Test Bank for Understanding Nutrition 16th Edition Ellie Whitney and Sharon Rady Rolfes. ISBN 978035

Chapter 01: An Overview of Nutrition

Understanding Nutrition 16th Edition Whitney 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, Amal drinks wine and eats hors d’oeuvres, even though she is not hungry. This is an example of a food choice based on . a. established habits 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. Established habit b. Easy availability c. Body image d. Environmental concerns e. Cultural values ANSWER: b

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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. Why should a health-care professional take a drug history before making nutrition recommendations? a. To assess for possible interactions that lead to nutrient deficiencies b. To identify conditions with a genetic component c. To identify diseases that interfere with nutrient absorption d. To assess for possible drug abuse of misuse e. To rule out the possibility of suspected nutrition problems ANSWER: a 7. Ang is a movie fan and always eats a big bucket of buttery popcorn at the theater. His food choice is most likely based on . a. regional cuisine b. personal 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

Chapter 01: An Overview of Nutrition 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 10. The RDA is set higher than the EAR to meet the needs of most healthy people. a. True b. False ANSWER: True 11. Which is the simplest nutrient? a. Minerals b. Water c. Protein d. Carbohydrates e. Vitamins ANSWER: a 12. Estimated Average Requirements (EARs) provide different amounts based on sex and age. a. True b. False ANSWER: True 13. Calories or kcalories are a measure of a. heat b. potential c. surface d. work e. light ANSWER: a

energy.

Chapter 01: An Overview of Nutrition 14. Which nutrient has the greatest energy density? a. Protein b. Water c. Carbohydrate d. Fat e. Vitamins ANSWER: d 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

Chapter 01: An Overview of Nutrition 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

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b. kilograms c. kilometers d. kilonewtons e. kiloliters ANSWER: a 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. Each of how many total vitamins has its own special dietary role to play? a. 8 b. 13 c. 16 d. 23 e. 26 ANSWER: b

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

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Chapter 01: An Overview of Nutrition 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 29. If a person consumes 50% of their daily kilocalories from carbohydrates and 30% from protein, what percentage of their daily kilocalories will come from fat? a. 10% b. 20% c. 30% d. 40% e. 50% ANSWER: b

Chapter 01: An Overview of Nutrition 30. Researchers benefit from a large sample size because a. chance variation is less likely to affect the results

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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 D, the less likelihood of depression.” What do your findings suggest? a. no correlation b. a positive correlation c. a negative correlation d. a placebo effect e. validity ANSWER: c 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 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

Chapter 01: An Overview of Nutrition 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 zinc. After the subjects take their seats in the laboratory, you distribute all the zinc pill bottles to individuals seated on the left side of the room and all the placebo pill bottles to individuals seated on the right side of the room. 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 zinc to individuals on the right side and placebo to individuals on the left side 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 zinc or the placebo, and then given them the opposite of what they requested.

ANSWER: d

Chapter 01: An Overview of Nutrition 37. Which type of article provides a quantitative summary of the evidence? a. Systematic review b. Meta-analysis c. Case study d. Clinical trial e. Cohort study ANSWER: b 38. If a person consumes 50% of their daily kilocalories from carbohydrates and 30% from protein, what percentage of their daily kilocalories will come from fat? a. 10% b. 20% c. 30% d. 40% e. 50% ANSWER: b 39. The Estimated Average Requirement (EAR) for a nutrient meets the needs of about a. 5%

of the population.

b. 25% c. 50% d. 75% e. 98% 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

Chapter 01: An Overview of Nutrition 41. The Recommended Dietary Allowance (RDA) for a nutrient meets the needs of about population. a. 5% b. 25% c. 50% d. 75% e. 98%

of the

ANSWER: e 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

Chapter 01: An Overview of Nutrition 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 46. It is not necessary for a person to meet the RDA for every nutrient every day. a. True b. False ANSWER: True 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. Ana is extremely thin, is losing muscle tissue, and is becoming prone to infections. Which term best describes Ana’s condition? a. undernutrition b. overnutrition c. nutrient overdose d. anemia e. subclinical deficiency ANSWER: a

Chapter 01: An Overview of Nutrition 49. Which of the following is a strength of epidemiological studies? a. Can narrow down the list of possible causes b. Can prove cause and effect c. Can control variables d. Can use treatments without ethical concerns e. Can generalize findings ANSWER: a 50. Physical signs and symptoms of a nutrient deficiency can be revealed by a. Laboratory tests b. Diet history c. Health history d. Family history e. Anthropometric measures ANSWER: e 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

Chapter 01: An Overview of Nutrition 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

deficiencies.

b. primary c. secondary d. covert e. anecdotal ANSWER: a 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. The lowest continuing intake of a nutrient that will maintain a specified criterion of adequacy is called a(n) a. minimum b. requirement c. allowance d. recommendation e. average ANSWER: b

Chapter 01: An Overview of Nutrition 57. Which of the following statements about progress toward the Healthy People 2030 goals is FALSE? a. The objective to meet physical activity has been achieved. b. The objective to meet muscle-strengthening guidelines has been achieved. c. Trends in overweight individuals have worsened. d. Trends in obese individuals have improved. e. The objective to eat more fruits and individuals has shown no improvement.

ANSWER: c 58. Most nutrient recommendations cannot be met through food alone and require the use of dietary supplements. a. True b. False ANSWER: False 59. Since minerals and water do not contain carbon, they are classified as a. Nonnutrients b. Micronutrients c. Inorganic d. Organic e. Essential ANSWER: c 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. When there is insufficient data to determine the RDA of a nutrient, the EAR is used instead. a. True b. False ANSWER: False

Chapter 01: An Overview of Nutrition 62. The Acceptable Macronutrient Distribution Range for fat is 20 to 35 percent kilocalories. a. True b. False ANSWER: True 63. What is the most prominent risk factor in the United States, contributing to one of every six deaths each year? a. poor dietary habits b. tobacco use c. alcohol consumption d. physical inactivity e. unsafe driving ANSWER: b 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. What is the Acceptable Macronutrient Distribution Range for protein? a. 5 to 30 percent kilocalories b. 10 to 35 percent kilocalories c. 15 to 40 percent kilocalories d. 20 to 45 percent kilocalories e. 25 to 50 percent kilocalories ANSWER: b

Chapter 01: An Overview of Nutrition 66. A dietitian is working with a client who was born in Jamaica. Many of the foods this client consumes are unfamiliar to the dietitian. What is the best way for the dietitian to use cultural competence in this scenario? a. Educate the client about typical foods in the standard American diet. b. Ask the client to offer education about traditional Jamaican foods. c. Encourage the client to share meals with people who eat the standard American diet. d. Educate the client about food groups and where traditional jamaican foods fit. e. Refer the client to a colleague who knows more about Jamaican foods.

ANSWER: d 67. It is appropriate to think of the RDA as the minimum amount of a nutrient required for most healthy people. a. True b. False ANSWER: False 68. Which of the following is the most reliable source of nutrition information? a. Placebo effect b. Personal anecdote c. Hypothesis d. Epidemiological study e. Double-blind experiment ANSWER: e 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

Chapter 01: An Overview of Nutrition 70. Physical signs and symptoms of a nutrient deficiency are always categorized as a. Primary b. Secondary c. Overt d. Covert e. Subclinical ANSWER: c 71. What effect can cooking have on the mineral content of food? a. Cooking can transform minerals for inorganic to organic compounds. b. Minerals can be drawn out of food during processing or cooking. c. Minerals can be destroyed by the cooking process. d. Cooking can increase the minearl content of food. e. Cooking can allow minerals to yield energy.

ANSWER: b 72. Vitamins can only function in the human body if they are consumed a. With fat b. In water c. Intact d. Slowly e. daily ANSWER: c 73. A healthy 150-pound body contains about how many pounds of water? a. 10 b. 30 c. 60 d. 90 e. 100 ANSWER: d

Chapter 01: An Overview of Nutrition 74. A healthy 150-pound body contains about how many pounds of fat? a. 5 to 25 b. 10 to 35 c. 15 to 40 d. 20 to 45 e. 25 to 50 ANSWER: d 75. Essential nutrients are those that a. the body cannot make for itself in sufficient quantity b. Contain hydrogen and carbon c. Yield energy when consumed d. Can be destroyed by light, heat, and chemical agents e. Are inorganic and therefore indestructible ANSWER: a 76. Which mineral is classified as a. Zinc b. Calcium c. Copper d. Lead e. manganese ANSWER: d 77. What step follows if a hypothesis is supported in the scientific method? a. Develop a theory b. Identify a problem to be solved c. Design a study d. Draw conclusions e. Formulate a tentative solution ANSWER: a

Chapter 01: An Overview of Nutrition 78. A tomato is composed primarily of a. fiber b. water c. protein d. fructose e. cellulose ANSWER: b 79. Sugar is classified as an energy-yielding nonnutrient a. True b. False ANSWER: False 80. Phytochemicals are categorized as An organic micronutrients. a. True b. False ANSWER: False 81. A calorie is a measure of heat energy. a. True b. False ANSWER: True 82. A case-control study is an example of an experimental study. a. True b. False ANSWER: False 83. Vitamins are categorized as nonnutrient compounds found in plants. a. True b. False ANSWER: False 84. A systematic review provides a qualitative summary of the evidence. a. True b. False ANSWER: True

Chapter 01: An Overview of Nutrition 85. There are 40 nutrients known to be essential to humans. a. True b. False ANSWER: True 86. The number of kilocalories required to increase the temperature of 1 kg of water 1°C is 10. a. True b. False ANSWER: False 87. There are 21 essential minerals in the human diet. a. True b. False ANSWER: False 88. 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 89. 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

Chapter 01: An Overview of Nutrition 90. The motive for people who tend to prefer foods they grew up eating is most likely related to their a. values

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b. body image c. ethnic heritage d. negative association e. economy ANSWER: c 91. An apple is composed primarily of a. fats b. Water and carbohydrates

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c. proteins d. phytochemicals e. vitamins and minerals ANSWER: b 92. 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 93. 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

Chapter 01: An Overview of Nutrition 94. 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 95. 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 96. 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 97. 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 98. Ask a question about nutrition that could be studied with an epidemiological or experimental study. Identify which type of study you would use and why.

