Advanced Nutrition and Human Metabolism, Gropper, 7e
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Chapter 08 Energy Expenditure Body Composition and Healthy Weight
MULTICHOICE
1. Bodymassindex(BMI)isonewaytoestimate
(A) appropriate weight for height
(B) actualbodyadiposity
(C) bodyfatdistribution
(D) risk factors associated with obesity
Answer : (A)
2. Which of the following represents a BMI range considered to be healthy for most adult men and women?
(A)<18.5
(B)15-18
(C)18.5-24.9
(D)>30
Answer : (C)
3. What is the BMI of a man who weighs 220 lbs and is 6 feet tall?
(A) 54.9
(B)36.7
(C) 29.9
(D)24.0
Answer : (A)
4. In the reference man and woman, respectively, what percentage of body weight is fat?
(A) 10%,20%
(B) 15%, 27%
(C)30%,40%
(D) 45%, 55%
Answer : (B)
5. Which bodycomponent comprises morediverse tissues?
(A) lean body mass
(B) fatmass
(C) fat-free mass
(D) skinfoldthickness
Answer : (C)
6. Theratioofcarbondioxideproducedrelativetooxygenconsumedisknownasthe
(A) respiratoryquotient
(B) respiratory balance
(C) respiratory deficit
(D) respiratoryratio
Answer : (A)
7. Underwater weighing, a method used to determine body composition, is based on which principle?
(A) Lean body tissue is denser than adipose tissue.
(B) Adipose tissue is denser than lean body tissue.
(C) Adipose tissue is composed mostlyof water.
(D) Body fluids are not being weighed using this method.
Answer : (A)
8. The generally accepted respiratory quotient (RQ) value for carbohydrate is .
(A)0.53
(B)0.70
(C) 0.82
(D)1.0
Answer : (D)
9. Whichofthe following techniquesformeasuringbody composition makesuse ofsmallexposures toradiation?
(A) MRI
(B) DEXA
(C) TOBEC
(D) BIA
Answer : (B)
10. Bioelectrical impedance analysis, a method used to determine body composition, is based on whichprinciple?
(A) Atomic nuclei behave like magnets when an external magnetic field is applied across the body.
(B) Adipose tissue is denser than lean body tissue.
(C) Electrical conductivity is greater in lean tissue than in adipose tissue.
(D) Fat-freemass is proportional to total body potassium.
Answer : (C)
11. Quantificationoftotalenergyexpendituremaybecalculatedusing
(A) neutron activation
(B) infrared light
(C) high-frequency ultrasonic energy
(D) thedoubly labeled water method
Answer : (D)
12. The incidence of obesity has increased rapidly in the last 30 years and is associated with increasedriskforwhich ofthe followingdisorders?
(A) stunting, wasting
(B) stroke, sleep apnea
(C) osteoporosis, osteopenia
(D) hepatitis, tuberculosis
Answer : (B)
13. Basalmetabolicraterepresents .
(A) the rate of energy expenditure that sustains basic life processes in all cells in the awake state
(B) therate of energy expenditure when the bodyis atrest andno food has been eaten in 4 hours
(C) minimalenergyexpenditureoveraperiodof24hours
(D) all energy expenditure except that is attributable to physical activity
Answer : (A)
14. Thethermiceffectoffoodrepresentsthe
(A) BMR minus the energy used in physical activity
(B) decrease in food energy due to cooking
(C) increase in energy expenditure associated with the body's processing of food
(D) body's storage of food as fat for insulation
Answer : (C)
15. Which of the following contributes the highest thermic effect of food?
(A) fats
(B) mixeddiet withatleast 50%carbohydrate
(C) carbohydrates
(D) proteins
Answer : (D)
16. Thermogenesis is associated with
(A) generation of water
(B) ingestion of food
(C) synthesisof fat
(D) processing of food
Answer : (D)
17. Thermoregulationrefers to .
(A) alterationsinmetabolismtomaintainbodycoretemperature
(B) alterations in food energy due to cooking
(C) the increase in energy expenditure associated with the body's processing of food
(D) the body's storage of food as fat for insulation
Answer : (A)
