dL is classified as diabetes.

ANSWER: d 8. Normal fasting plasma glucose levels are approximately a. 60 to 74 b. 75 to 100 c. 110 to 125 d. 126 to 140

mg/dL.

ANSWER: b 9. Type 1 diabetes accounts for a. 5 to 10 b. 15 to 25 c. 50 to 75 d. 90 to 95

percent of diabetes cases in the United States.

ANSWER: a 10. People with type 1 diabetes need exogenous insulin because they a. have become insulin-resistant b. have developed hyperinsulinemia

c. no longer synthesize insulin d. digest insulin with gastrointestinal enzymes ANSWER: c

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Chapter 26- Diabetes Mellitus 11. Which of the following is NOT a feature of type 2 diabetes? a. insulin resistance b. autoimmune disease c. obesity is a causative factor d. some cases require insulin therapy ANSWER: b 12. Diabetic ketoacidosis is characterized by severe ketosis, acidosis, and a. renal failure b. hallucinations c. hyperglycemia d. myocardial ischemia

ANSWER: c 13. Which ethnic population has the lowest relative risk for developing type 2 diabetes? a. Pacific Islanders b. Asian Indians c. European Americans d. Native Americans ANSWER: c 14. Diabetic ketoacidosis can develop when blood glucose is greater than a. 250 b. 450 c. 650 d. 700

mg/dL.

ANSWER: a 15. Symptoms of hypoglycemia include a. sweating and heart palpitations b. increased thirst and polyuria c. acetone breath d. warm, flushed skin

ANSWER: a

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Chapter 26- Diabetes Mellitus 16. What is the standard treatment for hyperosmolar hyperglycemic syndrome? a. intravenous fluid and electrolyte replacement and insulin therapy b. intravenous administration of ketones c. surgical resection of the pancreas d. a low-carbohydrate, low-fat diet ANSWER: a 17. Which is NOT a sign or symptom of diabetic neuropathy? a. Numbness or tingling in extremities b. gastroparesis c. bladder dysfunction d. diarrhea ANSWER: a 18. Which condition is a microvascular complication of diabetes? a. peripheral vascular disease b. diabetic retinopathy c. intermittent claudication d. hypertriglyceridemia ANSWER: b 19. The oral glucose tolerance test uses a glucose load of a. 25 b. 50 c. 75 d. 100

grams.

ANSWER: c 20. Using the “intensive therapy” approach, blood glucose is monitored at least diabetes. a. one b. two c. three

time(s) a day for people with type 1

d. four ANSWER: c

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Chapter 26- Diabetes Mellitus 21. What is an advantage seen with intensive therapy for patients with type 1 diabetes? a. delayed progression of retinopathy, nephropathy, and neuropathy b. less weight gain c. greater stability noted in fructosamine results d. fewer incidents of severe hypoglycemia ANSWER: a 22. What test may be used to determine glycemic control over the preceding 2- to 3-week period? a. fructosamine b. ketone c. glucose tolerance d. insulin antibody ANSWER: a 23. Hemoglobin A1c can best be described as a(n)

a. by-product of fat metabolism b. reflection of glycemic control over the preceding 2 to 3 months c. end-product of protein metabolism formed in the liver d. summary of hemoglobin rates for type 1 diabetes ANSWER: b 24. The goal of diabetes treatment is an HbA1c value under

percent.

a. 5 b. 7 c. 9 d. 10 ANSWER: b 25. Mr. Jacobs has high blood lipids. The physician would instruct him to limit dietary intake of which substance as an added sweetener but not from whole foods (i.e., fruits and vegetables)? a. fructose b. sucrose c. glucose d. sucralose ANSWER: a

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Chapter 26- Diabetes Mellitus 26. Insulin is most often administered by

a. subcutaneous injection b. oral administration c. intramuscular injection d. intravenous administration ANSWER: a 27. Mrs. Barclay has type 2 diabetes and you are preparing her for discharge. She tells you that she loves red beans and rice and knows that she must eliminate them from her diet because they will elevate her blood glucose level. You should explain to her that . a. on a carbohydrate-counting meal plan, these foods in recommended portion sizes can fit within her carbohydrate allowance at meals b. red beans are eliminated because they are high in complex carbohydrates c. red beans are high in water-soluble fiber and should be avoided d. peas are a better choice than red beans ANSWER: a 28. As per the carbohydrate-counting meal plan, how many grams of carbohydrates is in 2 cups of brown rice and a cup of red beans? a. 100 grams b. 120 grams c. 150 grams d. 175 grams ANSWER: b 29. As per the carbohydrate-counting meal plan, how many grams of carbohydrates is in a snack that consists of 2 cups of ice cream and a small apple? a. 60 grams b. 75 grams c. 45 grams d. 15 grams ANSWER: b 30. Which antidiabetic drug is classified as a biguanide? a. acarbose b. pramlintide c. metformin d. nateglinide ANSWER: c

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Chapter 26- Diabetes Mellitus 31. Short-acting insulin begins to act a. 15 to 20 minutes b. 30 to 60 minutes

after it is injected.

c. 1 to 3 hours d. 2 to 4 hours ANSWER: b 32. Mr. Lilly, a 42-year-old male, tells you that he used to take “pills” for his diabetes but is now taking insulin. What is the most likely reason that he no longer takes oral antidiabetic agents? a. Oral agents are effective only in type 1 diabetes. b. His body now stimulates enough insulin to meet his needs. c. Oral agents suppress insulin release. d. The oral agents were not effectively controlling his blood glucose levels. ANSWER: d 33. What is a metabolic effect that may occur with taking thiazolidinediones for glycemic control? a. fluid retention b. weight loss c. allergic skin reactions d. vitamin B12 deficiency ANSWER: a 34. Hyperglycemia that results from the release of counterregulatory hormones following nighttime hypoglycemia is known as . a. fasting hyperglycemia b. rebound hyperglycemia c. dawn phenomenon d. nocturnal hyperglycemia ANSWER: b 35. Which intervention is most appropriate as part of sick-day management of diabetes? a. Discontinue all antidiabetic medications and insulin. b. Measure blood glucose and urine ketones once a day. c. Discontinue antidiabetic drugs and only use insulin. d. Consume the usual diet if possible. ANSWER: d

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Chapter 26- Diabetes Mellitus 36. Approximately a. 4 to 14 b. 14 to 24

percent of nondiabetic women in the United States develop gestational diabetes.

c. 24 to 34 d. 34 to 44 ANSWER: a 37. Which recommendation is not advised for pregnant women with diabetes? a. insulin therapy b. 10% weight loss c. physical activity d. low-carbohydrate breakfast ANSWER: b 38. Women with gestational diabetes are at greater risk of which condition later in life? a. obesity b. type 2 diabetes c. metabolic syndrome d. chronic kidney disease ANSWER: b 39. The newborn of a mother with diabetes is at greater risk of which metabolic condition? a. hypocalcemia b. sepsis c. transient tachypnea d. congenital heart disease ANSWER: a 40. What maternal complication has been associated with uncontrolled diabetes during pregnancy? a. preeclampsia b. obesity c. hyperemesis gravidarum d. miscarriage ANSWER: d

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Chapter 26- Diabetes Mellitus 41. Macrosomia develops as a result of

a. insulin’s stimulatory effect on fat synthesis b. excessive insulin production by the fetal pancreas c. poor maternal kidney function due to excess glucose d. the enzymatic glycation of serum proteins ANSWER: b 42. Which patient would have the most risk factors for gestational diabetes? a. Rita, who has a prepregnancy body mass index (BMI) of 24 b. Zhu, who just moved to the United States from China c. Amy, who once had an 8-pound baby d. Sarah, whose father has diabetes ANSWER: d 43. Regina is at her first prenatal visit after recently discovering that she is pregnant. She is a low-risk patient with no history of diabetes. At what point will her physician test Regina for gestational diabetes? a. 12 to 15 weeks b. 16 to 20 weeks c. 24 to 28 weeks d. 29 to 32 weeks ANSWER: c 44. Emily has gestational diabetes and a BMI of 33. What nutrition recommendation should be made for Emily for weight control during her pregnancy? a. Strive to lose 11 to 14 lb by the end of her pregnancy. b. Increase carbohydrate intake to 55 to 60% of total energy. c. Reduce kcalorie intake by 30% to slow further weight gain. d. Continue with a normal diet and strive to lose weight after pregnancy. ANSWER: c 45. Which antidiabetic drug is sometimes prescribed for type 2 diabetic women during pregnancy? a. glimepiride b. nateglinide c. repaglinide d. glyburide ANSWER: d

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Chapter 26- Diabetes Mellitus 46. Diagnostic criteria for metabolic syndrome include a fasting plasma glucose of a. 80 b. 90

mg/dL or higher.

c. 100 d. 110 ANSWER: c 47. Diagnostic criteria for metabolic syndrome include waist circumference of greater than a. 33 b. 35 c. 38 d. 40

inches in women.

ANSWER: b 48. Diagnostic criteria for metabolic syndrome include very-low-density lipoprotein (VLDL) levels of higher. a. 100 b. 125 c. 150 d. 175

mg/dL or

ANSWER: c 49. Diagnostic criteria for metabolic syndrome include blood pressure of a. 110/80 b. 130/85 c. 150/90

mm Hg or higher.

d. 170/95 ANSWER: b 50. Diagnostic criteria for metabolic syndrome include high-density lipoprotein (HDL) levels of less than men. a. 30 b. 35

mg/dL in

c. 40 d. 50 ANSWER: c

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Chapter 26- Diabetes Mellitus 51. An estimated a. 6 b. 12

percent of adults in the United States meet the criteria for metabolic syndrome.

c. 23 d. 34 ANSWER: d 52. How does obesity lead to the development of hypertriglyceridemia? a. Insulin causes adipose cells to store more triglycerides. b. HDL competes with VLDL for cholesterol binding sites. c. The liver produces more VLDL in response to fatty acids released by insulin-resistant adipose cells. d. Fatty acids in the bloodstream resist excretion by HDL. ANSWER: c 53. The hyperinsulinemia that typically accompanies obesity promotes sodium reabsorption in the kidneys, resulting in fluid retention and . a. increased abdominal obesity b. hypertension c. atherosclerosis d. hypertriglyceridemia ANSWER: b 54. Inflammation of endothelial tissue, obesity, and insulin resistance can all contribute to blood clots by promoting the increased production of procoagulant proteins such as . a. hirudin b. fibrinogen c. dicoumarol d. andexanet alfa ANSWER: b 55. What dietary recommendation is advised for individuals with hypertriglyceridemia? a. Reduce intake of added sugars and refined grain products. b. Decrease sodium intake and improve intake of dairy products. c. Eliminate polyunsaturated fatty acids in the diet. d. Reduce kcalorie intake by 45% daily. ANSWER: a

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Chapter 26- Diabetes Mellitus 56-60. Short Case-Study Questions Michael Fern is a 21-year-old college student majoring in electrical engineering. His medical history is unremarkable. He comes to his family doctor for the second time this month because of symptoms of lethargy, fatigue, weight loss, and frequent thirst and urination. 56. Michael is rushed to the hospital after a simple blood test determines a blood glucose of 600 mg/dL. He is most likely suffering from . a. hypoglycemia b. hyperglycemia c. dehydration d. infection ANSWER: b 57. Michael has been diagnosed with diabetic ketoacidosis. In addition to severely elevated blood glucose levels, what other symptom is associated with this condition? a. fruity odor on the breath b. fluid retention c. high blood pressure d. vision loss ANSWER: a 58. Michael’s ketoacidosis leads to a diagnosis of type 1 diabetes. Which medication will Michael need to take to treat his diabetes? a. sulfonylureas b. metformin c. insulin injections d. alpha-glucosidase inhibitors ANSWER: c 59. The registered dietitian visits with Michael to instruct him on his diabetic diet. What is important for Michael to know about consuming alcohol? a. He should not consume any alcohol. b. He should consume food when he ingests alcoholic beverages to avoid hypoglycemia. c. He should limit his food intake prior to consuming alcohol in order to avoid hyperglycemia. d. Excessive alcohol intake will likely cause severe hypoglycemia. ANSWER: b