ANSWER: Answers will vary. What is the effect of a high protein diet vs. low protein diet on sleep. A laboratory-based animal study could be used. Researchers could have two different groups of mice: one fed high protein and the other fed low protein. Both groups would receive the same number of kcalories. The researchers would observe the time of sleep in both groups.

Chapter 01: An Overview of Nutrition 99. 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 100.

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.

101.

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 102.

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).

103.

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 104.

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.

Chapter 01: An Overview of Nutrition 105.

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.

106.

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.

Chapter 01: An Overview of Nutrition 107.

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 108.

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. A person allergic to seafood could consume which food to increase their intake of omega-3 fatty acids? a. Peanuts b. Walnuts c. Whole grains d. Soybeans e. Black beans ANSWER: b 2. Which nutrient commonly deficient in a vegan diet may be added to soy milk in the fortification process? a. Vitamin B12 b. Protein c. Fiber d. Vitamin C e. Vitamin E ANSWER: a 3. A 1,200-kcalorie diet that is 15 percent protein supplies how many grams of protein? a. 25 b. 35 c. 45 d. 55 e. 65 ANSWER: c 4. Which nutrient is commonly added to cow’s milk in the fortification process? a. Vitamin B12 b. Vitamin D c. Protein d. Fiber e. Vitamin C ANSWER: b

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Chapter 02: Planning a Healthy Diet 5. Orange juice containing added calcium is an example of which type of food? a. fortified b. enriched c. functional d. imitation e. processed ANSWER: a 6. Margarine containing plant sterols is an example of which type of food? a. Fortified b. Enriched c. Functional d. Imitation e. Processed ANSWER: c 7. Balance is the principle of consuming a number of foods in proportion to each other. a. True b. False ANSWER: True 8. Nutrient density is the principle of recognizing that a food has more iron than another food when expressed per kcalorie. a. True b. False ANSWER: True 9. Relative to the other four food groups, dairy makes up the largest proportion of MyPlate. a. True b. False ANSWER: False 10. Soybeans are a legume belonging to the starch category of exchange lists. a. True b. False ANSWER: False

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Chapter 02: Planning a Healthy Diet 11. Endosperm is the part of grain richest in fiber. a. True b. False ANSWER: False 12. Bran is the part of the grain containing most of the starch. a. True b. False ANSWER: False 13. Baked beans are an example of a plant-based food that should be limited due to added sugar. a. True b. False ANSWER: True 14. Green peas are commonly used to make textured vegetable protein. a. True b. False ANSWER: False 15. Based on the Daily Value, the recommended amount of fat for a 2000-kcalorie diet is 45 grams. a. True b. False ANSWER: False 16. Drinking a glass of fruit juice will satisfy a person’s appetite better than eating a whole fruit like an apple a. True b. False ANSWER: False 17. A 1-oz serving of grains is equivalent to 1/2 cup of cooked pasta. a. True b. False ANSWER: True

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Chapter 02: Planning a Healthy Diet 18. The USDA is the agency that regulates food labeling in the United States. a. True b. False ANSWER: False 19. Plant-based diets support lower rates of hypertension. a. True b. False ANSWER: True 20. Milk is often described by its fat content. a. True b. False ANSWER: True 21. Iron is best absorbed from which food? a. Whole grain bread b. Legumes c. Meat d. Oranges e. Iron-fortified cereal ANSWER: c 22. A person who eats only eggs, milk products, and plant foods is following which diet? a. Omnivorous b. Paleo c. Lacto-ovo-vegetarian d. Vegan e. Carnivorous ANSWER: c

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Chapter 02: Planning a Healthy Diet 23. The Facts Up Front labeling is a standardized presentation of nutrient information that benefits consumers in which way? a. Offers consumers a quick and easy way to select products b. Makes the nutrient content values more meaningful c. Standardizes serving sizes d. Ensures FDA approval of health claims e. Alerts consumers to common allergenic ingredients ANSWER: a 24. Daily Values labeling reflects dietary recommendations to benefit consumers in which way? a. Offers consumers a quick and easy way to select products b. Makes the nutrient content values more meaningful c. Standardizes serving sizes d. Ensures FDA approval of health claims e. Alerts consumers to common allergenic ingredients ANSWER: b 25. Define the five major food groups and discuss why individuals should consume a variety of foods within each group.

ANSWER: The five major food groups are fruits, vegetables, grains, protein, and dairy. Individuals should select foods from each of the food groups daily and vary their choices within each food group from day to day for several reasons. First, different foods within the same group contain different arrays of nutrients. Second, no food is guaranteed to be entirely free of substances that, in excess, could be harmful. Third, variety keeps meals containing healthy foods interesting and staves off boredom.

26. Which of the following products is an example of an enriched food? a. Orange juice with added calcium b. Whole wheat flour c. White bread with added thiamin d. Pasteurized cheese snack e. Powdered milk ANSWER: c

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Chapter 02: Planning a Healthy Diet 27. Which of the following foods is an example of an imitation food? a. Orange juice with added calcium b. Whole wheat flour c. White bread with added thiamin d. Pasteurized cheese snack e. Powdered milk ANSWER: d 28. Which of the following choices is an example of a fortified food? a. Orange juice with added calcium b. Whole wheat flour c. White bread with added thiamin d. Pasteurized cheese snack e. Powdered milk ANSWER: a 29. If someone eats mostly Asian cuisine, their diet may need to supplemented with nutrients high in which food group? a. Grains b. Fruits c. Vegetables d. Milk or milk products e. Protein foods ANSWER: d 30. For breakfast, Joni drank a cup of orange juice fortified with calcium. One cup of orange juice contains 100 kcal and has 250 mg of calcium. What is the nutrient density of this orange juice per kcalorie? a. 2.5 milligrams per kcalorie b. 3.5 milligrams per kcalorie c. 25 milligrams per kcalorie d. 35 milligrams per kcalorie e. 250 milligrams per kcalorie ANSWER: a

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Chapter 02: Planning a Healthy Diet 31. Which protein food would be the most appropriate to meet a vegetarian’s needs in one meal? a. 2 pieces of bread b. ½ c pinto beans c. 1 tbs peanut butter d. 1 c spinach e. ½ can tuna ANSWER: b 32. Which measure assigns foods to five major groups and recommends daily amounts from each group? a. USDA Food Patterns b. Healthy Eating Index c. Nutrition Facts Panel d. Percent Daily Values e. Facts Up Front ANSWER: a 33. Which entity developed the Facts Up Front label? a. United States Department of Agriculture b. Food and Drug Administration c. Academy of Nutrition and Dietetics d. Grocery Manufacturers Association e. American Medical Association ANSWER: d 34. Balance is the diet-planning principle of consuming a number of foods in proportion to each other. a. True b. False ANSWER: True 35. The USDA developed the MyPlate graphic. a. True b. False ANSWER: True

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Chapter 02: Planning a Healthy Diet 36. There are three major food groups. a. True b. False ANSWER: False 37. A 1800-kcalorie diet includes a maximum of how many discretionary kcalories? a. 70 b. 100 c. 170 d. 200 e. 270 ANSWER: e 38. What is the estimated daily energy needed for a sedentary sixty-year-old woman in kcalories? a. 1200 b. 1400 c. 1600 d. 1800 e. 2000 ANSWER: c 39. What is the maximum number of grams of fat recommended on a 2000-kcalorie diet based on the Daily Value? a. 34 b. 45 c. 56 d. 67 e. 78 ANSWER: a 40. What is the serving size (equivalent to 1 oz of grains) of cooked rice in the USDA Food Patterns? a. ¼ cup b. ⅓ cup c. ½ cup d. 1 cup e. 2 cups ANSWER: c Page 8

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Chapter 02: Planning a Healthy Diet 41. A health claim on a food label requires approval by which entity? a. United States Department of Agriculture b. American Medical Association c. Academy of Nutrition and Dietetics d. Food and Drug Administration e. State Health Department ANSWER: d 42. Calculate the grams of fat supplied by a 1200-kcalorie diet that is 30 percent fat. a. 20 grams b. 30 grams c. 40 grams d. 50 grams e. 60 grams ANSWER: c 43. Which type of claim does NOT require FDA approval to appear on a food label? a. Health claim b. Disease prevention claim c. Structure–function claim d. Nutrient claim e. Sugar content claim ANSWER: c 44. The Nutrition Facts panel must provide the a. percent daily value

for important nutrients.

b. nutrient claim c. average daily intake d. tolerable upper limit e. structure–function claims ANSWER: a

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Chapter 02: Planning a Healthy Diet 45. Which product would be excluded on a vegan diet? a. Seeds b. Eggs c. Legumes d. Nut butters e. Soy products ANSWER: b 46. By consuming a variety of vegetables every day, you contribute all of the following to your diet EXCEPT . a. niacin b. potassium c. magnesium d. folate e. vitamin C ANSWER: a 47. 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 48. 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