18. Whenoxidized,whichnutrient(s)provide(s)thelowestrespiratoryquotient?
(A) carbohydrate
(B) protein
(C) fat
(D) mixeddiet
Answer : (C)
19. Which RQ would not be possible for an ordinary mixed diet of carbohydrate, protein, and fat?
(A) 0.85
(B)0.80
(C) 0.75
(D)0.15
Answer : (D)
20. Inaclinicalsetting,whichRQsuggeststhatthepatientisnotusingfatasasourceofcalories?
(A)<0.70
(B)<0.80
(C) <0.90
(D)1.00
Answer : (D)
21. Which method of assessing energy expenditure requires the measurement of food intake?
(A) doublylabeledwatermethod
(B) Harris-Benedict prediction equation
(C) Mifflin-St.Jeorequation
(D) estimatedenergyrequirementequation
Answer : (A)
22. Which of the following methods of estimating energy expenditure does NOT require knowledge ofthe individual'sage?
(A) doublylabeledwatermethod
(B) Harris-Benedict prediction equation
(C) Mifflin-St.Jeorequation
(D) estimatedenergyrequirementequation
Answer : (A)
23. Arecommendedmeasurementto determine energyexpenditure is .
(A) basal metabolic rate
(B) resting metabolic rate
(C) urinary nitrogen excretion
(D) thermic effect of food
Answer : (C)
24. Quantifying the energy expenditure of physical activity requires measuring
(A) RMR(BMR)
(B) RQ
(C) thermal effect of food
(D) thermoneutrality
Answer : (A)
25. Theadjustments in metabolism necessary to maintain the body's core temperature are referred toas .
(A) thermoneutrality
(B) thermaleffects
(C) thermalcontrol
(D) thermoregulation
Answer : (D)
26. Aclusteringoffactorsthatoccurtogethermoreoftenthanexpectedonchancealoneisa .
(A) symptom
(B) syndrome
(C) disease
(D) condition
Answer : (B)
27. Centralobesity,increasedplasmafastingglucose,increasedfastingplasmatriglyceride, hypertension,anddecreasedplasmaHDLcholesterolareassociatedwith .
(A) diabetes
(B) insulin resistance
(C) metabolicsyndrome
(D) Cushing'sdisease
Answer : (C)
28. Which of the following hormones or molecules increases the urge to eat?
(A) leptin
(B) ghrelin
(C) adiponectin
(D) insulin
Answer : (B)
29. Which of the following is a suggested reason for the persistent feeling of hunger in the presence ofincreasedleptin levels?
(A) lack of leptin receptors
(B) ghrelin overproduction
(C) leptin resistance
(D) damage to the hypothalamus
Answer : (C)
30. Why shoulda person withmorethan theaverage amount of body fat feellesshungry?
(A) increased body fat means increased leptin that suppresses hunger
(B) increased body fat means more stored calories
(C) increased body fat insulates causing increased body temperature
(D) increased body fat means more ketones are available for energy
Answer : (A)
31. Where is insulin produced?
(A) stomachandduodenum
(B) β-cells of pancreas
(C) intestine
(D) whiteadipose tissue
Answer : (B)
32. Where is ghrelin produced?
(A) whiteadipose tissue
(B) pancreas
(C) intestine
(D) stomachandduodenum
Answer : (D)
33. Energyexpenditurecanbequantifiedbymeasuring
(A) theamountofwaterconsumedinonehour
(B) watervaporoutputinonehour
(C) heat dissipated by the body
(D) the change in muscle tone after exercise
Answer : (C)
34. Difficulties in getting accurate calculations of RMR based on the various equations developed arise in whichgroupof people?
(A) people with excess body fat
(B) people who arelean
(C) adolescents
(D) youngadults
Answer : (A)
35. In degrees Fahrenheit, how much of a change in body temperature both up and down is tolerable beforedeathresults?
(A) 10up,10down
(B) 5up,10down
(C) 10up,5down
(D) 5up,5down
Answer : (B)
36. Diet-inducedthermogenesisisalsocalled
(A) basal metabolic rate
(B) resting metabolic rate
(C) thermal regulation
(D) thermic effect of food
Answer : (D)