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Chapter 26- Diabetes Mellitus 60. After 6 months, Michael’s endocrinologist orders an insulin pump. Which best describes the use of an insulin pump with type 1 diabetes? a. Hyperglycemia is not a concern with the insulin pump. b. Hypoglycemia can occur with insulin treatment. c. Michael does not need to follow a modified diet. d. Michael no longer needs to worry about exercising. ANSWER: b 61–65. Short Case Study Questions Ruth Ann Glebowski is a 40-year-old woman. She has a medical history of gestational diabetes, high cholesterol, hypothyroidism, and depression. She is 5 ft 4 in. tall and weighs 190 lb. Recently she has made an appointment with her physician since she has been having excessive hunger and frequent urination. 61. Ruth Ann is diagnosed with type 2 diabetes. Which factors puts her at increased risk for diabetes? a. Weight and gestational diabetes b. Depression and middle age c. high cholesterol and hypothyroidism d. Hypothyroidism ANSWER: a 62. In addition to anti-diabetic medications, what can Ruth Ann do to help control her blood glucose? a. lose weight b. try a high-fat diet c. take calcium supplements d. start glucagon injections ANSWER: a 63. Ruth Ann meets with a registered dietitian and is educated on carbohydrate counting for meal planning. Which of the following snacks would be appropriate if she is allowed 30 grams of carbohydrates? a. A small apple and 4 sandwich cream-cookies b. A small granola bar and a medium peach c. 1 English muffin with a tablespoon of butter and 3 chocolate kisses d. 2 slices of bread and 2 tablespoons of grape jelly ANSWER: b

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Chapter 26- Diabetes Mellitus 64. Ruth Ann’s doctor can best evaluate long-term diabetic compliance by checking her a. fasting blood glucose b. urine ketones

c. blood pressure d. glycated hemoglobin ANSWER: d 65. Fifteen years pass and Ruth Ann is experiencing some visual impairments. Her eye doctor explains that it could be diabetic ______________ a. nephropathy b. hypoglycemia c. retinopathy d. gastroparesis ANSWER: c Match each word or phrase with the most appropriate definition or explanation. a. adiponectin b. macrosomia c. polyuria d. polydipsia e. polyphagia f. prediabetes g. type 1 diabetes h. type 2 diabetes i. hyperosmolar hyperglycemic syndrome j. advanced glycation end products k. glycated hemoglobin l. diabetic retinopathy m. diabetic nephropathy n. diabetic neuropathy o. metabolic syndrome 66. excessive thirst ANSWER: d 67. usually results from autoimmune destruction of pancreatic beta-cells; little or no insulin is produced in the pancreas ANSWER: g 68. blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes; considered a major risk factor for future cardiovascular disease ANSWER: f

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Chapter 26- Diabetes Mellitus 69. hormone produced by adipose cells that promotes insulin sensitivity ANSWER: a 70. hemoglobin molecules with glucose attached; used to evaluate long-term glycemic control ANSWER: k 71. usually results from insulin resistance coupled with insufficient insulin secretion ANSWER: h 72. cluster of interrelated clinical symptoms, including central obesity, insulin resistance, high blood pressure, and abnormal blood lipids, which together increase cardiovascular disease risk two- to three-fold ANSWER: o 73. newborns having an abnormally large body when born to mothers with uncontrolled diabetes ANSWER: b 74. excessive urine production ANSWER: c 75. extreme hyperglycemia that is associated with hyperosmolar blood, dehydration, and altered mental status ANSWER: i 76. excessive appetite or eating ANSWER: e 77. kidney damage associated with diabetes ANSWER: m 78. retinal damage associated with diabetes ANSWER: l 79. nerve degeneration associated with diabetes ANSWER: n 80. compounds formed when glucose combines with proteins; can damage tissues and lead to diabetic complications ANSWER: j

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Chapter 26- Diabetes Mellitus 81. Describe the criteria that are currently used to diagnose diabetes. ANSWER: The diagnosis of diabetes is based primarily on plasma glucose levels, which can be measured under fasting conditions or at random times during the day. In some cases, an oral glucose tolerance test is given: the individual ingests a 75-gram glucose load, and plasma glucose is measured at one or more time points following glucose ingestion. Glycated hemoglobin (HbA1c) levels, which reflect hemoglobin’s exposure to glucose over the preceding 2–3 months, are an indirect assessment of blood glucose levels. The following criteria are currently used to diagnose diabetes: the plasma glucose concentration is 126 mg/dL or higher after a fast of at least 8 hours (normal fasting plasma glucose levels are 75–100 mg/dL); in a person with classic symptoms of hyperglycemia, the plasma glucose concentration of a random or casual blood sample is 200 mg/dL or higher; the plasma glucose concentration measured 2 hours after a 75-gram glucose load is 200 mg/dL or higher; and/or the HbA1c level is 6.5 percent or higher. A diagnosis of diabetes generally requires two abnormal test results from the same blood sample or two separate blood samples. If overt symptoms of hyperglycemia are present, diagnosis can be based on a single abnormal test result. 82. Illustrate the acute complications of uncontrolled diabetes. ANSWER: A severe lack of insulin causes diabetic ketoacidosis mainly in type 1 diabetic patients. Without insulin, glucagon’s effects become more pronounced, leading to the unrestrained breakdown of the triglycerides in adipose tissue and the protein in muscle. As a result, an increased supply of fatty acids and amino acids arrives in the liver, fueling the production of ketone bodies and glucose. Ketone bodies, which are acidic, can reach dangerously high levels in the bloodstream and spill into the urine. Blood pH typically falls below 7.30. Blood glucose levels usually exceed 250 mg/dL and rise above 1000 mg/dL in severe cases. The main features of diabetic ketoacidosis therefore include severe ketosis, acidosis, and hyperglycemia. The hyperosmolar hyperglycemic syndrome typically observed in type 2 diabetics is a condition of severe hyperglycemia and dehydration that develops in the absence of significant ketosis. The hyperglycemia that develops in poorly controlled diabetes leads to polyuria, which results in substantial fluid and electrolyte losses. In the hyperosmolar hyperglycemic syndrome, patients are unable to recognize thirst or adequately replace fluids because of age, illness, sedation, or incapacity. The profound dehydration that eventually develops exacerbates the rise in blood glucose levels, which often exceed 600 mg/dL and may climb above 1000 mg/dL. Blood plasma may become so hyperosmolar as to cause neurological abnormalities, such as confusion, speech and vision impairments, muscle weakness, abnormal reflexes, and seizures; about 10 percent of patients lapse into coma. Hypoglycemia is the most frequent complication of type 1 diabetes and may occur in type 2 diabetes as well. It is due to the inappropriate management of diabetes rather than to the disease itself, and is usually caused by excessive dosages of insulin or antidiabetic drugs, prolonged exercise, skipped or delayed meals, inadequate food intake, or the consumption of alcohol without food.

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Chapter 26- Diabetes Mellitus 83. Describe the different types of neuropathy that may develop in patients with diabetes. ANSWER: Diabetic neuropathy most often involves the peripheral nerves (peripheral neuropathy) or nerves that control body organs and glands (autonomic neuropathy). Peripheral neuropathy—the most common form of neuropathy in diabetes—may be experienced as pain, numbness, or tingling in the hands, feet, and legs or weakness of the limbs. Pain and cramping in the legs are often severe during the night and may interrupt sleep. Peripheral neuropathy also contributes to the development of foot ulcers because cuts and bruises may go unnoticed until wounds are severe. Autonomic neuropathy may be evidenced by sweating abnormalities, disturbed bladder function, erectile dysfunction, delayed stomach emptying (gastroparesis), constipation, and cardiac arrhythmias. Neuropathy occurs in about 50 percent of patients with diabetes; the extent of nerve damage depends on the severity and duration of hyperglycemia. 84. Compare and contrast conventional and intensive therapies for type 1 diabetic patients, including the advantages and disadvantages of each. ANSWER: The main goal of diabetes treatment is to maintain blood glucose levels within a desirable range to prevent or reduce the risk of complications. Several multicenter clinical trials have shown that intensive diabetes treatment, which keeps blood glucose levels tightly controlled, can greatly reduce the incidence and severity of some chronic complications. Therefore, maintenance of near-normal glucose levels has become the fundamental objective of diabetes care plans. Note that intensive therapy is recommended only if the benefits of therapy outweigh the potential risks. Intensive therapy involves blood glucose monitoring at least three times per day and three or more daily injections of glucose or an external insulin pump. Landmark studies conducted in the 1980s and 1990s suggested that keeping blood glucose levels as close to normal as possible offers clear advantages over less rigorous diabetes treatment. The participants undergoing intensive therapy had delayed onset and reduced progression of retinopathy, nephropathy, and neuropathy; however, they also experienced more frequent episodes of severe hypoglycemia and gained more weight. Conventional therapy requires daily glucose monitoring, and one or two daily injections without daily adjustments. Conventional therapy is associated with fewer incidences of severe hypoglycemia and less weight gain, but it may lead to more rapid progression of neuropathy, nephropathy, and retinopathy.

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Chapter 26- Diabetes Mellitus 85. Discuss how the intakes of protein, carbohydrate, fat, sodium, and alcohol are modified for a patient with diabetes. ANSWER: The amount of carbohydrate consumed has the greatest influence on blood glucose levels after meals— the more grams of carbohydrate ingested, the greater the glycemic response. The carbohydrate recommendation is based in part on the person’s metabolic needs (which are related to the type of diabetes, degree of glucose tolerance, and blood lipid levels), the type of insulin or other medications used to manage the diabetes, and individual preferences. For optimal health, the carbohydrate sources should be vegetables, fruits, whole grains, legumes, and milk products, whereas foods made with refined grains and added sugars should be limited. Recommendations for whole grain and fiber intakes are similar to those for the general population. People with diabetes are encouraged to include fiber-rich foods such as whole-grain cereals, legumes, fruits, and vegetables in their diet. Although some studies have suggested that very high intakes of fiber may improve glycemic control, many individuals have difficulty tolerating such large amounts of fiber. A Mediterranean-style dietary pattern that emphasizes monounsaturated fats may benefit both glycemic control and cardiovascular disease risk. In addition, increased intakes of omega-3 fatty acids from fatty fish or plant sources may improve the lipoprotein profile and various other CVD risk factors. Other guidelines related to fat intake are similar to those suggested for the general population: saturated fat should be less than 10 percent of total kcalories and trans fat intake should be as low as possible. Protein recommendations for people with diabetes are similar to those for the general population. Although several small short-term studies have suggested that higher protein levels (28 to 40 percent of total kcalories) may improve glycemic control or lipoprotein levels in diabetic individuals, other studies did not show any benefit. Guidelines for alcohol intake are similar to those for the general population, which recommend that women and men limit their average daily intakes of alcohol to 1 drink and 2 drinks per day, respectively. In addition, individuals using insulin or medications that promote insulin secretion should consume food when they ingest alcoholic beverages to avoid hypoglycemia. Conversely, an excessive alcohol intake (3 or more drinks per day) can worsen hyperglycemia and raise triglyceride levels in some individuals. 86. Explain the relationship of body weight and type 2 diabetes. ANSWER: Because excessive body fat can worsen insulin resistance, weight loss is recommended for overweight or obese individuals who have diabetes. Even moderate weight loss (5–10 percent of body weight) can help to improve insulin resistance, glycemic control, blood lipid levels, and blood pressure. Weight loss is most beneficial early in the course of diabetes, before insulin secretion has diminished. Not all persons with type 2 diabetes are overweight or obese. Older adults and those in long-term care facilities are often underweight and may need to gain weight. Low body weight increases risks of morbidity and mortality in these individuals. 87. Describe the variations in insulin preparations available for the treatment of diabetes. ANSWER: The forms of insulin that are commercially available differ by their onset of action, timing of peak activity, and duration of effects. Insulin preparations vary in how they are classified: they may be rapid acting (lispro, aspart, glulisine, and inhaled insulin), short acting (regular), intermediate acting (NPH), or long acting (glargine, detemir), thereby allowing substantial flexibility in establishing a suitable insulin regimen. The rapid- and short-acting insulins are typically used at mealtimes, whereas the intermediateand long-acting insulins provide basal insulin for the periods between meals and during the night. Mixtures of several types of insulin can produce greater glycemic control than any one type alone. Some premixed formulations are also available.