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Chapter 02: Planning a Healthy Diet 49. A food that provides 100 mg of magnesium and 25 kcal in a serving has a magnesium density (mg per kcal) of . a. 0.25 b. 0.4 c. 2.5 d. 4 e. 25 ANSWER: d 50. 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 51. 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 52. 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 53. Which food item is a healthy choice for protein in the USDA Food Patterns? a. Nuts b. Bacon c. Luncheon meats d. Sweet potatoes e. Marbled meats ANSWER: a 54.

can be used 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

55. Kcalories from which of these foods would most likely be part of someone’s discretionary kcalories allowance? a. Jam b. Watermelon c. Raw carrots d. Brussels sprouts e. Green beans ANSWER: a 56. 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

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Chapter 02: Planning a Healthy Diet 57. 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 (Forge) Guide ANSWER: a 58. The 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 59. Which food is most typically consumed in amounts greater than the amounts recommended by the USDA? a. Milk products b. Fruits c. Vegetables d. Nuts e. Refined grains ANSWER: d 60. 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

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Chapter 02: Planning a Healthy Diet 61. With food lists, to what group are olives assigned? a. Fat b. Meat c. Carbohydrate d. Meat substitute e. Fruit ANSWER: a 62. Whole-grain flour contains all parts of the grain EXCEPT for the a. bran

.

b. husk c. germ d. endosperm e. heart ANSWER: b 63. Liquid fats are not usually solid at room temperature; in order to achieve this solid and creamy state, the oil must be . a. processed b. combined with sugars c. hydrogenated d. oxygenated e. nutrient dense ANSWER: c 64. What typically contain more saturated and trans fats than most oils? a. Solid fats b. kCalorie controls c. Added sugars d. Proteins e. Carbohydrates ANSWER: a

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Chapter 02: Planning a Healthy Diet 65. What is the first guideline from 'The 2015–2020 Dietary Guidelines for Americans' that encourages healthy eating patterns? a. That 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. To be sure and limit their 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 66. Which of the following best describes enriched grains? a. Grains that have lost many nutrients during processing b. Grains that have nutrients added that were not originally present c. Grains that contain minimal nutrients d. Grains that have not been processed and retainall their nutrients e. Grains that have had nutrients added back in ANSWER: d 67. Which one of these nutrients must be used to enrich grains? a. Zinc b. Folate c. Protein d. Calcium e. Sodium ANSWER: b 68. 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

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Chapter 02: Planning a Healthy Diet 69. Which of the following items does a healthy eating pattern limit? a. A variety of protein foods, lean meats b. Sodium to less 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 70. 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 71. 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 72. Omega-3 fatty acids are commonly found in a. oils b. crabs

.

c. peanuts d. fatty fish e. chicken ANSWER: d

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Chapter 02: Planning a Healthy Diet 73. 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 74. According to 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 75. 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 76. 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

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Chapter 02: Planning a Healthy Diet 77. On the 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 78. 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 79. Population groups such as sedentary older men, sedentary younger women, and active older women have a daily energy need of approximately kcalories. a. 1200 b. 1500 c. 1800 d. 2000 e. 2400 ANSWER: d 80. 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

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Chapter 02: Planning a Healthy Diet 81. What is a feature of the 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 82. Which of the following statements is correct in context with non-vegetarians? a. They easily obtain large quantities of other nutrients including folate, vitamin C, 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 83. 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 84. According to the FDA, a food label that reads "improves memory" is an example of a(n) a. health claim

.

b. Daily Value claim c. ingredient claim d. structure-function claim e. nutrient claim ANSWER: d

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Chapter 02: Planning a Healthy Diet 85. 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 86. Which food items are consumed in the diet of a vegan? a. Plant foods only b. Eggs and plant foods only c. Animal foods only d. Milk products and plant foods only e. Fish, eggs, and dairy only ANSWER: a 87. Tempeh is made from . a. soybeans b. any legume c. fermented leafy vegetables d. fermented yellow vegetables e. wheat proteins ANSWER: a 88. 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

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Chapter 02: Planning a Healthy Diet 89. Which statement describes a feature of iron nutrition in vegetarians? a. Vegetarians adapt to absorbing iron more efficiently. b. Iron utilization is inhibited by the high zinc content in grains. c. The absorption of iron is low due 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 90. What 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. Intakes of vitamins A and C are lower.

ANSWER: c 91. 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. Cholesterol-free c. Less fat d. Fat-free e. Lean ANSWER: b 92. 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.

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Chapter 02: Planning a Healthy Diet 93. 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.

94. Define the Dietary Guidelines for Americans, including their purposes, and how they play a role in food politics.

ANSWER: The Dietary Guidelines for Americans are an evidenced-based document used to develop federal food, nutrition, and health policies and programs. They help translate the nutrient recommendations of the DRI into food recommend-dations.

By law, the Dietary Guidelines for Americans are reviewed and revised as needed every five years.

Each edition contains some of the same information as previous editions but also introduces new concepts. 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 exert 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 persuaded politicians that sustainability was outside the scope of providing dietary guidance.

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Chapter 02: Planning a Healthy Diet 95. 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 for 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 avoid oversized portions.

96. Define processed, refined, enriched, fortified, and whole-grain foods.

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 to 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 are added to the food to compensate for losses occurring during the food’s processing 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.

97. 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 state 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. The Nutrition Facts panel must provide the nutrient amount, percent Daily Value, or both for kcalories, total fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrate, fiber, total sugars, added sugars, and protein. The Nutrition Facts panel must also present nutrient content information for Vitamin D, Calcium, Iron, and Potassium.

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Chapter 02: Planning a Healthy Diet 98. 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 nutrient amounts listed more meaningful to consumers. The Daily Values reflect recommendations for nutrients and other 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.

99. 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 100.

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 so 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 milligrams of cholesterol, a “cholesterol-free” product may not contain more than 2 grams of saturated fat and trans fat combined per serving.

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 state that “ Very limited and preliminary research suggests that eating one-half 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.

101.

List and discuss the health benefits of a plant-based diet.

ANSWER: Plant-based diets are associated with lower rates of obesity, diabetes, low blood pressure, and lower rates of hypertension. This may be related to the intake of healthier fats and higher amounts of fiber.

Plant-based diets are associated with lower rates of hyperlipidemia and lower risk for heart disease.

Plant-based diets may also protect against certain types of cancer, which may be attributed to the high intake of fruits and vegetables.

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Chapter 03: Digestion, Absorption, and Transport 1. Someone who overeats may upset which process, leading to indigestion? a. segmentation b. absorption c. colonic irrigation d. peristalsis e. homeostasis ANSWER: d 2. Which of the following defines lumen? a. the continuous inner space within the GI tract b. the intestinal enzyme that hydrolyzes dietary nucleic acids c. the conduit from the mouth to the stomach d. the opening between the duodenum and jejunum e. the flavor of monosodium glutamate ANSWER: a 3. Which of the following statements about taste buds is FALSE? a. They react only with particles in solution. b. They can individually sense only one of the basic taste sensations at a time. c. There are five basic taste sensations: sweet, sour, bitter, salty, and umami. d. Fluid is needed to help dissolve foods for tasting. e. Taste perceptions are influenced by aroma, appearance, and temperature.

ANSWER: b 4. Flatulence is caused by undigested carbohydrates reaching the a. esophagus b. stomach c. small intestine d. large intestine e. pyloric sphincter ANSWER: d

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Chapter 03: Digestion, Absorption, and Transport 5. What is the role of bile? a. emulsify fats b. break down proteins c. regulate pH d. break down starches e. stimulate the gallbladder ANSWER: a 6. Exchange of oxygen, nutrients, and waste materials takes place across the walls of a. arteries b. veins c. cells d. capillaries e. epithelia ANSWER: d 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. Choking occurs when food has slipped into the a. esophagus b. epiglottis c. larynx d. trachea e. throat ANSWER: d

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Chapter 03: Digestion, Absorption, and Transport 9. In which part of the digestive tract does food exist as a bolus ? a. mouth b. esophagus c. stomach d. small intestine e. large intestine ANSWER: c 10. The pyloric sphincter opens into the a. large intestine

.

b. rectum c. small intestine d. colon e. bile duct ANSWER: c 11. Which term describes the body’s maintenance of constant internal conditions? a. digestion b. absorption c. segmentation d. peristalsis e. homeostasis ANSWER: e 12. Which of the following is secreted from the duodenal wall? a. stomach acid b. secretin c. gastrin d. CCK e. protease ANSWER: b

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Chapter 03: Digestion, Absorption, and Transport 13. Protecting the airways during swallowing is the primary function of the a. pharynx b. epiglottis c. esophagus d. trachea e. throat ANSWER: b 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 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

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Chapter 03: Digestion, Absorption, and Transport 17. Which hormone is produced by cells in the duodenum and targets the pancreas? a. CCK b. gastrin c. secretin d. bile e. protease ANSWER: c 18. Regulating the flow of food particles along the GI tract is the job of the a. crypts b. goblet cells c. bile ducts d. sphincter muscles e. villi ANSWER: d 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. Intestinal ischemia is caused by diminished a. peristalsis in the intestine b. blood flow to the intestines c. production of bile d. secretion of enzymes e. pH level in the stomach ANSWER: b