37. Thehighestincidenceofheat-relateddeathsoccursamong .
(A) high school baseball players
(B) professional football players
(C) high school football players
(D) professional soccer players
Answer : (C)
38. Excessbodyfatincreasestheriskofdeveloping
(A) hyperthyroidism
(B) breast and endometrial cancer
(C) hypothyroidism
(D) rheumatoidarthritis
Answer : (B)
39. The connection between body, weight, body fat, and health were recognized centuries ago by
(A) Hippocrates
(B) Socrates
(C) Galen
(D) Plato
Answer : (A)
40. In order to determine disease risk, many health professionals use BMI and which other measurement?
(A) bodytemperature
(B) tibial length
(C) head diameter
(D) waist circumference
Answer : (D)
41. ColdenvironmentscanincreaseBMRdueto .
(A) lowering metabolic rate
(B) increasing the rate of digestion
(C) shivering
(D) reduction in sweating
Answer : (C)
42. Physical activity typically accounts for what percentage of total energy expenditure?
(A) 10-20%
(B)15-30%
(C) 20-35%
(D)25-35%
Answer : (B)
43. Theactivitythatrequiresthegreateramountofenergyexpendedis .
(A) cross-countryskiingat 8mph
(B) vigorous, full-court basketball
(C) vigorous soccer
(D) runningat9mph
Answer : (A)
44. Historically, the gross anatomy and chemical composition of the human body were determined using .
(A) athletes
(B) premenopausalwomen
(C) cadavers
(D) postmenopausalwomen
Answer : (C)
45. Bioelectricalmethods of determiningthe two-compartmentmodelare basedon
(A) capacitance
(B) resistance
(C) voltage
(D) impedance
Answer : (D)
46. Respectively, the reference man and reference woman have what total percentage of body fat?
(A) 27%,15%
(B) 18%, 28%
(C)15%,27%
(D) 12%, 28%
Answer : (C)
47. Themaintargetofhormonesthatregulatehungerandsatietyisthe .
(A) medulla oblongata
(B) cerebellum
(C) hypothalamus
(D) thalamus
Answer : (C)
48. Receptors for which hormone are located in the hypothalamus, skeletal muscle, liver, and smoothmuscle?
(A) adiponectin
(B) cholecystokinin
(C) pancreatic polypeptide
(D) GLP-1
Answer : (A)
49. Leptin and one other hormone have similar effects on orexigenic and anorexigenic neurons. That hormoneis
(A) ghrelin
(B) adiponectin
(C) peptideyy
(D) insulin
Answer : (D)
50. Which factor is a strong determinant of the microbiota composition in the gastrointestinal tract?
(A) gender
(B) diet
(C) age
(D) hormones
Answer : (B)
51. AtwofoldincreaseinriskforCVD,myocardialinfarction,strokeandCVD-relatedmortalityis associatedwith
(A) hyperthyroidism
(B) diabetes
(C) metabolicsyndrome
(D) obesity
Answer : (C)
TRUEFALSE
52. Five sites commonly used for measuring skin fold thickness are the triceps, subscapula, suprailiac, abdomen, andthigh.
(A) True
(B) False
Answer : (A)
53. All individuals will experience a reduction in hunger if given leptin injections.
(A) True
(B) False
Answer : (B)
54. When an individual is in positive energy balance over time, excess energy will be stored as glycogen inmuscle and liver tissue.
(A) True
(B) False
Answer : (B)
55. Lean body mass has a higher metabolic activity than adipose tissue.
(A) True
(B) False
Answer : (A)
56. The body's core temperature varies from about 98.2°F to 98.6°F.
(A) True
(B) False
Answer : (A)
57. A BMI in children between the 75th and 85th percentiles is considered overweight.
(A) True
(B) False
Answer : (B)
58. Because BMI has limitations, many health professionals also measure BMR.
(A) True
(B) False
Answer : (B)
59. Thedensityofbodyfatisabout0.9g/mL.
(A) True
(B) False
Answer : (A)
60. Hormones that regulate appetite target the region of the hypothalamus known as the arcuate nucleus.
(A) True
(B) False
Answer : (A)
61. Adiponectin levels decrease with decreased fat mass and increase with increased fat mass.
(A) True
(B) False
Answer : (B)
62. PeptideYYisthe only known orexigenic hormone.
(A) True
(B) False
Answer : (B)
63. Leptin decreases the urge to eat and increases physical activity to produce a negative energy balance.
(A) True
(B) False
Answer : (A)
64. Obesogens stimulate body fat accumulation by binding to hormone receptors and either stimulatingorinhibiting the signalingpathway.