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Chapter 26- Diabetes Mellitus 88. Describe the different methods of insulin delivery available to people with diabetes. ANSWER: Insulin is most often administered by subcutaneous injection, either self-administered or provided by caregivers (note that insulin is a protein, and would be destroyed by digestive processes if taken orally). Disposable syringes, which are filled from vials that contain multiple doses of insulin, are the most common devices used for injecting insulin. Another option is to use insulin pens, injection devices that resemble permanent marking pens. Disposable insulin pens are prefilled with insulin and used one time only, whereas reusable pens can be fitted with prefilled insulin cartridges and replaceable needles. To eliminate the need for multiple punctures, injection ports for insulin are sometimes inserted through the skin and left in place for several days. Some individuals use insulin pumps, computerized devices that infuse insulin through thin, flexible tubing that remains in the skin; the pump can be attached to a belt or kept in a pocket. Some of the newer insulin pumps include built-in continuous glucose monitoring systems. A rapid-acting inhalation powder (called Afrezza) is available for use before meals. Because it cannot be used by individuals with lung disease, patients may require serial lung function testing prior to and after starting therapy with this form of insulin. 89. Discuss sick-day management for people with diabetes. ANSWER: Illness, infection, or injury can cause hormonal changes that raise blood glucose levels and increase the risk of developing diabetic ketoacidosis or the hyperosmolar hyperglycemic syndrome. During illness, patients with diabetes should measure blood glucose and ketone levels several times daily. They should continue to use antidiabetic drugs, including insulin, as prescribed; adjustments in dosages may be necessary if they alter their diet or have persistent hyperglycemia. If patients use over-the-counter drugs, they should be cautioned that some types of drugs may raise blood glucose levels or interact with antidiabetic drugs. During illness, individuals with diabetes should consume their usual diet, if possible. If appetite is poor, they should select easy-to-manage foods and beverages that provide the prescribed amount of carbohydrate at each meal. Foods that are easily tolerated include toast, crackers, soup, yogurt, fruit, fruit juices, frozen juice bars, and carbohydrate-sweetened beverages. To prevent dehydration, especially if vomiting or diarrhea is present, patients should make sure they consume adequate amounts of liquids throughout the day. 90. Discuss how diabetes develops as a consequence of pregnancy and the potential consequences for both mother and fetus. ANSWER: Women with diabetes face new challenges during pregnancy. Due to hormonal changes, pregnancy increases insulin resistance and the body’s need for insulin, so maintaining glycemic control may be more difficult. In addition, 4 to 14 percent of nondiabetic women in the United States develop gestational diabetes (the prevalence depends on the patient population). Women with gestational diabetes are at greater risk of developing type 2 diabetes later in life, and their children are at increased risk of developing obesity and type 2 diabetes as they enter adulthood. A pregnancy complicated by diabetes increases health risks for both mother and fetus. Uncontrolled diabetes is linked with increased incidences of miscarriage, birth defects, and fetal deaths. Newborns are more likely to suffer from respiratory distress and to develop metabolic problems such as hypoglycemia, hypocalcemia, and jaundice. Women with diabetes often deliver babies with macrosomia, which makes delivery more difficult and can result in birth trauma or the need for a cesarean section. Macrosomia results because maternal hyperglycemia induces excessive insulin production by the fetal pancreas, which stimulates growth and fat deposition.

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Chapter 27- Cardiovascular Diseases 1. What is the term for the accumulation of fatty deposits, smooth muscle cells, and fibrous connective tissue in the walls of blood vessels? a. Plaque b. platelets c. thrombosis d. embolism ANSWER: a 2. When a blood clot or an air bubble travels in the bloodstream and obstructs the blood vessel, causing sudden tissue death, it is called a(n) . a. embolism b. platelet c. aneurysm d. thrombus ANSWER: a 3. The subtle damage caused by disturbed blood flow initially leads to which response in the beginning stages of atherosclerosis? a. inflammation b. platelet aggregation c. enzyme accumulation d. foam cell development ANSWER: a 4. Which of the following lipoproteins becomes oxidized before they are engulfed by macrophages? a. chylomicrons b. very-low-density lipoproteins (VLDLs) c. low-density lipoproteins (LDLs) d. high-density lipoproteins (HDLs) ANSWER: c 5. Elevated levels of the amino acid for atherosclerosis. a. proline b. leucine c. homocysteine d. valine

impairs endothelial cell function in the heart, thereby increasing the risk

ANSWER: c

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Chapter 27- Cardiovascular Diseases 6. The stress of blood flow along the artery walls is known as a. shear stress b. metabolic stress

c. inflammatory stress d. thrombotic stress ANSWER: a 7. Which of the following best describes lipoprotein(a)? a. a lipoprotein that transports triglycerides to the liver b. a variant form of LDL that speeds the progression of atherosclerosis c. a lipoprotein that removes cholesterol from the bloodstream d. a compound that is formed after glucose combines with protein ANSWER: b 8. Arterial macrophages engulf oxidized LDL and become a. foam cells b. a thrombus c. an embolus d. clots

ANSWER: a 9. Impaired blood circulation in the legs that can cause severe pain and weakness while walking is called a. angina pectoris b. shearing c. intermittent claudication d. an aneurysm

ANSWER: c 10. The most common cause of aneurysms (abnormal dilation of blood vessels) is a. genetic defects b. external injury

c. advancing age d. atherosclerosis ANSWER: d

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Chapter 27- Cardiovascular Diseases 11. In women, high risk of coronary heart disease occurs when HDL levels are below a. 50 b. 125

c. 175 d. 200 ANSWER: a 12. What is a nonmodifiable risk factor for CHD? a. diabetes mellitus b. male sex c. alcohol overconsumption d. low HDL cholesterol ANSWER: b 13. Ms. Thomas has blood work done as ordered by her physician. Her total cholesterol level is 240 mg/dL and HDL 35 mg/dL. Ms. Thomas's total cholesterol and HDL indicate that she . a. has a desirable blood lipid profile b. is at borderline risk for CHD c. is at high risk for CHD d. requires more testing ANSWER: c 14. What condition significantly decreases the risk for cardiovascular disease? a. elevated levels of C-reactive protein b. metabolic syndrome c. LDL cholesterol less than 100 mg/dl d. High coronary calcium score ANSWER: c 15. Medications most often prescribed for reducing LDL levels include a. aspirin b. antihypertensives c. statins d. diuretics

ANSWER: c

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Chapter 27- Cardiovascular Diseases 16. About of plant sterols or stanols daily can lower cholesterol by 5 to10%. a. 500 milligrams b. 2 grams c. 5 grams d. 8 grams ANSWER: b 17. Martha has been advised to limit trans fats in her diet. Which snack food would most likely be excluded? a. chocolate b. skim milk c. Corn chips d. Poached egg ANSWER: c 18. What type of physical activity would provide the greatest benefits in lowering risk factors for CHD? a. horseback riding b. brisk walking c. bicep curls d. sit-ups ANSWER: b 19. The American Heart Association recommends eating at least reduction. a. two b. three c. four d. five

servings of fatty fish per week for CHD risk

ANSWER: a 20. What describes the relationship of over-the-counter (OTC) fish oil supplements to the treatment of hypertriglyceridemia? a. OTC supplements typically provide 4 g of combined eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA) per capsule. b. OTC supplements provide small amounts of EPA/DHA, requiring the use of 10 to13 capsules daily. c. OTC supplements contain so much EPA and DHA that the patient would be at risk for toxicity. d. OTC supplements provide enough EPA and DHA, but they may cause depression and should be avoided ANSWER: b

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Chapter 27- Cardiovascular Diseases 21. One of the medications given for coronary heart disease prevention is the anticoagulant warfarin. Patients taking warfarin should be told to . a. avoid vitamin D supplements, as they may increase the effects of warfarin b. consume a moderate amount (two drinks for women, three for men) of alcohol daily c. keep their vitamin K intake consistent d. avoid antacids, as they may decrease the effectiveness of warfarin ANSWER: c 22. What is an example of a bile acid sequestrant medication? a. Lipitor b. Repatha c. Colestid d. Crestor ANSWER: c 23. Following a heart attack, what type of diet would a patient most likely require? a. low-carbohydrate diet b. neutropenic diet c. low-fiber diet d. sodium-restricted diet ANSWER: d 24. The main source of trans fat in baked goods is a. Coconut oil b. eggs c. partially hydrogenated vegetable oil d. canola oil

ANSWER: c 25. Which food is a good source of unsaturated fats? a. avocados b. palm kernel oil c. cheese d. organ meats ANSWER: a

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Chapter 27- Cardiovascular Diseases 26. Hemorrhagic strokes occur in about a. 5 b. 13

percent of cases.

c. 56 d. 87 ANSWER: b 27. Which individual is at the highest risk for stroke? a. a 55-year-old Caucasian with a family history of heart disease b. a 65-year-old African American with a history of hypertension c. a 55-year-old Asian with a family history of osteoporosis d. a 45-year-old Caucasian with a family history of diabetes ANSWER: b 28. Harry has a doctor’s appointment for his annual physical. The doctor has determined that Harry is at risk for a stroke and prescribes a(n) . a. anticoagulant b. statin c. diuretic d. low-sodium diet ANSWER: a 29. Which type of program would most likely be provided to facilitate rehabilitation after a stroke? a. physical therapy b. smoking cessation classes c. fitness training d. stress management ANSWER: a 30. Ideally, thrombolytic drugs should be used within a. 4.5 b. 5.5 c. 6.5

hours following an ischemic stroke.

d. 7.5 ANSWER: a

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Chapter 27- Cardiovascular Diseases 31. Following stroke, rehabilitation programs typically begin a. within 24 hours after the stroke b. as soon as possible after stabilization

c. 48 hours after stabilization d. 72 hours after stabilization ANSWER: b 32. What is the significance of a transient ischemic attack (TIA)? a. It is a warning sign that a severe stroke may follow b. It causes permanent damage to the neurological system. c. It requires intravenous tissue plasminogen activator. d. It requires frequent monitoring but no other treatment. ANSWER: a 33. Which blood pressure reading is indicative of prehypertension? a. 117/80 mm Hg b. 125/80 mm Hg c. 140/90 mm Hg d. 140/80 mm Hg ANSWER: b 34. Hypertension affects nearly a. one-fourth b. one-third c. one-half d. two-thirds

of adults in the United States.