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Chapter 03: Digestion, Absorption, and Transport 21. What separates the upper half of the torso from the lower half? a. stomach b. diaphragm c. liver d. gallbladder e. appendix ANSWER: b 22. Which organ stores bile until it is needed? a. stomach b. gallbladder c. liver d. pancreas e. small intestine ANSWER: b 23. The five basic taste sensations are characterized as which type of sensation? a. chemical b. aroma c. appearance d. texture e. temperature ANSWER: a 24. When food is swallowed, what is the first place it passes through? a. pharynx b. esophagus c. trachea d. stomach e. pyloric sphincter ANSWER: a

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Chapter 03: Digestion, Absorption, and Transport 25. The pyloric sphincter separates which two organs? a. esophagus and stomach b. stomach and small intestine c. esophagus and trachea d. large intestine and anus e. small intestine and large intestine ANSWER: b 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. 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 28. In which organ does most absorption take place? a. small intestine b. large intestine c. liver d. gallbladder e. stomach ANSWER: a

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Chapter 03: Digestion, Absorption, and Transport 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 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

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Chapter 03: Digestion, Absorption, and Transport 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 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

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Chapter 03: Digestion, Absorption, and Transport 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 ileocecal valve separates which two organs? a. esophagus and stomach b. stomach and small intestine c. esophagus and trachea d. large intestine and anus e. small intestine and large intestine ANSWER: e 40. Which hormone is responsible for slowing gut motility? a. Gastrin b. Secretin c. CCK d. Bile e. Lipase ANSWER: c

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Chapter 03: Digestion, Absorption, and Transport 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

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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. If left untreated, GERD can eventually increase the risk of a. cancer b. Celiac disease c. colitis d. diverticulosis e. irritable bowel syndrome ANSWER: a 48. Bacteria in the GI tract also produce a. mucus b. several minerals

.

c. glucose d. several vitamins e. energy ANSWER: d

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Chapter 03: Digestion, Absorption, and Transport 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 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. When a stimulus elicits a response that causes a decrease in function, this is called a. homeostasis b. peristalsis c. segmentation d. negative feedback e. positive feedback ANSWER: d 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

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Chapter 03: Digestion, Absorption, and Transport 53. What is the role of the rectum? a. absorb water b. absorb nutrients c. store waste d. store bile e. secrete enzymes ANSWER: c 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

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Chapter 03: Digestion, Absorption, and Transport 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 59. The lower esophageal sphincter separates the esophagus from the a. stomach b. pharynx c. trachea d. small intestine e. throat ANSWER: a 60. Which type of structure conveys bile from the liver to the gallbladder? a. sphincter b. artery c. vein d. duct e. tubule ANSWER: d

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Chapter 03: Digestion, Absorption, and Transport 61. In diverticulosis, where do diverticula most commonly occur? a. stomach b. esophagus c. small intestine d. colon e. liver ANSWER: d 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 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

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Chapter 03: Digestion, Absorption, and Transport 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 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

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Chapter 03: Digestion, Absorption, and Transport 69. 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. Which of the following is secreted from the stomach wall? a. bile b. secretin c. gastrin d. CCK e. protease ANSWER: c 72. Which of the following is TRUE of dietary fats? a. Dietary fat can slow down gut motility b. Dietary fat can speed up the absorption of nutrients. c. Dietary fat is harmful to health. d. Dietary fat should not be consumed with protein. e. Dietary fat regulates the stomach’s pH. ANSWER: a

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Chapter 03: Digestion, Absorption, and Transport 73. Which food is most likely to be a choking hazard for young children? a. halved grapes b. popcorn c. crackers d. banana ANSWER: b 74. What intervention is commonly needed after persistent vomiting? a. gallbladder removal b. liver transplant c. IV saline and glucose d. extensive dental work e. reduced sodium diet ANSWER: c 75. Researchers are looking into the role of stress and the nervous system on which condition? a. colitis b. irritable bowel syndrome c. Celiac disease d. diverticulitis e. hemorrhoids ANSWER: b 76. Symptoms related to nonceliac gluten sensitivity might also be related to the intake of a. inadequate fluids b. excess sodium c. high FODMAP d. low fiber e. dairy foods ANSWER: c

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Chapter 03: Digestion, Absorption, and Transport 77. Which of the following is secreted from the intestinal wall? a. bile b. secretin c. gastrin d. CCK e. protease ANSWER: d 78. The esophagus is a conduit from the mouth to the stomach. a. True b. False ANSWER: True 79. The liver is a sac containing bacteria and lymph cells. a. True b. False ANSWER: False 80. Periodic squeezing by the intestine’s circular muscles is called segmentation. a. True b. False ANSWER: True 81. The ileocecal valve is a sphincter separating the small and large intestines a. True b. False ANSWER: True 82. Cholecystokinin is an enzyme that digests fats a. True b. False ANSWER: False 83. The unit of measure expressing a substance’s acidity is its pH. a. True b. False ANSWER: True Page 20

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Chapter 03: Digestion, Absorption, and Transport 84. Hydrolysis is a chemical reaction in which one molecule splits into two a. True b. False ANSWER: True 85. The gallbladder is an organ that stores bile until needed a. True b. False ANSWER: True 86. The appendix is an organ that manufactures bile salts to help digest fats. a. True b. False ANSWER: False 87. Goblets are tubular glands lying between villi a. True b. False ANSWER: False 88. Crypt cells a. True

secrete

mucus.

b. False ANSWER: False 89. Villi are fingerlike projections in the small intestine a. True b. False ANSWER: True 90. Water is a nutrient absorbed by simple diffusion a. True b. False ANSWER: True

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Chapter 03: Digestion, Absorption, and Transport 91. Arteries carry blood from the heart to tissues a. True b. False ANSWER: True 92. Lymph is a clear fluid containing white blood cells a. True b. False ANSWER: True 93. The hepatic portal vein carries blood from GI tract to liver a. True b. False ANSWER: True 94. The lymphatic system includes tissues and organs that transport fluids toward the heart a. True b. False ANSWER: True 95. Secretin is a hormone secreted by stomach wall a. True b. False ANSWER: False 96. Gastrin is a hormone that targets the pancreas a. True b. False ANSWER: False 97. Describe the process by which the gallbladder senses that fat is present in the GI tract.

ANSWER: ANSWER: 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.

Cholecystokinin 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.

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Chapter 03: Digestion, Absorption, and Transport 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.

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Chapter 03: Digestion, Absorption, and Transport 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.

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.

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Chapter 03: Digestion, Absorption, and Transport 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.

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 bicarbonate-rich 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.

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Chapter 03: Digestion, Absorption, and Transport 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. What is the difference between the average daily intake of fiber in the United States and the recommended intake for women? a. 3 grams b. 6 grams c. 9 grams d. 12 grams ANSWER: c 2. Which of the following vegetables contains about 5 grams of carbohydrates per half-cup serving? a. peas b. sweet potatoes c. corn d. green beans ANSWER: c 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. peristalsis d. condensation

.”

e. segmentation ANSWER: d

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 5. Which of the following is an effect of the bacterial by-products of fiber fermentation in the colon? a. bind with bile acids in the GI tract b. inhibit cholesterol synthesis in the liver c. slow glucose absorption d. block absorption of unwanted constituents ANSWER: b 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

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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

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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. brain and blood cells b. spleen and lymphatics c. stomach and intestines d. pancreas and kidneys e. muscles and liver ANSWER: e 12. Which of the following is an effect of soluble fiber trapping nutrients and delaying their transit through the GI tract? a. bind with bile acids in the GI tract b. inhibit cholesterol synthesis in the liver c. slow glucose absorption d. block absorption of unwanted constituents ANSWER: c

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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. glycogen b. fiber c. lactose d. sucrose e. starch ANSWER: e 14. Pectin from fruit is an example of which type of fiber? a. viscous 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

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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. How does adequate fiber intake protect against diverticular disease? a. strengthening GI tract muscles b. binding to bile acids in the GI tract c. trapping nutrients and delaying their transit d. slowing glucose absorption ANSWER: a 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. What function does sugar serve in jams and jellies? a. Provides fuel for yeast fermentation b. Inhibits microbial growth c. Acts as a bulking agent d. Imparts a creamy consistency ANSWER: b

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

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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. Which source of fiber is LEAST likely to confer protection against cancer? a. lentils b. oats c. apples d. psyllium ANSWER: d 24. What action does cellulose have in the body? a. increase fecal weight b. hold moisture in stools c. bind to bile d. slow glucose absorption ANSWER: a 25. Which form of fruit is recommended for the most fiber intake? a. fruit juice b. fruit sorbet c. fruit with skin d. canned fruit ANSWER: c Page 6

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 26. When 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 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

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 30. The liver can store enough glycogen to meet the body’s energy needs for a. one day

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b. three days c. one week d. ten days e. two 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 33. When blood glucose falls, which organ responds first? a. brain b. liver c. muscle d. pancreas e. gallbladder ANSWER: d

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 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 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

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 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 what percentage of the added sugars consumed in the United States? a. 10% b. 25% c. 50% d. 75% e. 90% ANSWER: c 41. The American Heart Association recommends women limit added sugars to how many kcalories per day? a. 50 b. 75 c. 100 d. 150 e. 125 ANSWER: c

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 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 percent fructose and 50 percent 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 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

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 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

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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 4g of carbohydrates and about how many kcalories? a. 8 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 49. Which non-nutritive artificial sweetener is herb-derived and generally recognized as safe? a. stevia b. aspartame c. saccharine d. sucralose e. advantame ANSWER: a