(A) True
(B) False Answer : (A)
65. Type 2diabetesisassociated with veryloworabsent insulin.
(A) True
(B) False
Answer : (B)
66. Experts agree that moderate weight loss (5-10 kg) consisting of both fat mass and fat-free mass can beachieved bycalorierestriction alone.
(A) True
(B) False
Answer : (A)
MATCH
67. Formulas: Match each clinically useful method or index with the formula for its calculation.
MATCH
68. Measurable Characteristics: Match each clinically useful method or index with the trait that it estimates.
SHORTANSWER
69. Delineate the six levels of disease risk relative to normal BMI and waist circumference in both males and females.Answer : Refer to Table 8.5 (p. 283), which lists the overall disease risks associated with six levelsof BMI categories for both males and females.
70. Explain the difference between direct calorimetry and indirect calorimetry.Answer : Both direct andindirectcalorimetryassesstotalenergyexpenditure.Directcalorimetrymeasurestheheat dissipation from an organism using an isothermal principle, a gradient-layer system, or a watercooled garment. Indirect calorimetry measures oxygen consumed and carbon dioxide breathed out and total energy expenditure can be calculated from the respiratory quotient (RQ). This method also allowscalculationofthesubstrate(fatorcarbohydrate)beingoxidized.Urinarynitrogencanbe measuredinaddition to oxygen consumption andcarbon dioxide production in ordertoestimate protein oxidation.
71. Explain the principles underlying the use of doubly labeled water to assess total energy expenditure. Include a discussion of the main source of error.Answer : Doubly labeled water uses stable isotopes of both hydrogen and oxygen to assess the total energy expenditure over several days. The isotopes equilibrate with body water in about 5 hours. Labeled hydrogen leaves the body aslabeledwaterinsweat,urine,andexhaledwatervapor.Labeledoxygen leaves the body as labeled water or carbon dioxide. The disappearance of water with labeled oxygen and with labeled hydrogen ismeasured over time (usually 3 weeks). The disappearance oflabeled hydrogen represents water turnover alone. Labeled oxygen, however, can leave as either water or carbon dioxide.Therefore,thedifferenceinthedisappearanceofhydrogen-labeledwaterand oxygenlabeled water represents the oxygen leaving as carbon dioxide. The food quotient is measured by keeping a food record during the experimental period. Oxygen consumption can be calculated from the food quotient and the calculated carbon dioxide production. The main source of error is the inaccuracyassociated withuseoffood records.
72. Define basal metabolic rate and delineate the percentage of energy used at rest by the liver, brain,kidneys,heartandskeletalmuscle.Answer : Basalmetabolicrate(BMR)represents the amountofenergyneededtosustainbasiclifeprocessessuchasrespiration, heartbeat, renal function, brain and nerve function, blood circulation, active transport and synthesis of proteins and other molecules. Mostof the energyusedatrest isused by theliver(27%), brain (19%),kidneys (10%),heart(7%),andskeletalmuscle(18%).
73. What is the main factor that determines whether body weight remains stable, increases or decreases?Whichdiseasesareassociatedwithexcess body fat? What is one drawback of using only body weight as an indicator of health?Answer : The main factor that determines the stability of body weightis the extent to which total energy expenditure is being met orexceeded by energy intake. If intake is equal to expenditure, the weight remains stable. Excess intake will lead to weight
gain while insufficient intake will result in weight loss.
Answer : Excess body fat is associated with an increased risk of heart disease, stroke, diabetes mellitus, hypertension, osteoarthritis, infertility and cancers such as breast, endometrial, colon and kidney.
Answer : Usingonlybodyweightasanindicatorofhealthmaybeinaccurateifanindividualhas addedbodyweightbyincreasingmusclemassinsteadofaddingfat.Addingmusclemassmakesthe bodyhealthierwhereasaddingfatreducesthehealthofthebody.
74. Whichgland,andspecifically,whichregionofthat gland, controls appetite? Describe how hunger and satiety are achieved and which hormones are responsible for both.Answer : The gland that regulates appetite is the hypothalamus. The specific area of this gland is the arcuate nucleus, which contains specialized neurons. One population of neurons have hormone receptors that, when stimulated, release orexigenic peptides that stimulate appetite. These include neuropeptide Y (NPY) andagouti-related peptide (AgRP).Thesecond population of neurons produces anorexigenic peptides thatinhibit appetite. These belong to the pro-opiomelanocortin (POMC) family. These work in other areas of the hypothalamus as well as in other partsof the brain to curb appetite.