ANSWER: c 35. Which condition has been identified as a nonmodifiable contributing risk factor for hypertension? a. obesity b. body mass index (BMI) >30 c. genetics d. alcoholism ANSWER: c

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Chapter 27- Cardiovascular Diseases 36. Dietary strategies for improving hypertension includes decreasing intake of foods containing intake of foods containing . a. calcium; iron b. sodium; potassium c. potassium; sodium d. zinc; chloride

and increasing

ANSWER: b 37. Dietary guidelines for the management of hypertension emphasize a. avoidance of calcium-rich foods b. a diet rich in fresh fruits and vegetables c. 6 oz of wine per day d. avoidance of starchy foods

ANSWER: b 38. Hypertension caused by a known physical or metabolic disorder is termed a. primary b. secondary c. essential d. regulatory

hypertension.

ANSWER: b 39. Which medication is prescribed to treat hypertension? a. nicotinic acid b. diuretics c. thrombolytics d. biguanides ANSWER: b 40. What is a primary risk factor associated with the development of hypertension? a. age between 35 and 45 years b. high vegetable intake c. Asian ethnicity d. heavy alcohol intake ANSWER: d

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Chapter 27- Cardiovascular Diseases 41. Which medication reduces blood pressure by reducing blood volume? a. diuretics b. angiotensin-converting enzyme (ACE) inhibitors c. beta blockers d. calcium channel blockers ANSWER: a 42. Which medication reduces blood pressure by promoting vasodilation? a. diuretics b. ACE inhibitors c. beta blockers d. calcium channel blockers ANSWER: d 43. Participation in 90 to 150 minutes of moderate-to-vigorous aerobic activity in addition to three sessions of resistance training each week can potentially result in a decrease in systolic blood pressure of mm Hg. a. 1 to 2 b. 2 to 3 c. 4 to 8 d. 9 to 11 ANSWER: c 44. The DASH Eating Plan limits total cholesterol to less than a. 150 b. 200 c. 300 d. 350

mg per day.

ANSWER: a 45. According to the DASH Eating Plan, a person on a 2000-kcal diet should include how many servings of milk products each day? a. 2 to 3 b. 3 to 4 c. 4 to 5 d. 5 to 6 ANSWER: a

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Chapter 27- Cardiovascular Diseases 46. Which dietary intervention would be most successful in reducing sodium intake? a. selecting mostly packaged foods and canned goods b. drinking 1 to 3 glasses of water each night before bed c. substituting chicken broth for wine, milk, or water in recipes d. avoiding putting salt on foods while at the table ANSWER: d 47. Left-sided heart failure often leads to a. pulmonary edema b. ascites c. esophageal varices d. gastroparesis

ANSWER: a 48. The term for severe malnutrition characterized by significant weight loss and tissue wasting associated with end-stage heart failure is . a. cardiac cachexia b. anorexia nervosa c. dyspnea d. tachycardia ANSWER: a 49. When patients have edema associated with chronic heart failure, physicians usually order a. cholesterol restriction and bile acid sequestrants b. saturated fat restriction and corticosteroids c. sodium restriction and diuretics d. carbohydrate restriction and insulin

ANSWER: c 50. Generally, patients with heart failure benefit from a daily sodium restriction of a. 1 to 1.25 b. 1.5 to 3 c. 3.5 to 4

d. 4.5 to 5 ANSWER: b

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Chapter 27- Cardiovascular Diseases 51. Ms. Conley has congestive heart failure with liver enlargement. What should she avoid? a. liquid supplements b. high-fiber foods c. alcohol d. exercise ANSWER: c 52. Mr. Silvestri is not able to grasp his utensils, nor can he feed himself. Which professional can best help him? a. registered dietitian b. registered nurse c. occupational therapist d. physical therapist ANSWER: c 53. Which of the following health care professionals evaluates the chewing and swallowing abilities of patients? a. registered diet technician b. registered dietitian c. speech-language pathologist d. physical therapist ANSWER: c 54. What feeding intervention would be most appropriate for a patient with impaired vision a. helping the patient assume the correct posture while eating b. placing foods between teeth to promote chewing c. providing plates with food guards to prevent spilling d. making sure the patient’s lips and jaw are closed while chewing ANSWER: c 55. Which type of utensil may be helpful for an individual with extreme muscle weakness? a. rocker or roller knives b. flatware with built-up handles c. flatware with modified handle d. weighted utensils ANSWER: c

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Chapter 27- Cardiovascular Diseases 56. Michael, who was right-handed, suffered the traumatic amputation of his right arm below the elbow in an industrial accident. Which item may help him feed himself independently? a. rocker or roller knives b. flatware with built-up handles c. flatware with modified handle d. weighted utensils ANSWER: a 57. Tina has uncontrolled tremors as a result of traumatic brain injury. Which item may help her feed herself independently? a. rocker or roller knives b. flatware with built-up handles c. flatware with modified handle d. weighted utensils ANSWER: d 58. Doyle experiences limited neck motion because of degenerative disc disease. Which item may help him drink beverages? a. cut-out plastic cup b. slotted cup c. two-handed cup d. covered cup ANSWER: a 59. Monica is extremely weak following a bone marrow transplant to treat her cancer. She is anxious to regain her independence. Which item may help her drink beverages? a. cut-out plastic cup b. slotted cup c. two-handed cup d. covered cup ANSWER: c

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Chapter 27- Cardiovascular Diseases Margaret Leland is 76 years old; she is retired and lives alone. Her only daughter lives two hours away. She has a history of heart attack, smoking for 20 years, hypertension, and type 2 diabetes. She reports decreased appetite and disinterest in food. 60. Ms. Leland is admitted to the cardiac unit with shortness of breath and pulmonary edema. What is the most likely diagnosis? a. stroke b. heart failure c. chronic obstructive pulmonary disease d. myocardial infarction ANSWER: b Margaret Leland 61. Which medication is appropriate to improve Ms. Leland's fluid status? a. diuretic b. vasodilator c. insulin d. anticoagulant ANSWER: a 62. Ms. Leland has developed constipation. What nutrition intervention is most appropriate? a. high-calorie, high-protein diet b. low-sodium diet c. low-carbohydrate diet d. high-fiber diet ANSWER: d 63. Ms. Leland is discharged from the hospital and returns for her follow-up appointment reporting continued severe constipation. What is likely contributing to her constipation? a. increased activity b. diuretic usage c. increased intake of food d. increased intake of water ANSWER: b

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Chapter 27- Cardiovascular Diseases 64. Over time, Ms. Leland suffers from cardiac cachexia, and the physician will most likely order her nutritional needs. a. enteral or parenteral nutrition b. high carbohydrate low fat diet c. mechanically altered diet d. low-carbohydrate diet

to help meet

ANSWER: a Margaret Leland 65. The prognosis for cardiac cachexia is a. generally good b. fair c. fair, with prompt intervention d. poor

ANSWER: d Brian Schmidt is a 58-year-old lawyer with a history of hypertension. His blood pressure has been under fairly good control with prescription medication. His secretary notices that he had a period of confusion and difficulty speaking at a meeting. She advises him to see his doctor. 66. What best explains Brian’s symptoms? a. transient ischemic attack b. myocardial infarction c. hypoglycemia d. thrombosis ANSWER: a

67. Brian ignores these warning signs and does not see his physician. Eight months later, Brian’s son finds him lying on the floor of his bathroom. Brian most likely has . a. heart failure b. angina c. suffered a stroke d. an acutely bleeding ulcer ANSWER: c

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Chapter 27- Cardiovascular Diseases

68. The physician informs the family that Brian has an obstruction of blood flow to the brain, also known as a. a myocardial infarction b. angina c. a hemorrhagic stroke

d. an ischemic stroke ANSWER: d

69. Brian is stable and will be transferred to a rehabilitation center. He has developed dysphagia as a result of his stroke. What is the best way to meet his nutritional needs? a. Apply downward pressure to the tongue with a spoon. b. Provide plates with food guards. c. Provide thickened liquids and pureed foods. d. Place foods in similar locations on the plate at each meal. ANSWER: c 70. As Brian recovers his diet is progressively advanced. The dietitian recommends that he follow the DASH Eating Plan. This eating plan promotes intake of foods that are a. high in potassium, calcium, and magnesium, and low in sodium b. low in fiber and potassium, and high in sodium and calcium c. low in sodium and contain no more than 250 mg of cholesterol per day d. high in calcium and fluoride, and low in iron and magnesium ANSWER: a Match each word or phrase with the most appropriate definition or explanation. a. myocardial infarction b. cerebrovascular accident c. plaque d. thrombosis e. embolism f. ischemia g. angina pectoris h. aneurysm i. heart failure j. cardiac cachexia k. transient ischemic attack l. ischemic stroke m. hemorrhagic stroke Page 15

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Chapter 27- Cardiovascular Diseases n. embolus o. thrombus 71. the obstruction of a blood vessel by an embolus, causing sudden tissue death ANSWER: e 72. causes damage when bleeding within the brain destroys or compresses brain tissue ANSWER: m 73. severe malnutrition associated with heart failure that causes weight loss and tissue wasting ANSWER: j 74. an abnormal accumulation of fatty deposits, smooth muscle cells, and fibrous connective tissue in blood vessels ANSWER: c 75. sudden tissue death caused by blockages of blood vessels that feed the heart muscle ANSWER: a 76. an abnormal particle, like a blood clot or air bubble, that travels in the blood ANSWER: n 77. abnormal enlargement or bulging of a blood vessel (usually an artery) caused by damage to or weakness in the blood vessel wall ANSWER: h 78. causes injury when blood flow within brain tissue is obstructed ANSWER: l 79. temporary reduction in blood flow to the brain, which causes temporary symptoms that vary depending on the part of the brain affected ANSWER: k 80. inadequate blood supply to tissues due to obstructed blood flow through arteries ANSWER: f 81. an injury to brain tissue due to disturbed blood flow through arteries that supply blood to the brain ANSWER: b 82. the formation or presence of a blood clot in vessels ANSWER: d 83. a blood clot formed within a blood vessel that remains attached to its place of origin ANSWER: o 84. condition caused by ischemia in the heart muscle that results in discomfort or dull pain in the chest region; the pain often radiates to the left shoulder and arm, or to the back, neck, and lower jaw ANSWER: g Page 16

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Chapter 27- Cardiovascular Diseases 85. failure of the heart to pump adequate blood, resulting in fluid congestion in tissues and veins leading to the heart ANSWER: i 86. What is the interrelationship between atherosclerosis and hypertension? ANSWER: The stress of blood flow along artery walls—called “shear stress”—can cause physical damage to arteries. (Disturbed blood flow can be harmful to endothelial cells, whereas regular blood flow is protective.) Hypertension intensifies the stress of blood flow on arterial tissue, provoking a low-grade inflammatory state that may stimulate plaque formation or progression. 87. Describe when it might be appropriate to initiate drug therapy for people with CHD. What types of drug therapies are used? ANSWER: Individuals who cannot improve CHD risk with dietary and lifestyle changes alone may be prescribed one or more medications. The drugs most often prescribed for lowering LDL levels are the statins (such as Lipitor and Crestor), which reduce cholesterol synthesis in the liver. The medication ezetimide (Zetia) reduces cholesterol levels by inhibiting cholesterol absorption. Bile acid sequestrants (such as Colestid or Questran) reduce LDL levels by interfering with bile acid reabsorption in the small intestine. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (such as Praluent and Repatha) are injectable medications that lower LDL by enhancing the liver’s ability to remove cholesterol from the blood. For lowering triglyceride levels and increasing HDL, both fibrates (such as Lopid and Tricor) and nicotinic acid (a form of niacin) are effective; nicotinic acid can also reduce LDL and lipoprotein(a) levels. Individuals using these medications should continue their dietary and lifestyle modifications so that they can use the minimum effective doses of the drugs they require. 88. Discuss the nutritional concerns associated with patients who have suffered a stroke. ANSWER: The focus of nutrition care is to help patients maintain nutrition status and overall health despite the disabilities caused by the stroke. The initial assessment should determine the nature of the patient’s selffeeding difficulty (if any) and the adjustments required for appropriate food intake. Some patients may need to learn about dietary treatments that improve blood lipid levels and blood pressure. Dysphagia (difficulty swallowing) is a frequent complication and is associated with a poorer prognosis. Difficulty with speech may prevent patients from communicating food preferences or describing the problems they may be having with eating. Coordination problems can make it hard for patients to grasp utensils or bring food from table to mouth. In some cases, tube feedings may be necessary until the patient has regained these skills. 89. Describe risk factors for stroke that can be modified and how. ANSWER: Stroke is largely preventable by recognizing its risk factors and making lifestyle choices that reduce risk. Many of the risk factors are similar to those for heart disease and include hypertension, elevated LDL cholesterol, diabetes mellitus, cigarette smoking, physical inactivity, aging, and previous cardiovascular disease. Medications that suppress blood clotting reduce the risk of ischemic stroke, especially in people who have suffered a first stroke or a transient ischemic attack. The drugs prescribed are usually antiplatelet drugs (including aspirin) and anticoagulants such as warfarin (Coumadin). Anticoagulant therapy requires regular follow-up and occasional adjustments in dosage to prevent excessive bleeding.