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 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 what percentage 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 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

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 54. Carbohydrates should provide what percentage of the day's total energy intake to support good health? a. 5 to 9% 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 how many grams per day? a. 10 b. 45 c. 130 d. 250 e. 400 ANSWER: c 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

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 58. One ounce of a grain (e.g., one slice of bread) provides about how many grams of carbohydrate? a. 5 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 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

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 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 from . a. fat b. protein c. alcohol d. carbohydrate e. lipoproteins ANSWER: d 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

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 66. Which of the following is the Daily Value of carbohydrates used on food labels, based on a 2000-calorie diet? a. 90 grams b. 130 grams c. 165 grams d. 220 grams e. 275 grams ANSWER: e 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. Drinking water instead of soda can help a person lose how many pounds in 1 year? a. 5 b. 10 c. 15 d. 20 e. 25 ANSWER: b 69. Sugary soft drinks are dense in a. vitamins

.

b. minerals c. energy d. fiber e. prebiotics ANSWER: c

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 70. Fructose is metabolized primarily by the a. pancreas

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b. liver c. small intestine d. large intestine e. gallbladder ANSWER: b 71. Excess fructose consumption can lead to which of the following conditions? a. fatty liver b. diverticulosis c. hyperlipidemia d. hypercholesterolemia e. heart disease ANSWER: a 72. Plant polysaccharides composed of many glucose molecules are a. soluble fibers b. insoluble fibers c. sugars d. starches e. indigestible ANSWER: d 73. The American Heart Association recommends men limit added sugars to how many kcalories per day? a. 50 b. 100 c. 150 d. 75 e. 125 ANSWER: c

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 74. Products containing which sweetener must carry a warning for people with phenylketonuria? a. sucralose b. saccharine c. stevia d. aspartame ANSWER: d 75. Which protein food provides about a third of its carbohydrates from fiber? a. nuts b. legumes c. eggs d. fish ANSWER: b 76. Simple carbohydrates composed of monosaccharides, disaccharides, or both are called a. soluble fibers b. insoluble fibers c. sugars d. starches e. indigestible

.

ANSWER: c 77. When serving a protein-sparing action, carbohydrates provide a. energy

.

b. amino acids c. fatty acids d. peptides e. glucose ANSWER: a

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 78. Prediabetes is the condition of which of the following measures that is higher than normal but does not meet the diagnostic criteria for diabetes? a. blood glucose b. hemoglobin A1C c. insulin d. cholesterol e. triglycerides ANSWER: a 79. When fat is broken down when carbohydrate is not available, ketone bodies are produced by the a. pancreas

.

b. gallbladder c. liver d. brain e. heart ANSWER: c 80. Lactase is the enzyme required to digest the disaccharide lactose into its component monosaccharides. a. True b. False ANSWER: True 81. Which of the following is secreted by the pancreas in response to low blood sugar? a. glucose b. glycogen c. glucagon d. amylase e. insulin ANSWER: c

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 82. Which substance is released during condensation? a. CO2 b. water c. glucose d. calcium e. HCl ANSWER: b 83. Which of the following is secreted by the pancreas in response to elevated blood sugar? a. glucose b. glycogen c. glucagon d. amylase e. insulin ANSWER: e 84. Glycogen is a polysaccharide not found in plants. a. True b. False ANSWER: True 85. Grains are the richest food source of starch. a. True b. False ANSWER: True 86. Cellulose is an insoluble fiber. a. True b. False ANSWER: True 87. Psyllium is a water-soluble fiber. a. True b. False ANSWER: True

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 88. Sucrose is a monosaccharide found in fruits. a. True b. False ANSWER: False 89. Maltose, sucrose, and lactose are broken down in the small intestine. a. True b. False ANSWER: True 90. Amylase is a salivary enzyme that breaks down protein. a. True b. False ANSWER: False 91. Bacterial enzymes digest fiber in the large intestine. a. True b. False ANSWER: True 92. Lactose is a disaccharide composed of glucose and galactose. a. True b. False ANSWER: True 93. Non-digestible carbohydrates contain small fat molecules that contribute some energy. a. True b. False ANSWER: True 94. A blood glucose level of 60 mg/dL indicates hypoglycemia a. True b. False ANSWER: True

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 95. Non-digestible carbohydrates attract water which softens stool for passage without straining. a. True b. False ANSWER: True 96. High fructose corn syrup is half glucose and half fructose. a. True b. False ANSWER: True 97. A ½ cup serving size of milk yields 12 g of carbohydrate. a. True b. False ANSWER: False 98. A ½ cup serving size of corn yields 15 g of carbohydrate. a. True b. False ANSWER: True 99. Sweeteners that yield energy, including both sugars and sugar alcohols, are called nutritive sweeteners. a. True b. False ANSWER: True 100.

Describe the glycemic response and dietary choices that can contribute to an ideal glycemic response.

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). Some studies have shown that selecting foods with a low glycemic index is a practical way to improve glucose control. People can choose foods with a low glycemic index and combine foods with a higher glycemic index with fiber, fat, and protein to improve the glycemic response.

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 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 non-starch 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 (non-viscous), 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.

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 percent of the activity at birth. Only a relatively small percentage (about 30 percent) 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 genetic 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.

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 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 a cup of 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 percent 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.

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.

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 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 high-starch 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 throughout 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.

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 Page 29

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Chapter 04: The Carbohydrates: Sugars, Starches, and Fibers 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. Non-sugary 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 percent 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 cancercausing 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 lowfat 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. Fatty acids consist of a chain of carbon and hydrogen atoms with an acid group on one end and which type of group at the other end?

a. hydroxyl b. methyl c. amino d. carboxyl e. phosphate ANSWER: b 4. Naturally occurring fatty acids contain even numbers of which molecules in their chains? a. carbon b. hydrogen c. oxygen d. nitrogen e. phosphorus 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 of

.

a. amino acids b. double bonds c. saccharide units d. peptide linkages e. oxygen atoms ANSWER: b 6. Which of the following has the highest proportion of saturated fatty acids? a. Cottonseed oil b. Walnut oil c. Peanut oil d. Palm oil e. Coconut oil ANSWER: e 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. What is the recommended weekly intake of fish? a. 3 ounces b. 8 ounces c. 13 ounces d. 18 ounces e. 23 ounces ANSWER: b 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. What does the process of hydrogenation do? a. shortens the carbon chain b. converts cis‐fatty acids to trans‐fatty acids c. removes the methyl group d. lengthens the carbon chain e. separates fatty acids from glycerol ANSWER: b 15. What is a unique property of phospholipids? a. They are both hydrophilic and hydrophobic. b. They have a trans structure. c. They have a multiple‐ring structure. d. They have three double bonds. e. They carry a negative charge.

ANSWER: a 16. Which of the following describes how lecithin is different from a triglyceride? a. Lecithin has to glycerol backbone. b. Lecithin has no phosphate group. c. Lecithin has only two fatty acids. d. Lecithin is only hydrophilic. e. Lecithin has no choline.

ANSWER: c

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Chapter 05: The Lipids: Triglycerides, Phospholipids, and Sterols 17. Which type of fat tends to be solid at room temperature? a. monounsaturated b. polyunsaturated c. saturated d. omega 3 e. omega 6 ANSWER: c 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. Which of the following is not a main source of fat in the Mediterranean diet? a. fish b. olives c. nuts d. butter e. cheese ANSWER: d

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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. Under what condition does lingual lipase play an active role in fat digestion? a. gallbladder removal b. infancy c. liver disease d. diabetes e. appendix removal ANSWER: b 23. The release of CCK and bile is triggered when fat enters the a. mouth b. esophagus c. stomach d. small intestine e. large intestine ANSWER: d 24. Which of the following removes each of a triglyceride’s fatty acids, leaving a monoglyceride. a. lingual lipase b. pancreatic lipase c. salivary amylase d. pancreatic protease e. pancreatic amylase ANSWER: b

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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. Jamila eats a meal containing some fats. Her body has removed the chylomicrons from her blood within how many hours after absorption? 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 type of tissue is responsible for secreting proteins to help regulate energy balance and protecting vital organs from shock? a. epithelial

b. adipose c. connective d. nervous e. muscle ANSWER: b

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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 what percentage 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 what percentage of the daily energy intake from fat? a. less than 10% 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 what percentage of their total energy from fat?

a. 25% 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 how many 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. How many kcalories are contributed by 1 gram of dietary fat? a. 3 b. 6 c. 9 d. 12 e. 15 ANSWER: c

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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. Which fatty acid has three double bonds? a. stearic acid b. oleic acid c. lauric acid d. linoleic acid e. linolenic acid ANSWER: e

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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. Which fish is commonly low in the environmental contaminant mercury? a. haddock b. tilefish c. swordfish d. king mackerel e. shark ANSWER: a 63. What effect does hydrogenation have on foods? a. Adds a creamy consistency. b. Enhances flavor. c. Protects against oxidation. d. Inhibits bacterial growth. e. Promotes yeast fermentation ANSWER: c 64. What is a unique property of sterols? a. They are both hydrophilic and hydrophobic. b. They have a trans structure. c. They have a multiple‐ring structure. d. They have three double bonds. e. They carry a negative charge.