75. Describeleptin'sassociation with whiteadipose tissueandexplain why thebody reacts toitasit does.Answer : Leptin interacts with the hypothalamus to reduce hunger. It is produced by white adipose tissue. When leptin binds to its receptors, orexigenicneurons are inhibited and the production of NPY and AgRP is reduced. At the same time, anorexigenic neurons are stimulated to releasePOMCpeptides.Studieshaveshownthatwhenthe amount of body fat increases, leptin levels increase as well. This suppresses hunger. Less body fat means less leptin resulting in a lower levelofappetite suppression. Thismakessense from abiochemical point ofview asindividuals with more body fat shouldeatlessand those with lower levelsof bodyfatshould havethedesire to eat more.
76. Describe metabolic syndrome and give the criteria for its clinical diagnosis.Answer : Metabolic syndrome is a group of risk factors that are associated with an increased risk of cardiovascular disease. The risk factors include central obesity, increased fasting plasma glucose, increased fasting plasmatriglyceride,decreasedplasmaHDLcholesterol and hypertension. The criteria for the clinicaldiagnosis ofmetabolic syndrome will come from Table8.7.
77. What relationship does insulin resistance have to metabolic syndrome? What are the causes of theseassociations?Answer : Insulinresistanceisassociatedwithexcessbodyfat,elevatedblood glucose levels, elevated triacylglycerols and high blood pressure. These conditions are the diagnostic criteriaformetabolicsyndrome.Insensitivitytoinsulinoccurs primarily in muscle and adipose tissue. The muscle loses its ability to uptake glucose. Resistant adipose tissue is no longer inhibited from releasing free fatty acids. Liver and kidney do not exhibit insulin resistance. The liver is able to respond to the elevated insulin levels by synthesizing triacylglycerol from the excess free fatty acids, thus elevating fasting serum triacylglycerol levels. In addition, the elevated triacylglycerol levels in the liver lead tononalcoholic fatty liver disease. The kidney responds to elevatedinsulin levels by increasingrenalsodiumretentionanddecreasinguric acid clearance. Essential hypertension develops due toahigher levelofretainedwater.
78. Explain why a high protein diet that includes a low carbohydrate intake and an average fat intake would lead to weight loss as long as the caloric intake did not exceedenergy expenditure.Answer : The thermiceffectoffood plays an importantrole in this type of weight loss diet.Because protein in foods has the greatest thermiceffect (20–30%), more energy will be expended indigesting these foods than would be expendeddigesting carbohydrates(5–10%)or fats (0–5%).Becausethedietis lowin carbohydrates, thatportion of theenergyExpenditure would be
minimal. Also, since the energy expenditure for fats is so low, a normal fat intake would not use very muchenergy.All of thesefactors combinedwouldlead to weightloss.
MULTICHOICE
79. Ofthefollowingstatements,oneisNOTtrueregardinganorexia.Choosethecorrectstatement.
(A) Of psychiatric disorders, anorexia has the highest mortality rate.
(B) Anorectics simply restrict calories severely and never binge and purge.
(C) People with anorexia have a distorted body image and fear weight gain.
(D) Anorectics often consume less than 800 kcal/day.
Answer : (B)
80. Thetypicalbulimic
(A) isoverly concerned with losing weight and being very thin
(B) seeks to eat without gaining weight
(C) is usually diagnosed with the female athlete triad
(D) characteristically experiences premature osteoporosis
Answer : (B)
81. Statistically, what percentage of individuals with anorexia nervosa recover completely?
(A) about 40-50%
(B) about 20-30%
(C) about 15-25%
(D) about 10-15%
Answer : (A)
82. Which factor may be a cause of weight loss that is not associated with an eating disorder in female athletes?
(A) the female athlete triad
(B) the feeling of comfort and well-being associated with certain foods
(C) inadequate energy intake associated with failure to meet the high energy needs of the sport
(D) excessive food restriction
Answer : (C)
83. Name the psychiatric disorder associated with the highest mortality rate.
(A) female athlete triad
(B) bulimianervosa
(C) binge eating disorder
(D) anorexia nervosa
Answer : (D)