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Chapter 27- Cardiovascular Diseases 90. List four feeding-related problems and describe corresponding interventions. ANSWER: Adaptive feeding devices can make a remarkable difference in a person’s ability to eat independently. A person with an inability to suck may use squeeze bottles to express liquids into the mouth; the tongue can also be stimulated with a spoon by applying downward pressure or slow, rhythmic strokes to stimulate sucking. Someone with an inability to chew may try different textures of foods or eat very soft foods that require minimal chewing. A person with dysphagia can use thickened liquids, pureed foods, and moist foods that form boluses to facilitate easier swallowing; sitting upright with correct posture and head position can help to promote swallowing as well. Someone with inability to grasp or coordinate movements can use utensils with modified handles or plates with food guards to make feeding easier.

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Chapter 28- Kidney Diseases 1. What best describes the function of the ureter? a. storing urine before it is excreted b. Conducting urine from the kidneys to the bladder c. transporting urine from the bladder to out side of the body d. carrying blood from the kidneys back to the heart ANSWER: b 2. What hormone secreted by the kidneys stimulates the production of red blood cells? a. erythropoietin b. renin c. aldosterone d. vasopressin ANSWER: a 3. To regulate blood pressure, the kidneys secrete a. aldosterone b. erythropoietin c. renin d. vasopressin

ANSWER: c 4. The cuplike component of the nephron that surrounds the glomerulus and collects the filtrate is called “ a. Bowman’s capsule b. the ureter c. the collecting duct d. the tubule

.”

ANSWER: a 5. In the nephrotic syndrome, the kidney’s ability to excrete a. potassium b. sodium c. renin

is impaired, contributing to edema.

d. calcium ANSWER: b

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Chapter 28- Kidney Diseases 6. A consequence of the nephrotic syndrome is the loss of plasma proteins in the urine, which contributes to a. an increased risk of blood clotting b. a fluid shift from interstitial spaces to blood plasma

c. an increased risk of vitamin D toxicity d. Anabolic buildup of muscle mass ANSWER: a 7. Daniel is a 10-year-old boy who has just been diagnosed with the nephrotic syndrome. Which condition might he develop as a result? a. beriberi b. pellagra c. anemia d. rickets ANSWER: d 8. Nutrition therapy for the nephrotic syndrome focuses on . a. increasing the fat content in the diet b. preventing protein-energy malnutrition and alleviating edema c. high protein and kcalorie intake d. high sodium intake ANSWER: b 9. A high-protein diet for a client with the nephrotic syndrome is contraindicated because . a. protein foods are usually high in fat b. energy requirements are decreased with nephrotic syndrome c. high protein intakes may exacerbate urinary protein losses and further damage the kidney d. protein levels in nephrotic syndrome are not altered ANSWER: c 10. For patients with nephrotic syndrome, the recommended daily protein intake is a. 0.4 to 0.6 b. 0.6 to 0.8 c. 0.8 to 1.0

g/kg of body weight.

d. 1.0 to 1.2 ANSWER: c

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Chapter 28- Kidney Diseases 11. What is the most abundant plasma protein? a. albumin b. immunoglobulins c. vitamin D–binding protein d. transferrin ANSWER: a 12. Billy Lewis is a 20-year-old man admitted to the hospital with the nephrotic syndrome. He is 5 ft 11 in., weighs 192 lb, and has edema. His blood values include albumin 1.7 g/dL, K+ 3.3 mEq/L, and LDL cholesterol 192 mg/dL. He says he is hungry and wants a snack. The most appropriate food choice is . a. a sausage biscuit b. a grilled chicken sandwich with lettuce and tomato c. peanut butter and crackers d. cottage cheese and canned fruit ANSWER: b 13. Diets high in vitamin D and calcium are recommended for children with nephrotic syndrome to prevent a. beriberi b. marasmus c. nephrosclerosis

d. rickets ANSWER: d 14. Daily sodium intake should be restricted to about a. 0.5 to 1.0 b. 1.0 to 2.0

grams for patients with the nephrotic syndrome.

c. 2.0 to 3.0 d. 3.0 to 4.0 ANSWER: b 15. The nephrotic syndrome is associated with accelerated atherosclerosis and a sharply increased risk of heart disease and ____. a. liver disease b. stomach cancer c. stroke d. hypertension ANSWER: c

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Chapter 28- Kidney Diseases 16. In the nephrotic syndrome, urinary protein losses generally average about a. 3 to 3.5 b. 5.5 to 6

grams daily.

c. 9 to 10.5 d. 11 to 12 ANSWER: a 17. Patients with the nephrotic syndrome may benefit from calcium supplementation of a. 500 to 1000 b. 1000 to 1500 c. 1500 to 2000 d. 2000 to 2500

mg daily.

ANSWER: b 18. In patients with the nephrotic syndrome, energy intake of about and spare protein. a. 15 b. 25 c. 35 d. 45

kcal/kg of body weight daily will sustain weight

ANSWER: c 19. One large egg contains about a. 10 b. 40 c. 60

mg of sodium.

d. 200 ANSWER: c 20. Proteinuria due to nephrotic syndrome results in a loss of immunoglobulins, which increases the risk for a. edema b. infection

c. wasting d. hypertriglyceridemia ANSWER: b

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Chapter 28- Kidney Diseases 21. In the nephrotic syndrome, the liver attempts to compensate for the loss in protein by a. decreasing its synthesis of various plasma proteins b. decreasing glomerular permeability

c. increasing albumin levels d. increasing its synthesis of various plasma proteins ANSWER: d 22. Why might patients with the nephrotic syndrome be advised to eat foods that are high in potassium? a. Treatment with certain diuretics results in potassium loss. b. Protein loss is typically accompanied by potassium loss. c. They are unable to properly absorb potassium. d. To reduce bone loss associated with low serum potassium. ANSWER: a 23. Normal urine volume is approximately a. 500 to 1000 b. 1000 to 1500 c. 1500 to 2000 d. 2000 to 2500

mL per day.

ANSWER: b 24. Acute kidney injury is characterized by reduced urine output coupled with a progressive rise in serum a. ammonia b. creatinine c. amino acids d. lipids

levels.

ANSWER: b 25. In patients with reduced urine production, recovery from acute kidney injury begins with a period of large amounts of fluid are excreted. a. catabolism

, in which

b. uremia c. diuresis d. oliguria ANSWER: c

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Chapter 28- Kidney Diseases 26. Hyperkalemia occurs when there is excessive a. calcium b. potassium

in the blood.

c. phosphorus d. vitamin D ANSWER: b 27. Edema that develops with acute kidney injury is most often treated with which type of medication? a. potassium-exchange resins b. phosphate binders c. diuretics d. insulin ANSWER: c 28. What is the percentage of sodium that comes from processed foods, unprocessed natural foods, and table salt respectively? a. 50, 40, 10 b. 75, 10, 15 c. 90, 5, 5 d. 90, 0, 10 ANSWER: b 29. A patient whose height is 5 ft 9 in. and weight 185 lb is admitted to the hospital with acute kidney injury and is started on hemodialysis. What would be the recommended protein intake (in grams) for this patient? a. 40 to 65 b. 60 to 82 c. 84 to 143 d. 150 to 165 ANSWER: c 30. What is a prerenal cause of acute kidney injury? a. heart failure b. sickle cell disease c. diabetes mellitus d. pregnancy ANSWER: a

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Chapter 28- Kidney Diseases 31. What is a postrenal cause of acute kidney injury? a. infection b. nephrotoxic drugs c. pregnancy d. heart attack ANSWER: c 32. What is an intrarenal cause of acute kidney injury? a. food poisoning due to Escherichia coli b. pregnancy c. blood clots d. bladder rupture ANSWER: a 33. Diabetes mellitus causes about a. 35% b. 45% c. 55% d. 65%

of chronic kidney disease cases in the United States.

ANSWER: b 34. What is considered to be the best index of overall kidney function? a. glomerular filtration rate b. albumin levels c. anemia d. renal osteodystrophy ANSWER: a 35. The rate at which filtrate is formed within the kidney is normally about a. 15 b. 60 c. 100 d. 125

mL/min in healthy adults.

ANSWER: d

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Chapter 28- Kidney Diseases 36. A glomerular filtration rate (GFR) of a. <15 b. 15 to 29 c. 30 to 59 d. 60 to 89

mL/min is characteristic of kidney failure.

ANSWER: a 37. Which condition often develops as a result of increased secretion of parathyroid hormone in patients with chronic kidney disease? a. fatty liver disease b. gastroesophageal reflux c. dumping syndrome d. bone loss ANSWER: d 38. A type of skin change that develops due to uremia from chronic kidney disease is a. maceration b. pruritus c. hives d. diaphoresis

ANSWER: b 39. The removal of excess fluids and wastes from the blood using the peritoneum as a semipermeable membrane is called “____.” a. chronic dialysis b. hemodialysis c. peritoneal dialysis d. acute dialysis ANSWER: c 40. The glucose absorbed from the dialysate used in peritoneal dialysis can provide as many as a. 200 b. 400 c. 600 d. 1000

kcalories daily.

ANSWER: c

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Chapter 28- Kidney Diseases 41. Which food is high in phosphorus? a. gelatin b. apple c. chocolate d. fish ANSWER: d 42. Supplements of folic acid prescribed for dialysis patients typically supply a. 1 b. 5 c. 10 d. 20

mg daily.