ANSWER: c

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Chapter 05: The Lipids: Triglycerides, Phospholipids, and Sterols 65. Which of the following has the highest proportion of monounsaturated fatty acids? a. fish oil b. olive oil c. soybean oil d. coconut oil e. butter ANSWER: b 66. Which is a chemical reaction in which water is released as two molecules that combine to form one larger product?

a. hydrogenation b. hydrolysis c. oxidation d. condensation e. saturation ANSWER: d 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. Which fatty acid has two double bonds? a. stearic acid b. oleic acid c. lauric acid d. linoleic acid e. linolenic acid 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, is called the a. point of unsaturation b. point of entry c. point of view

.

d. point of hydrogenation e. point of composition ANSWER: a

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Chapter 05: The Lipids: Triglycerides, Phospholipids, and Sterols 73. An alcohol composed of a three‐carbon chain, which can serve as the backbone for a triglyceride is called . a. alcohol

b. hydroxyl c. sorbitol d. glycerol e. aldehyde ANSWER: d 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 a. trans

.

b. de c. endo d. exo e. cis ANSWER: e 75. Which term refers to water‐soluble substances? a. hydraulic b. hydrophilic c. hydrophobic d. hydroxyl e. hydrolytic ANSWER: b 76. Where does exogenous cholesterol come from? a. environmental contaminants b. the food we consume c. the liver d. the gallbladder e. genetic predisposition ANSWER: b

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Chapter 05: The Lipids: Triglycerides, Phospholipids, and Sterols 77. A diglyceride is two fatty acids attached to a molecule of a. glucose b. glycogen c. glycerol d. glycol e. glucagon

.

ANSWER: c 78. Clusters of lipids derived from VLDL that move through the blood are called a. low‐density lipoproteins b. high‐density lipoproteins c. micelles d. chylomicrons e. fatty acids

.

ANSWER: a 79. Adipokines secreted by adipose cells are a. lipids

.

b. proteins c. hormones d. micronutrients e. neurotransmitters ANSWER: b 80. Which substance promotes insulin resistance? a. insulin b. resistin c. adiponectin d. glycogen e. secretin ANSWER: b

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Chapter 05: The Lipids: Triglycerides, Phospholipids, and Sterols 81. Which set of blood tests reveals a person’s total cholesterol, triglycerides, and various lipoproteins? a. complete blood count b. comprehensive metabolic panel c. blood lipid profile d. full thyroid panel e. white blood cell count ANSWER: c 82. Linolenic acid is an 18‐carbon polyunsaturated fatty acid with two double bonds. a. True b. False ANSWER: False 83. The point of unsaturation is the double bond of a fatty acid, where hydrogen atoms can be added. a. True b. False ANSWER: True 84. Stearic acid is an 18‐carbon saturated fatty acid. a. True b. False ANSWER: True 85. Canola oil is a common source of oleic acid. a. True b. False ANSWER: True 86. Choline is part of the phospholipid lecithin. a. True b. False ANSWER: True 87. Cholesterol is the most well‐known sterol. a. True b. False ANSWER: True Page 21

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Chapter 05: The Lipids: Triglycerides, Phospholipids, and Sterols 88. The gallbladder makes bile from cholesterol. a. True b. False ANSWER: False 89. Bile is a fat‐digesting enzyme secreted from the stomach. a. True b. False ANSWER: False 90. Most of the hydrolysis of triglycerides occurs in the stomach. a. True b. False ANSWER: False 91. Gastric lipase is a complex of emulsified fat. a. True b. False ANSWER: False 92. Chylomicrons are the largest and least dense lipoprotein a. True b. False ANSWER: True 93. Very low‐density lipoproteins primarily transport triglycerides from liver to other tissues a. True b. False ANSWER: True 94. High‐density lipoproteins are half protein. a. True b. False ANSWER: True

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Chapter 05: The Lipids: Triglycerides, Phospholipids, and Sterols 95. Eicosanoids are derivatives of 20‐carbon fatty acids. a. True b. False ANSWER: True 96. Linoleic acid is an essential fatty acid with three double bonds. a. True b. False ANSWER: False 97. Doughnuts are a common source of trans‐fatty acids. a. True b. False ANSWER: True 98. What replaces the glycerol molecule in the fat replacer olestra? a. Maltose b. Dextrose c. Sucralose d. Glucose e. Sucrose ANSWER: e 99. Trout is a lean source of dietary protein a. True b. False ANSWER: True 100.

Describe the characteristics of the fat replacer olestra and its relationship to fat‐soluble vitamins.

ANSWER: 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.”

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Chapter 05: The Lipids: Triglycerides, Phospholipids, and Sterols 101.

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 102.

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.

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Chapter 05: The Lipids: Triglycerides, Phospholipids, and Sterols 103.

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 percent 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.

104.

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), Page 26

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Chapter 05: The Lipids: Triglycerides, Phospholipids, and Sterols 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 andlong‐ 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 therest 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 105.

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 anti‐nflammatory 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 106.

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, their dinner’s triglycerides provide some of the fuel that keeps them moving. When a person loses their appetite, their stored triglycerides fuel much of their body’s work until thye 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 non‐ adipose 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.

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Chapter 05: The Lipids: Triglycerides, Phospholipids, and Sterols 107.

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.

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Chapter 05: The Lipids: Triglycerides, Phospholipids, and Sterols 108.

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 109.

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 110. 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. Which group does each amino acid have? a. acid b. hydroxyl c. methyl d. carbonyl e. phosphate ANSWER: a

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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. What does the amino acid glycine have as its side group? a. 1 carbon and 3 hydrogens b. 1 hydrogen c. 1 carbon d. 1 hydrogen and 3 carbons e. 1 hydrogen and 1 carbon ANSWER: b 8. Which amino acid is conditionally essential in the condition phenylketonuria? a. tryptophan b. serine c. tyrosine d. alanine e. phenylalanine ANSWER: c

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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 b. secondary c. tertiary d. quaternary e. denaturalized

structure, which gives it maximum stability.

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. What does the amino acid alanine have as its side group? a. 1 carbon and 3 hydrogens b. 1 hydrogen c. 1 carbon d. 1 hydrogen and 3 carbons e. 1 hydrogen and 1 carbon ANSWER: a 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. Which types of bridges are present in the protein insulin? a. dipeptide b. tripeptide c. polypeptide d. disulfide e. trisulfide ANSWER: d 18. The primary structure of proteins is the a. polypeptide tangles b. double helix c. polypeptide shapes d. amino acid sequence e. polypeptide interactions ANSWER: d 19. The secondary structure of proteins is the a. polypeptide tangles b. double helix c. polypeptide shapes d. amino acid sequence e. polypeptide interactions 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 tertiary structure of proteins is the a. polypeptide tangles b. double helix c. polypeptide shapes d. amino acid sequence e. polypeptide interactions ANSWER: a 22. The quaternary structure of proteins is the a. polypeptide tangles b. double helix c. polypeptide shapes d. amino acid sequence e. polypeptide interactions ANSWER: e 23. The protein‐making machinery of the cell is the a. mitochondria b. nucleus c. cell wall d. cytoplasm e. ribosome ANSWER: e 24. Sickle‐cell anemia involves a sequencing error in the structure of a. hemoblobin b. valine c. insulin d. thyroxine ANSWER: a

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Chapter 06: Protein: Amino Acids 25. To build a bone or tooth, cells first lay down a matrix and then fill it with crystals of a. amino acids b. DNA c. minerals d. vitamins e. glucose ANSWER: c 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. 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

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Chapter 06: Protein: Amino Acids 29. Transport proteins within a cell membrane pick up and release which of the following across the membrane? a. fats and carbohydrates b. sodium and potassium c. hydrogen and nitrogen d. acids and enzymes e. calcium and phosphorus ANSWER: b 30. Which protein transports oxygen from the lungs to the cells? a. collagen b. insulin c. pepsin d. hemoglobin e. prolactin ANSWER: d 31. What is fibrin? a. an antigen b. an antibody c. a light‐sensitive protein d. a blood clotting protein e. a sterol ANSWER: d 32. Which of the following proteins inactivates foreign bacteria and viruses? a. enzymes b. collagen c. hormones d. antibodies e. antigens ANSWER: d

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Chapter 06: Protein: Amino Acids 33. The degradation and synthesis of protein is called “ a. protein turnover b. nitrogen balance c. amino acid pool d. immunity e. transamination

.”

ANSWER: a 34. 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 35. For whom is nitrogen balance typically positive? a. pregnant women b. starving children c. burn victims d. febrile children e. adult men ANSWER: a 36. 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

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Chapter 06: Protein: Amino Acids 37. 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 38. 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 39. 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 40. The production of urea hits its maximum rate at intakes approaching a. 5 b. 50

grams of protein per day.

c. 100 d. 250 e. 500 ANSWER: d

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Chapter 06: Protein: Amino Acids 41. 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 42. 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 43. 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 44. 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

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Chapter 06: Protein: Amino Acids 45. 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 46. 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 47. 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 48. 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

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Chapter 06: Protein: Amino Acids 49. Which of the following is NOT a limiting amino acid? a. lysine b. methionine c. threonine d. tryptophan e. serine ANSWER: e 50. 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 51. 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 52. 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

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Chapter 06: Protein: Amino Acids 53. The amino acid homocysteine is elevated in a. cancer b. kidney disease c. heart disease d. protein‐energy malnutrition e. osteoporosis

.

ANSWER: c 54. 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 55. 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 56. 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

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Chapter 06: Protein: Amino Acids 57. 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 58. The protein RDA for adults is a. 0.08 b. 0.36 c. 0.8 d. 3.6 e. 8

grams per kilogram of body weight.