ANSWER: a 43. Morgan Simmons, a 74-year-old woman, is on hemodialysis. She wants to continue consuming 3 cups of non-fat milk per day. What is the most appropriate response? a. “Continue consuming three cups a day; you need calcium and vitamin D.” b. “Increase your milk intake to four cups per day.” c. “Milk contains phosphorus and too much can be harmful for your medical condition.” d. “Do not drink milk at all. Take the vitamin D and calcium supplements instead.” ANSWER: c 44. Intakes of supplemental vitamin C are restricted to 100 mg/day in patients with chronic renal failure to prevent a. kidney stones b. scurvy c. colds d. hemochromatosis

ANSWER: a 45. Approximately a. 15% b. 20% c. 40%

of patients with end-stage renal disease receive a kidney transplant.

d. 55% ANSWER: b

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Chapter 28- Kidney Diseases 46. Prior to his kidney transplant, John Miller was on dialysis and his sodium intake was restricted to 2000 mg daily. His blood pressure levels have averaged 140/90 mmHg. When Mr. Miller inquires if he should continue to restrict his sodium after his transplant, you reply, . a. “Since your renal function has been restored, you will never need to restrict your sodium intake.” b. “Since your blood pressure is still elevated, you need to restrict your sodium level to 2.0 to 2.4 g/day.” c. “Since you are going to be on diuretics, there is no need to restrict sodium.” d. “Once you are on the immunosuppressants, you will no longer need to restrict sodium intake.” ANSWER: b 47. Which item is a high-potassium food? a. honeydew melon b. watermelon c. avocado d. blueberries ANSWER: c 48. Intradialytic parenteral nutrition . a. combines parenteral nutrition with hemodialysis b. substitutes parenteral nutrition for hemodialysis c. substitutes hemodialysis for parenteral nutrition d. delays the need for hemodialysis by manipulating nutrition ANSWER: a 49. Which interaction is associated with the use of immunosuppressants? a. Alcohol intake has the potential for toxic effects. b. Bioavailability of medication is increased when the drug is taken with food. c. Grapefruit juice can dangerously decrease serum concentrations of the medication. d. Calcium and magnesium supplements must be taken separately. ANSWER: a 50. Which factor would most likely predispose a person to development of kidney stones? a. urinary obstruction b. increased urine volume c. decreased protein intake d. administration of immunosuppressant medications ANSWER: a

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Chapter 28- Kidney Diseases 51. Which item contributes to high uric acid levels? a. oxalate b. purines c. cystine d. magnesium ANSWER: b 52. Struvite stones are composed mainly of a. magnesium ammonium phosphate b. bile acid salts c. urinary citrate d. purines

ANSWER: a 53. What best describes renal colic? a. urination urgency as a result of kidney stone obstruction b. intense pain as a kidney stone passes through the ureter c. a kidney infection that develops due to struvite kidney stones d. crystallized urine that has backed up into the kidneys ANSWER: b 54. The best preventive treatment for all types of kidney stones is to a. drink plenty of fluids b. consume a diet high in berries and juices c. limit plant proteins d. increase vitamin C intake

ANSWER: a 55. The most common method used to evaluate the adequacy of dialysis treatment is a. blood urea nitrogen b. urea kinetic modeling

c. weighing a patient predialysis and postdialysis d. self-report of fluid intake and output ANSWER: b

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Chapter 28- Kidney Diseases 56. What is the most common complication of peritoneal dialysis? a. hypoglycemia b. infection c. hypotension d. hernia ANSWER: b 57. Which treatment is used to dialyze patients with acute kidney injury? a. peritoneal dialysis b. hemodialysis c. continuous renal replacement therapy d. intermittent dialysis ANSWER: c 58. The movement of solutes from an area of high concentration to one of low concentration is known as a. osmosis b. diffusion c. permeability d. oncotic pressure

ANSWER: b 59. What is an advantage of using continuous renal replacement therapy (CRRT)? a. It does not damage arteries b. It does not cause sudden shifts in blood volume c. It does not lead to blood clots. d. It prevents patients from developing hypotension. ANSWER: b 60. One of the most common complications associated with hemodialysis is a. hypertension

b. blood clots c. hyperglycemia d. joint inflammation ANSWER: b

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Chapter 28- Kidney Diseases Charlie is a 2½-year-old boy with a history of asthma and allergies. He is on several maintenance medications. His parents rush him to the emergency department because of increased lethargy, high fever, edema, and foamy urine. His laboratory results reveal proteinuria, hypoalbuminemia, and hyperlipidemia. 61. What is Charlie suffering from? a. cystic fibrosis b. type 1 diabetes c. nephrotic syndrome d. uremic syndrome ANSWER: c Charlie 62. Which part of Charlie's body is malfunctioning and causing this condition? a. beta cells b. neurons c. lymphatic system d. glomerulus ANSWER: d Charlie 63. Which diet is the most appropriate for Charlie? a. high-kcalorie, high-protein b. high-carbohydrate, high-fat c. low-fat, low-carbohydrate d. adequate-protein, low-sodium, low-fat ANSWER: d Charlie 64. Charlie is prescribed calcium and vitamin D supplements to prevent a. fluid retention b. rickets c. osteopenia

d. renal failure ANSWER: b

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Chapter 28- Kidney Diseases Charlie 65. Which meal is most appropriate for Charlie? a. low-fat milk, fried chicken strips, ketchup, French fries, and sliced apples b. apple juice, shrimp fried rice, duck sauce, and spring roll c. grape juice, canned chicken noodle soup, cheeseburger with ketchup, and fruit cup d. low-fat milk, grilled chicken, rice pilaf, and sliced pears ANSWER: d Jasmine Singh is 25 years old. She has had hypercalciuria due to elevated serum levels of parathyroid hormone over the past year. She makes an appointment with her physician after an episode of nausea, vomiting, severe pain in the groin, and pain while urinating. 66. At her doctor’s office, Jasmine provides a urine sample. Testing confirms blood in her urine. This indicates . a. renal colic b. hematuria c. acute kidney injury d. ketones ANSWER: b Jasmine Singh 67. Jasmine has been diagnosed with a kidney stone. The blood in Jasmine’s urine is most likely a result of a. damage from the stone passing through the ureter b. irritation of the lining of the rectum c. infection from the stone obstructing the convoluted tubules

d. ketones in the urine from elevated glucose ANSWER: a Jasmine Singh 68. Due to her history of hypercalciuria, Jasmine most likely has a. struvite b. cystine c. uric acid

stones.

d. calcium oxalate ANSWER: d

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Chapter 28- Kidney Diseases Jasmine Singh 69. Which dietary factors are most important to prevent kidney stones in Jasmine’s case? a. adequate calcium, moderate protein, controlled sodium b. high protein/high kcalorie with fluid restriction c. low purine with plenty of fluids d. low protein with fluid restriction ANSWER: a Jasmine Singh 70. During flu season Jasmine wants to take high-dose vitamin C supplements as prophylaxis. What is the most appropriate response? a. Take 2000-mg vitamin C supplements twice daily b. Take a combination of vitamin C supplements and food sources of vitamin C c. Avoid vitamin C supplements, since they degrade to oxalate, which increases the risk for stones d. Take high-dose vitamin D supplements along with vitamin C ANSWER: c Match each word or phrase with the most appropriate definition or explanation. a. Cystinuria b. Renal osteodystrophy c. Uremic syndrome d. Hyperkalemia e. Hypercalcemia f. Hypercalciuria g. Hyperoxaluria h. Struvite i. Renal colic j. Gout k. Hematuria l. Purines m. Hemodialysis n. peritoneal dialysis o. continuous renal replacement therapy 71. elevated serum potassium levels ANSWER: d 72. excessive amounts of oxalate in the urine ANSWER: g

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Chapter 28- Kidney Diseases 73. metabolic disorder that results in excessive uric acid in the blood and urine, and uric acid deposits in and around the joints causing acute joint inflammation ANSWER: j 74. excessive amounts of calcium in the urine ANSWER: f 75. genetic disorder characterized by elevated urinary excretion of several amino acids, including cysteine ANSWER: a 76. bone disorder in patients with chronic renal failure as a result of increased parathyroid hormone secretion, reduced serum calcium, acidosis, and impaired vitamin D activation by the kidney ANSWER: b 77. crystals of magnesium ammonium phosphate ANSWER: h 78. slow, continuous method of removing solutes and fluid from blood by gently pumping blood across a filtration membrane over a prolonged period of time ANSWER: o 79. blood in the urine ANSWER: k 80. cluster of symptoms associated with inadequate kidney function; complications include fluid, electrolyte and hormonal imbalances, altered heart function, neuromuscular disturbances, and reduced immunity ANSWER: c 81. severe, stabbing pain that occurs when a kidney stone passes through the ureter ANSWER: i 82. elevated serum calcium levels ANSWER: e 83. end products of nucleotide metabolism that eventually degrade to uric acid ANSWER: l 84. removal of fluids and wastes from blood by passing the blood through a dialyzer ANSWER: m 85. removal of fluids and wastes by using the peritoneal membrane as a filter ANSWER: n

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Chapter 28- Kidney Diseases 86. Discuss three of the roles of the kidneys in maintaining our health. ANSWER: The kidneys filter the blood to eliminate excess fluids and wastes in urine. They help to regulate blood pressure by secreting the enzyme renin. Renin catalyzes the formation of angiotensin I from the plasma protein angiotensinogen. In the lungs and elsewhere, angiotensin I is converted to angiotensin II, a potent vasoconstrictor that narrows the diameters of arterioles and thereby raises blood pressure. Angiotensin II also stimulates the release of aldosterone, an adrenal hormone that induces the kidneys to increase reabsorption of sodium and water; this increases plasma volume, which raises blood pressure. The kidneys produce the hormone erythropoietin, which stimulates the production of red blood cells in the bone marrow. The kidneys convert vitamin D to its active form, thereby helping to regulate calcium balance and bone formation. 87. Explain the nephrotic syndrome and the diet modifications used to treat it. ANSWER: The nephrotic syndrome is not a specific disease; rather, the term refers to a syndrome caused by significant urinary protein losses that result from severe glomerular damage. The condition arises because damage to the glomeruli increases their permeability to plasma proteins, allowing the proteins to escape into the urine. The loss of these proteins (typically more than 3 to 3.5 g daily) may cause serious consequences, including edema, blood lipid abnormalities, blood coagulation disorders, and infections. In some cases, the nephrotic syndrome can progress to renal failure. Nutrition therapy can help to prevent PEM, alleviate edema, and correct lipid abnormalities. Meeting protein and energy needs helps to minimize the loss of muscle tissue. High-protein diets are not advised because they can exacerbate urinary protein losses and result in further damage to the kidneys. Instead, the protein intake should fall between 0.8 and 1.0 g/kg of body weight per day; at least half of the protein consumed should come from high-quality sources, such as milk products, meat, fish, poultry, eggs, and soy products. An adequate intake (up to 35 kcal/kg of body weight daily) sustains weight and spares protein. Controlling sodium intake helps to control edema; therefore, the sodium intake may be limited to 1000 to 2000 mg (1 to 2 g) daily. If diuretics prescribed for the edema cause potassium losses, patients are encouraged to select foods rich in potassium. A diet low in saturated fat, trans fats, and refined sugars may help to control elevated blood lipids. Dietary measures are usually inadequate for controlling blood lipids, and physicians may prescribe lipid-lowering medications as well. In some cases, treating the underlying cause of nephrotic syndrome is sufficient for correcting the lipid disorders. Multivitamin–mineral supplementation can help patients avoid nutrient deficiencies; nutrients at risk include iron and vitamin D. 88. Explain how chronic kidney disease can lead to cardiovascular complications. ANSWER: Fluid and electrolyte imbalances result in hypertension, arrhythmias, and eventually heart muscle enlargement. Excessive parathyroid hormone secretion leads to calcification of arteries and heart tissue. Patients with uremia are at increased risk of stroke, heart attack, and heart failure. 89. Describe the events leading to the development of bone disease in patients with chronic kidney disease. ANSWER: Increased secretion of parathyroid hormone helps to prevent elevations in serum phosphate but contributes to bone loss and the development of renal osteodystrophy, a bone disorder common in renal patients. Electrolyte imbalances are likely when the GFR is very low (below 5 mL/min), when hormonal adaptations are inadequate, or when intakes of water or electrolytes are either very restricted or excessive. Because the kidneys are responsible for maintaining acid–base balance, acidosis often develops in chronic kidney disease. Although usually mild, the acidosis exacerbates renal bone disease because compounds in bone (e.g., protein and phosphates) are released to buffer the acid in blood. Page 17

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Chapter 28- Kidney Diseases 90. A client is diagnosed with calcium oxalate kidney stones. What is the appropriate diet therapy for her treatment? ANSWER: Most dietary strategies and drug treatments for calcium oxalate stones aim to reduce urinary calcium and oxalate levels. Dietary measures may include adjustments in calcium, oxalate, protein, and sodium intakes. Patients should consume adequate calcium from food sources (about 800 to 1200 mg per day) because dietary calcium combines with oxalate in the intestines, reducing oxalate absorption and helping to control hyperoxaluria. Conversely, low-calcium diets promote oxalate absorption and higher urinary oxalate levels. Some individuals with hyperoxaluria may benefit from dietary oxalate restriction. Vitamin C intakes should not exceed the RDA (90 and 75 mg for men and women, respectively) because vitamin C degrades to oxalate. High intakes of protein (especially from meat, fish, poultry, or eggs) and sodium increase urinary calcium excretion, so moderate protein consumption (0.8 to 1.0 g/kg of body weight per day) and a controlled sodium intake (no more than about 2000 to 3000 mg daily) are also advised. Patients with hypocitraturia are usually advised to reduce intakes of animal proteins and increase intakes of fruits and vegetables.

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Chapter 29- Cancer and HIV Infection 1. Cancer ranks number a. one b. two

among the leading causes of death in the United States.

c. three d. four ANSWER: b 2. The type of cancer that arises from white blood cell precursors is a. carcinoma b. glioma c. leukemia d. melanoma

ANSWER: c 3. Melanoma is a type of cancer that arises from a. pigmented skin cells b. lymph tissues c. epithelial tissues d. glandular tissues

ANSWER: a 4. A new growth of tissue that forms an abnormal mass with no physiological function is a a. carcinogen b. tumor c. benign mass d. metastasis

ANSWER: b 5. The first step in the development of cancer is alter gene expression and induce abnormal cell division. a. carcinogenesis b. promotion c. initiation

, which results in the formation of genetic mutations that

d. metastasis ANSWER: c

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Chapter 29- Cancer and HIV Infection 6. Toxins found in moldy grains and peanuts are most commonly associated with which type of cancer? a. liver b. leukemia c. bladder d. breast ANSWER: a 7. Which food or beverage may decrease risk for colon cancer? a. T-bone steak b. beer c. bologna d. milk products ANSWER: d 8. Larry has a family history of prostate cancer and wants to decrease his chances of getting it. Which food item may decrease the risk of prostate cancer? a. milk b. pork chops c. tomatoes d. oranges ANSWER: c 9. There is evidence that an adequate intake of pharynx, and larynx. a. meat b. fruits and vegetables c. unsaturated fat d. protein

protects against the development of cancers of the lung, mouth,

ANSWER: b 10. About 1 in a. 5 b. 10 c. 30 d. 50

cancer deaths can be attributed to alcohol consumption.

ANSWER: c

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Chapter 29- Cancer and HIV Infection 11. To minimize carcinogen formation during cooking, a. use high-heat options, such as an outdoor grill b. marinate meat before cooking

c. choose fatty cuts of meat d. cook all meat until well done ANSWER: b 12. Infection caused by Helicobacter pylori can cause cancer of the ____. a. liver b. breast and cervix c. stomach and lymphoid tissue d. nasal cavity and lung ANSWER: c 13. Consumption of can increase risk for colon and rectal cancers? a. salted foods b. red meat and processed meat c. high-calcium foods d. nonstarchy vegetables ANSWER: b 14. Which guideline is appropriate in reducing cancer risk? a. Strive to maintain a BMI between 22 and 28. b. Engage in at least 25 minutes of physical exercise 7 days a week. c. Consume at least ½ cup of starchy vegetables or fruits every day. d. Limit sedentary activities such as watching television. ANSWER: d 15. Diabetes mellitus is a potential nutrition-related side effect of a. pancreatic b. esophageal

resection.

c. gastric d. intestinal ANSWER: a

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Chapter 29- Cancer and HIV Infection 16. Malabsorption of is associated with gastric resection. a. vitamin B12, iron, and folate b. vitamin C and selenium c. niacin and thiamin d. zinc and chromium ANSWER: a 17. The drugs used during chemotherapy are known as “ a. antiviral drugs b. antispasmodic medications c. antineoplastic agents d. antimetabolite drugs

.”

ANSWER: c 18. Methotrexate, a medication used for chemotherapy, resembles a. iron b. folate c. vitamin K d. selenium

ANSWER: b 19. Radiation enteritis is inflammation of the a. skin b. epithelial c. intestinal d. beta

cells caused by radiation therapy.

ANSWER: c 20. Hematopoietic stem-cell transplantation can be used as a primary treatment for a. leukemia b. gliomas c. pancreatic cancer

d. breast cancer ANSWER: a

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Chapter 29- Cancer and HIV Infection 21. Which best describes the specific action of immune checkpoint inhibitors? a. blocking proteins that prevent the immune system’s ability to attack cancer cells b. attacking immune host cells in transplanted tissue c. producing new white blood cells from the bone marrow d. preventing cancer by enhancing immune responses ANSWER: a 22. Up to of patients with cancer combine one or more complementary and alternative medicine approaches with standard treatment. a. 36% b. 45% c. 68% d. 83% ANSWER: d 23. Which intervention is most appropriate for a patient who suffers from frequent nausea related to chemotherapy? a. consuming limited amounts of liquids. b. avoiding foods that have strong odors and are greasy c. adding sauces and gravies to dry foods. d. eating a big meal just before chemotherapy treatments. ANSWER: b 24. Daily intake of protein in cancer patients at risk of weight loss and wasting should be a. 0.4 to 1.0 b. 1.0 to 1.5 c. 1.6 to 2.2

g/kg of body weight.

d. 2.2 to 2.8 ANSWER: b 25. Dietary modifications that might be appropriate for a patient with cancer of the brain include a. fluid restrictions b. a mechanically altered diet c. total parenteral nutrition

d. protein restrictions ANSWER: b

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Chapter 29- Cancer and HIV Infection 26. Which cancer site may require dietary considerations including tube feeding, total parenteral nutrition (TPN), or a fatand lactose-restricted diet prescription? a. kidneys b. pancreas c. intestine d. brain ANSWER: c 27. To avoid microbial contamination, cancer patients who are immunosuppressed may be prescribed a low-microbial diet, which is also known as the diet. a. paleo b. neutropenic c. macrobiotic d. keto ANSWER: b 28. What food should a patient with immunosuppression avoid? a. pasteurized milk products b. smoked or cured meats c. unwashed raw fruits d. baked goods with high-fructose corn syrup ANSWER: c 29. Anamaria Kruschenko has been diagnosed with neutropenia. Which meal would be most appropriate? a. Greek salad with whole milk b. macaroni and cheese with canned fruit cocktail c. tuna sandwich and an apple d. bacon, lettuce, and tomato sandwich and chocolate pudding ANSWER: b 30. What is an environmental risk factor for skin cancer? a. arsenic b. hexavalent chromium c. hepatitis B or C infection d. infection with Helicobacter pylori ANSWER: a

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Chapter 29- Cancer and HIV Infection 31. What is an environmental risk factor for liver cancer? a. asbestos b. hexavalent chromium c. hepatitis B or C infection d. ultraviolet radiation ANSWER: c 32. An estimated a. 5% b. 10% c. 15% d. 21%

of persons in the United States who have HIV infection are unaware that they are infected.

ANSWER: c 33. The cells essential for immune function that are affected by HIV infection are a. CD4+ T cells b. red blood cells c. pigmented skin cells d. antibodies

ANSWER: a 34. Infections from microorganisms that normally do not cause disease in the general population but can cause detrimental health issues in people with HIV are called “ .” a. tissue rejection b. AIDS-defining illnesses c. opportunistic infections d. lipomas ANSWER: c 35. Although the global incidence of HIV infection has been declining in recent years, its prevalence continues to be high in . a. sub-Saharan Africa b. the United Arab Emirates c. northern Africa d. southeast Asia ANSWER: a

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Chapter 29- Cancer and HIV Infection 36. HIV is most often spread through which route? a. sexual transmission b. sharing infected needles c. transmission from infected mother to child d. unsafe food handling practices ANSWER: a 37. What causes the abnormalities seen in glucose and fat metabolism in patients with HIV infection? a. high-fat, high-protein diet b. side effects of antiretroviral drugs c. sedentary lifestyle d. genetic predisposition ANSWER: b 38. What is a characteristic of lipodystrophy? a. breast enlargement b. swelling and edema in the face c. dementia d. fat accumulation in the hips ANSWER: a 39. What is a fungal infection that affects mucous membranes of the oral cavity in patients with HIV infection? a. cheilosis b. Helicobacter pylori c. candidiasis d. herpes simplex ANSWER: c 40. A type of cancer frequently associated with HIV infection that is characterized by lesions of the mouth and throat is called “ .” a. adenomas b. gliomas c. Kaposi’s sarcoma d. thrush ANSWER: c

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Chapter 29- Cancer and HIV Infection 41. What is an example of a drug classified as a CCR5 antagonist? a. maraviroc b. enfuvirtide c. ritonavir d. zidovudine ANSWER: a 42. What is a primary objective of nutrition therapy for patients with HIV? a. providing micronutrient supplements b. maintaining lean body mass c. reducing risk of hypolipidemia d. correcting changes in blood glucose ANSWER: b 43. What are the benign tumors composed of fatty tissue in HIV patients called? a. adenoma b. sarcoma c. myeloma d. lipoma ANSWER: d 44. Water can transmit a parasite that causes a. Kaposi’s sarcoma b. cryptosporidiosis c. pneumonia d. listeriosis

in HIV-infected individuals.

ANSWER: b 45. Which type of enteral feeding is well-tolerated in cases of severe malabsorption in patients with HIV? a. energy-dense formulas administered via tube feeding b. hydrolyzed formulas with medium-chain triglycerides (MCT) administered via tube feeding c. hydrolyzed formulas with MCT administered orally d. high-protein formulas with MCT administered intravenously ANSWER: c

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Chapter 29- Cancer and HIV Infection 46. People who take antiretroviral drugs are at greater risk of developing which condition? a. end-stage renal disease b. pancreatitis c. insulin resistance d. cirrhosis ANSWER: c 47. Patients taking the antiretroviral drug zidovudine should be told to a. take it on an empty stomach b. take it 2 hours before or 3 hours after a meal c. avoid taking it with a high-fat meal d. avoid magnesium supplements while taking it

ANSWER: c 48. Which type of antiretroviral drug prevents HIV from entering cells by binding to a viral protein needed for its entry? a. integrase inhibitors b. nucleoside reverse-transcriptase inhibitors c. protease inhibitors d. fusion inhibitors ANSWER: d 49. An estimated a. 28 b. 38 c. 48 d. 58

million cases of foodborne illnesses occur each year in the United States.