ANSWER: c 59. Which condition would require an adjustment in the recommended intake of protein that differs from the RDA? a. kidney disease

b. heart disease c. osteoporosis d. stroke e. diabetes ANSWER: e 60. 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

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Chapter 06: Protein: Amino Acids 61. Which amino acid important for muscle growth is high in whey protein? a. leucine b. isoleucine c. lysine d. methionine e. tryptophan ANSWER: a 62. 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 63. 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 64. 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

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Chapter 06: Protein: Amino Acids 65. 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 66. Which nutrient increases methylation in certain genes and may protect against some cancers? a. folate b. vitamin C c. vitamin D d. thiamine e. vitamin B12 ANSWER: a 67. Which nutrient decreases methylation in certain genes and may protect against some cancers? a. folate b. vitamin D c. vitamin C d. thiamine e. vitamin B12 ANSWER: c 68. Whether silencing or activating a gene is beneficial or harmful for the body depends on a. which nutrient is involved b. what the gene does c. which area of the gene is involved d. the amount of kcalories consumed e. the age of the person ANSWER: b

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Chapter 06: Protein: Amino Acids 69. In PKU, the body cannot convert phenylalanine to a. serine b. leucine c. isoleucine d. tyrosine e. tryptophan ANSWER: d 70. The process by which a cell converts the genetic code into RNA and protein is called a. transcription b. translation c. expression d. sequencing e. denaturation ANSWER: c 71. What is the effect of compounds that do not fit an enzyme’s active site? a. A new compound is formed. b. The compounds are denatured. c. No reaction is triggered. d. The enzyme is converted to its inactive form. e. The enzyme is activated.

ANSWER: c 72. When does the pancreas release insulin? a. When blood glucose falls b. After a meal c. When cells destroy glucose d. When plasma proteins leak e. After detecting an antigen ANSWER: b

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Chapter 06: Protein: Amino Acids 73. The process of messenger RNA directing the sequence of amino acids and synthesis of proteins is called a. transcription b. translation c. expression d. sequencing e. denaturation ANSWER: b 74. The process of messenger RNA being made from a template of DNA is a. transcription b. translation c. expression d. sequencing e. denaturation ANSWER: a 75. Without enough protein, the body may become more susceptible to infection due to inability to manufacture a. antagonists b. antibodies c. antigens d. antidiuretic hormone e. antioxidants ANSWER: a 76. What must happen to the transport protein before it releases sodium outside the cell? a. It must pick up oxygen b. It must pick up potassium c. It must change shape d. It must change charge e. It must be hydrolyzed ANSWER: c

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Chapter 06: Protein: Amino Acids 77. Which process renders hemoglobin unable to carry oxygen? a. transcription b. expression c. translation d. hydrogenation e. denaturation ANSWER: e 78. The essential amino acids leucine, isoleucine, and valine, which are present in large amounts in skeletal muscle tissue, are called

amino acids.

a. essential b. nonessential c. branched‐chain d. conditionally essential e. polypeptide ANSWER: c 79. Arginine is a dietary nonessential amino acid a. True b. False ANSWER: False 80. Dipeptide is a term for two or more amino acids bonded together. a. True b. False ANSWER: True 81. Sulfur is an element found in some amino acids a. True b. False ANSWER: True 82. Hemoglobin is a globular protein that accounts for 80 percent of the body’s iron a. True b. False ANSWER: True Page 20

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Chapter 06: Protein: Amino Acids 83. Proteins help maintain the pH balance of the blood by acting as a. acids b. bases c. buffers d. ions e. pumps

.

ANSWER: c 84. Protein turnover is a change in protein when agitated. a. True b. False ANSWER: False 85. Pepsin is an enzyme active in the stomach. a. True b. False ANSWER: True 86. Translation occurs when messenger RNA is made from DNA. a. True b. False ANSWER: False 87. Transcription occurs when messenger RNA sequences amino acids a. True b. False ANSWER: False 88. Sickle‐cell anemia is a disease caused by sequencing errors. a. True b. False ANSWER: True

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Chapter 06: Protein: Amino Acids 89. Gene expression occurs when a cell converts genetic code into RNA and protein. a. True b. False ANSWER: True 90. Denaturation is the degradation and synthesis of protein. a. True b. False ANSWER: False 91. Serotonin is a neurotransmitter that regulates sleep. a. True b. False ANSWER: True 92. Which protein regulates the body’s metabolic rate? a. collagen b. thyroxine c. pepsin d. oxytocin e. prolactin ANSWER: b 93. Urea is a combination of ammonia and carbon dioxide. a. True b. False ANSWER: True 94. Which protein regulates fluid and electrolyte balance? a. renin b. pepsin c. insulin d. oxytocin e. glucagon ANSWER: a

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Chapter 06: Protein: Amino Acids 95. Which protein supports lactation? a. glucagon b. thyroxine c. pepsin d. oxytocin e. calcitonin ANSWER: d 96. Tryptophan is a typical limiting amino acid. a. True b. False ANSWER: True 97. Marasmus is a condition of protein malnutrition. a. True b. False ANSWER: True 98. Serine is an amino acid that may lower blood pressure. a. True b. False ANSWER: False 99. 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.

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Chapter 06: Protein: Amino Acids 100.

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.

101.

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.

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Chapter 06: Protein: Amino Acids 102.

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.

103.

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 Page 25

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Chapter 06: Protein: Amino Acids 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 104.

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.

105.

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).

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Chapter 06: Protein: Amino Acids 106.

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.

107.

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.

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Chapter 06: Protein: Amino Acids 108.

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 glycolysis, what is the net yield of one glucose molecule? a. one pyruvate molecule b. two pyruvate molecules c. three pyruvate molecules d. four pyruvate molecules e. five pyruvate molecules ANSWER: a 3. What are the “powerhouses” of the cell? a. DNA b. ribosomes c. RNA 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

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ANSWER: a

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Chapter 07: Energy Metabolism 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 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. synthesis of lipid c. synthesis of vitamins and minerals d. synthesis of cholesterol 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

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Chapter 07: Energy Metabolism 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 11. Which of the following is a group of enzymes for metabolizing drugs and alcohol? a. ADH b. MEOS c. ATP d. TCA e. ETOH ANSWER: b 12. The liver converts which of the following to fatty acids? a. glucose b. dextrose c. sucrose d. maltose e. fructose ANSWER: e

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Chapter 07: Energy Metabolism 13. What is the sugar that helps make up ATP? a. sucrose b. glucose c. dextrose d. phosphate e. ribose ANSWER: e 14. What is true of alcohol intake in heavy doses? a. It contributes to weight gain. b. It generates more heat than fat metabolically. c. It causes most body fat gain in the extremities. d. It is defined as one drink daily. e. It causes increased excretion of vitamin A. ANSWER: b 15. The metabolic breakdown of glucose to pyruvate is known as a. hydrolysis b. synthesis c. glycolysis d. activation e. energy release

.

ANSWER: c 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

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Chapter 07: Energy Metabolism 17. What happens first when carbohydrates are eaten in excess? a. They are stored as glycogen. b. They are stored as body fat. c. Dietary fat is spared from oxidation. d. They are converted to fatty acids. e. They are converted to amino acids.

ANSWER: a 18. Ketone bodies can efficiently provide fuel for which type of cells? a. Hepatic b. Adipocytes c. Brain d. Renal e. Epithelial ANSWER: c 19. How many carbons does acetyl CoA have? a. 2 b. 3 c. 4 d. 5 e. 6 ANSWER: a 20. In the Cori cycle, lactate is converted to glucose in the a. muscles b. liver c. bloodstream d. gallbladder e. pancreas

.

ANSWER: b

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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. The conversion of pyruvate to acetyl CoA is a. part of the TCA cycle b. reversible c. part of the Cori cycle d. anaerobic e. part of the electron transport chain

.

ANSWER: a 23. In energy metabolism, glycerol can convert to a. vitamin A b. fructose c. 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. convert to ammonia d. turn into carbon dioxide e. make fats

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ANSWER: e

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Chapter 07: Energy Metabolism 25. Fatty acid oxidation produces a. ketones b. fructose c. pyruvate d. acetyl CoA e. lactate

.

ANSWER: d 26. Fatty acids are metabolized via a. the TCA cycle b. the Cori cycle c. the electron transport chain d. glycolysis e. hydrolysis ANSWER: b 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

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Chapter 07: Energy Metabolism 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 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

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Chapter 07: Energy Metabolism 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 36. If a cell needs energy and oxygen is available, pyruvate enters which part of the cell? a. Ribosome b. Cell wall c. Cytoplasm d. Nucleus e. Mitochondria ANSWER: e

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Chapter 07: Energy Metabolism 37. Amino acids that enter the TCA cycle directly are considered a. glycogenic b. gluconeogenic c. glucogenic d. ketogenic e. oxalates

.

ANSWER: c 38. What is the final metabolic pathway for all energy-yielding nutrients? a. the TCA cycle b. the Cori cycle c. the electron transport chain d. glycolysis e. hydrolysis ANSWER: a 39. Which of the following cannot be made into glucose by cells? a. pyruvate b. glycerol c. glycogen d. fatty acids e. amino acids ANSWER: d 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

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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

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Chapter 07: Energy Metabolism 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 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

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Chapter 07: Energy Metabolism 49. During the first few days of a fast, body protein provides about what percentage of the glucose the body needs to fuel itself? a. 15%

b. 25% c. 35% d. 75% e. 90% ANSWER: e 50. Ketogenic diets are useful for a. sustaining weight loss b. treating epilepsy c. growing muscle d. maintaining a healthy pregnancy e. treating gout

.