ANSWER: c 50. Toxicity means that a substance . a. can cause harm if enough is consumed b. is not safe at any level of consumption c. is likely to cause harm in common real-life situations d. results in appreciable morbidity and mortality if consumed ANSWER: a

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Chapter 29- Cancer and HIV Infection 51. Among foodborne infections, a. E. coli b. Salmonella

is the leading cause of hospitalizations.

c. Campylobacter d. norovirus ANSWER: b 52. Which is an example of a foodborne infection? a. E.coli b. botulism c. aflatoxin d. Staphylococcus ANSWER: a 53. The most common food intoxication is from a. E. coli b. toxoplasma c. botulism d. Staphylococcus

ANSWER: d 54. Campylobacter is most commonly spread through a. unwashed fruits and vegetables b. person-to-person contact c. undercooked poultry d. raw cookie dough

ANSWER: c 55. Honey may contain dormant bacterial spores, which can awaken in the human body to produce a. botulism b. gastritis

c. listeriosis d. colitis ANSWER: a

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Chapter 29- Cancer and HIV Infection 56. Onset of the foodborne infection toxoplasma typically occurs a. 1 to 6 hours b. 8 to 16 hours

after exposure to the toxin.

c. 1 to 3 days d. 7 to 21 days ANSWER: d 57. When serving hot foods, temperatures should be at least a. 120 b. 130 c. 140 d. 150

ANSWER: c 58. Leftovers should be thoroughly reheated to at least a. 125 b. 145 c. 165 d. 185

ANSWER: c 59. Ground beef should be cooked to an internal temperature of at least a. 100 b. 120 c. 140 d. 160

ANSWER: d 60. Cold foods should be kept at a. 30 b. 40 c. 50 d. 60

or lower.

ANSWER: b

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Chapter 29- Cancer and HIV Infection 61-65. Short Case-Study Questions Sixty-four-year-old Jeffery Thomson has been diagnosed with esophageal cancer. He has experienced a 20-lb weight loss in the past 2 months due to decreased appetite and difficulty eating. He will begin cancer treatment in a week and is visiting with the registered dietitian for nutrition counseling. 61. Possible dietary interventions to better meet Mr. Thomson's nutritional needs include . a. serving large portions b. tube feeding c. a bland diet d. a high-kcalorie, high-protein diet ANSWER: b 62. Factors than can decrease the risk of esophageal cancer include intake of a. vitamin C–containing foods b. alcohol c. high-calcium foods d. high-sugar foods

ANSWER: a 63. Mr. Thomson begins body. a. radiation therapy b. chemotherapy c. dietary therapy d. acupuncture

. His doctor chooses this treatment because it is better able to target specific parts of the

ANSWER: a

64. Mr. Thomson continues his cancer treatment and is scheduled for esophageal resection. What is a possible nutritionrelated side effect after surgery? a. acid reflux b. urinary incontinence c. inability to taste food d. dumping syndrome ANSWER: a

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Chapter 29- Cancer and HIV Infection

65. If Mr. Thomson’s cancer spreads, it will be considered a. malignant b. benign c. metastasized

d. carcinogenic ANSWER: c 66-70. Short Case-Study Questions Fifty-eight-year-old Janet Englewood has been living with HIV for the past 15 years. Today, she returns to her physician for a follow-up appointment. 66. Janet should expect the doctor to check her to assess disease progression. a. viral load b. beta cells c. white blood cells d. albumin ANSWER: a

67. The physician reports that Janet's blood glucose, low-density lipoprotein (LDL), triglycerides and total cholesterol are elevated. She has also gained a significant amount of fat around her abdomen. Janet is diagnosed with . a. HIV cachexia b. AIDS hypoglycemia c. HIV lipodystrophy d. HIV respiratory syndrome ANSWER: c

68. In view of Janet’s elevated triglyceride levels, the physician recommends hypertriglyceridemia. a. vitamin C b. zinc c. fish oil d. calcium

supplementation to control the

ANSWER: c

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Chapter 29- Cancer and HIV Infection

69. On further testing, the physician observes pathological changes in Janet’s small intestine that are characterized by villus atrophy and blunting. What is this condition known as? a. HIV lipodystrophy b. HIV enteropathy c. AIDS radiculopathy d. HIV neuropathy ANSWER: b

70. Janet is taking the medication ritonavir. What dietary instructions should she receive? a. It should be taken on an empty stomach. b. Alcohol should be avoided while taking the drug. c. It should be taken 1.5 hours before or 2 hours after a meal. d. It is one of the few protease inhibitors that do not interact with alcohol. ANSWER: b Match each word or phrase with the most appropriate definition or explanation. a. Tumor b. Metastasize c. Benign d. Myelomas e. Buffalo hump f. Cryptosporidiosis g. Carcinogen h. Cancer cachexia i. Chemotherapy j. Radiation therapy k. Radiation enteritis l. Opportunistic infections m. Thrush n. Kaposi’s sarcoma o. Lipodystrophy 71. cancers that arise from plasma cells in the bone marrow ANSWER: d 72. a substance that is capable of causing cancer ANSWER: g

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Chapter 29- Cancer and HIV Infection 73. use of X-rays, gamma rays, or atomic particles to destroy cancer cells ANSWER: j 74. a foodborne illness caused by the parasite Cryptosporidium parvum ANSWER: f 75. new growth of tissue forming an abnormal mass with no function ANSWER: a 76. cancer that spreads from one part of the body to another ANSWER: b 77. cancer-wasting syndrome characterized by anorexia, muscle wasting, weight loss, and fatigue ANSWER: h 78. collection of abnormalities in fat and glucose metabolism that result from drug treatments for HIV, including body fat redistribution, abnormal lipid levels, and insulin resistance ANSWER: o 79. inflammation of the intestinal tissue caused by exposure to radiation ANSWER: k 80. describes an abnormal mass of cells that is noncancerous ANSWER: c 81. use of drugs to arrest or destroy cancer cells ANSWER: i 82. the accumulation of fatty tissue at the base of the neck ANSWER: e 83. infections from microorganisms that normally do not cause disease in the general population but can cause great harm in people whose immune systems are compromised ANSWER: l 84. fungal infection of the mucous membranes of the oral cavity and elsewhere ANSWER: m 85. type of cancer common in people with HIV infections and characterized by skin lesions ANSWER: n

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Chapter 29- Cancer and HIV Infection 86. Describe the possible effects of cancer surgeries on nutritional status in five different regions of the body. ANSWER: Surgery is performed to remove tumors, determine the extent of cancer, and protect nearby tissues. Often, surgery must be followed by other cancer treatments to prevent the growth of new tumors. The acute metabolic stress caused by surgery raises protein and energy needs and can exacerbate wasting. Surgery also contributes to pain, fatigue, and anorexia, all of which can reduce food intake at a time when nutritional needs are substantial. Surgeries to the head and neck can cause dry mouth, reduce chewing and swallowing abilities, and increase the risk of aspiration; esophageal surgery reduces swallowing ability and contributes to acid reflux; gastric surgery increases the risk of dumping syndrome and malabsorption of folate and iron; intestinal surgery can lead to diarrhea, malabsorption, and fluid and electrolyte imbalances; and pancreatic surgery increases the risk of diabetes. 87. Explain the role nutrition therapy plays in the treatment of cancer. ANSWER: The goals of nutrition therapy for cancer patients are to maintain a healthy weight, preserve muscle tissue, prevent or correct nutrient deficiencies, and provide a diet that patients can tolerate and enjoy despite the complications of illness. Appropriate nutrition care helps patients preserve their strength and improves recovery after stressful cancer treatments. Moreover, malnourished cancer patients develop more complications and have shorter survival times than patients who maintain good nutrition status. For patients at risk of weight loss and wasting, the focus of nutrition care is to ensure appropriate intakes of protein and energy. Protein requirements are often between 1.0 and 1.5 g/kg of body weight daily and may be somewhat higher in critically ill patients. Patients should consume adequate energy to prevent weight loss; those who cannot eat enough food may be able to meet their needs by supplementing the diet with nutrient-dense oral supplements. Tube feedings or parenteral nutrition may be necessary for patients who develop complications that interfere with food intake or have long-term or permanent GI impairment. Whenever possible, enteral nutrition is strongly preferred over parenteral nutrition to preserve gastrointestinal function and avoid infection. 88. Discuss common causes of decreased dietary intake among cancer and HIV patients and suggest ways to improve nutrition status or intake. ANSWER: Anorexia is a major contributor to the weight loss that is often associated with cancer. Some factors that contribute to anorexia or reduced food intake include chronic nausea and early satiety, mental stress, fatigue, pain, gastrointestinal obstructions, and the side effects of cancer treatments. Poor food intake associated with HIV may result from various factors. Oral infections associated with HIV infection may cause discomfort and interfere with food consumption. Common infections include candidiasis and herpes simplex virus infection. Oral candidiasis can cause mouth pain, dysphagia, and altered taste sensation; an oral infection with herpes simplex virus may cause painful lesions around the lips and in the mouth. Kaposi’s sarcoma, a type of cancer frequently associated with HIV infection, can cause lesions in the mouth and throat that make eating painful. The medications given to treat HIV infection, other coexisting infections, and cancer often cause anorexia, nausea and vomiting, altered taste sensation, food aversions, and diarrhea. Respiratory infections, including pneumonia and tuberculosis, are common in people with HIV infection. Symptoms associated with respiratory disorders may include chest pain, shortness of breath, and cough, which interfere with eating and contribute to anorexia. The physical and social problems that accompany chronic illness may cause fear, anxiety, and depression, which contribute to anorexia. Pain and fatigue, which may be associated with some disease complications, can lead to anorexia and difficulty with eating.

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Chapter 29- Cancer and HIV Infection 89. Discuss the key points in safe handling of seafood. ANSWER: Most seafood available in the United States is safe, but eating it undercooked or raw can cause severe illnesses—hepatitis, worms, parasites, viral intestinal disorders, and other diseases. Rumor has it that freezing fish will make it safe to eat raw, but this is only partly true. Commercial freezing kills mature parasitic worms, but only cooking can kill all worm eggs and other microorganisms that can cause illness. For safety’s sake, all seafood should be cooked until it is opaque. At least 10 species of bacteria found in raw oysters can cause serious illness and even death. Raw oysters may also carry the hepatitis A virus, which can cause liver disease. Some hot sauces can kill many of these bacteria, but not the virus; alcohol inactivates some bacteria, but not enough to guarantee protection (or to recommend drinking alcohol). Pasteurization of raw oysters—holding them at a specified temperature for a specified time—holds promise for killing bacteria without cooking the oyster or altering its texture or flavor. Chemical pollution and microbial contamination lurk not only in the water, but also in the boats and warehouses where seafood is cleaned, prepared, and refrigerated. Because seafood is one of the most perishable foods, time and temperature are critical to its freshness, flavor, and safety. To keep seafood as fresh as possible, people in the industry must “keep it cold, keep it clean, and keep it moving.” Wise consumers eat it cooked. 90. Identify and discuss one example of foodborne infection and one example of food intoxication. ANSWER: Foodborne infections are caused by eating foods contaminated with infectious microbes. Among foodborne infections, Salmonella is the leading cause of hospitalizations. Pathogens commonly enter the gastrointestinal tract through contaminated foods such as undercooked poultry, eggs, and meats, and unpasteurized milk. Symptoms generally include abdominal cramps, fever, vomiting, and diarrhea. Food intoxications are caused by eating foods containing natural toxins or, more likely, microbes that produce toxins. The most common food toxin is produced by Staphylococcus aureus; it affects more than 1 million people each year. Less common, but more infamous, is Clostridium botulinum, an organism that produces a deadly toxin in anaerobic conditions such as improperly canned (especially home-canned) foods and improperly stored foods (such as homemade herb-flavored oils or commercially made, chilled foods stored at room temperature). The botulinum toxin paralyzes muscles, making it difficult to see, speak, swallow, and breathe. Because death can occur within 24 hours of onset, botulism demands immediate medical attention. Even then, survivors may suffer the effects for months or years.

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