ANSWER: b 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

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Chapter 07: Energy Metabolism 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 55. What happens first when a person overeats protein? a. Muscle is built. b. Protein oxidation increases. c. Normal daily losses are replaced. d. It is stored as body fat. e. It is converted to glucose.

ANSWER: c 56. Alcohol depresses the pituitary gland’s production of a. ADH b. acetyl CoA c. CCK d. ATP e. ketone bodies

.

ANSWER: a

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Chapter 07: Energy Metabolism 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 12-ounce serving of regular beer? a. 103 kcal b. 153 kcal c. 205 kcal d. 235 kcal e. 526 kcal ANSWER: b 59. When consumed while drinking, which nutrient contributes to keeping alcohol in the stomach longer? a. water b. high-fat snacks c. high-carbohydrate snacks d. high-protein snacks e. salty snacks ANSWER: b 60. Which area of the brain is first sedated by alcohol? a. frontal lobe b. pons c. midbrain d. cerebellum e. medulla oblongata ANSWER: a

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Chapter 07: Energy Metabolism 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

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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. thiamin

b. folate c. antidiuretic hormone d. protein e. alcohol dehydrogenase ANSWER: b 68. What effect does chronic alcohol abuse have on the B vitamin folate? a. It increases the liver’s ability to retain folate. b. It decreases kidney excretion of folate. c. It damages the small intestine’s ability to retrieve folate. d. It interferes with the conversion of methionine to homocysteine. e. It increases the production of new cells in the intestines.

ANSWER: c

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Chapter 07: Energy Metabolism 69. Which type of alcohol is used to make triglycerides? a. methanol b. isopropanol c. ethanol d. glycerol e. mannitol ANSWER: d 70. Which of the following is NOT a protein? a. coenzymes b. enzymes c. hormones d. hemoglobin e. collagen ANSWER: a 71. The simultaneous hydrolysis of ATP with reactions that will use energy is known as a. major b. metabolic c. coupled d. enzymatic e. chemical

reactions.

ANSWER: c 72. Some of the energy released in the TCA cycle is captures in which compound? a. acetyl CoA b. ATP c. glucose d. glycerol e. fatty acid ANSWER: b

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Chapter 07: Energy Metabolism 73. When the body needs energy quickly, pyruvate is converted to a. acetyl CoA b. lactate c. ATP d. carbon dioxide e. oxygen

.

ANSWER: b 74. The process in which fatty acids are taken apart two carbons at a time is known as a. electron transport b. hydrogenation c. fatty acid oxidation d. dehydrogenase e. moderation

.

ANSWER: c 75. The process of converting lactate from muscles to glucose in the liver that can be returned to the muscles is known as (the) ________. a. TCA cycle

b. electron transport chain c. hydrolysis d. Cori cycle e. fatty acid oxidation ANSWER: d 76. The process of making glucose from non-carbohydrate sources is called a. glycolysis b. gluconeogenesis c. ketosis d. deamination e. oxidation

.

ANSWER: b

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Chapter 07: Energy Metabolism 77. The acidic compounds produced by the liver during incomplete breakdown of fat when carbohydrate is not available are known as ______ _.

a. fatty acids b. triglycerides c. coenzymes d. ketone bodies e. amino acids ANSWER: b 78. The synthesis of protein from amino acids is an example of an anabolic reaction. a. True b. False ANSWER: True 79. The breakdown of glycogen to glucose is an example of a catabolic reaction. a. True b. False ANSWER: True 80. An enzyme is a protein that accelerates a chemical reaction. a. True b. False ANSWER: True 81. A coenzyme is a small nonprotein organic substance that promotes optimal activity of an enzyme. a. True b. False ANSWER: True 82. Pyruvate is a product of glycolysis. a. True b. False ANSWER: True

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Chapter 07: Energy Metabolism 83. AcetylCoA is a product of pyruvate metabolism when oxygen is limited. a. True b. False ANSWER: False 84. Lactate is an oxidation product of pyruvate. a. True b. False ANSWER: False 85. The TCA cycle is a series of metabolic reactions once known as the Krebs cycle. a. True b. False ANSWER: True 86. The synthesis of glucose from acetyl is an irreversible reaction. a. True b. False ANSWER: True 87. Glycogen is the part of a triglyceride that is convertible to glucose. a. True b. False ANSWER: False 88. Ammonia is a product of deamination. a. True b. False ANSWER: True 89. The glycerol part of a triglyceride can be converted to pyruvate or glucose. a. True b. False ANSWER: True

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Chapter 07: Energy Metabolism 90. Urea is the principal nitrogen-containing waste product. a. True b. False ANSWER: True 91. Water is a nonenergy product of the electron transport chain. a. True b. False ANSWER: True 92. Glycerol is a storage form of carbohydrate. a. True b. False ANSWER: False 93. Glucose is the major energy fuel for the central nervous system. a. True b. False ANSWER: True 94. Which term describes the excretion of ketones in the urine? a. ketosis b. ketoacidosis c. ketonuria d. ketonemia e. ketolysis ANSWER: c 95. Which term describes the excretion of ketones in the urine? a. ketosis b. ketoacidosis c. ketonuria d. ketonemia e. ketolysis ANSWER: c

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Chapter 07: Energy Metabolism 96. Which type of alcohol is present in beer, wine, and spirits? a. methanol b. isopropanol c. ethanol d. glycerol e. mannitol ANSWER: c 97. Discuss the dangers of binge drinking.

ANSWER: Binge drinking is relatively common among college students, especially males. Compared with nondrinkers or moderate drinkers, people who frequently binge drink (at least three times within two weeks) are more likely to engage in unprotected sex, have multiple sex partners, damage property, and perform poorly in school. Binge drinking poses serious health and safety risks. Each year, alcohol is involved in the death of 1,519 college students, the sexual assault of 97,000 college students, and the assault of 696,000 college students. The dangers of binge drinking have been amplified by the use of beverages that contain caffeine as an additive. The caffeine seems to mask the sensory cues that an individual normally relies on to detect intoxication.

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).

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.

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Chapter 07: Energy Metabolism 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 non-carbohydrate 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 percent of the needed glucose; glycerol, about 10 percent. 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 productio

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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%

fat and

lean.

b. 20%; 80% c. 35%; 65% 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. physiological fuel value

.

b. basal metabolism c. bomb calorimetry value d. food combustion e. psychological fuel value ANSWER: a 7. Which statement accurately describes the energy measurement of foods? a. Bomb calorimetry provides precise amounts of energy a person derives from the foods consumed..

b. A bomb calorimeter measures the amount of oxygen released when a food is oxidized. c. The amount of carbon dioxide consumed gives an indirect measure of energy released. d. In general, the fuel value of protein foods will exceed their energy value as measured by bomb calorimetry.

e. Bomb calorimetry typically overstates the physiological fuel value.

ANSWER: e 8. What is the physiological fuel value? a. The amount of oxygen consumed as energy is released. b. The scientific measure of kcalories a food provides. c. The feeling of satisfaction during or after a mean. d. The energy needed to maintain life when the body is at complete rest. e. The number of kcalories the body derives from a food.

ANSWER: d

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Chapter 08: Energy Balance and Body Composition 9. Which part of the brain is the primary center for appetite control? a. medulla b. cerebral cortex c. cerebellum d. hippocampus e. hypothalamus ANSWER: e 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. appetite c. hunger d. bulimia e. depression ANSWER: b 11. What hormone becomes active in the stomach and causes satiation? a. gastrin b. cholecystokinin c. pepsin d. adipokines e. neuropeptide Y ANSWER: b 12. Satiety determines . a. what kinds of foods are consumed at meals b. how long it takes digestion to begin c. protein versus carbohydrate intake d. how much food is consumed during a meal e. how much time passes between meals ANSWER: e

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Chapter 08: Energy Balance and Body Composition 13. Among the following, which has the greatest power to suppress hunger? a. biscuits b. chocolate c. carrots d. french fries e. potato chips ANSWER: c 14.

Which energy-yielding nutrient is the most satiating? a. water

b. fat c. carbohydrate d. alcohol e. protein ANSWER: e 15. The primary site in the brain where chemical messengers associated with hunger originate and act is the . a. pituitary gland

b. frontal lobe c. cerebellum d. thalamus e. hypothalamus ANSWER: e 16.

Which of the following describes thermogenesis? a. a fat-synthesizing hormone

b. a fat-metabolizing enzyme c. the generation of water d. the generation of heat e. a release of oxygen, similar to oxygenation ANSWER: d

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Chapter 08: Energy Balance and Body Composition 17. Quiet metabolic activities account for about a. 10%

of the average person’s daily energy expenditures.

b. 25% c. 30% d. 40% e. 50% or more 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. What is the effect of environmental temperature on BMR? a. Cold temperatures raise BMR. b. Hot temperatures lower BMR. c. Environmental temperature has no effect on BMR. d. Cold temperatures lower BMR. e. Both hot and cold temperatures lower BMR. ANSWER: a 20. The thermic effect of food accounts for a. 10%

of the average person’s energy expenditure each day.

b. 25% c. 30% d. 40% e. 50% or more ANSWER: a

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Chapter 08: Energy Balance and Body Composition 21.

Which of the following factors raises the BMR? a. fasting

b. obesity c. sleep d. growth e. malnutrition ANSWER: d 22. Which of the following has the most significant influence on the body’s metabolic rate? a. amount of fat tissue b. age c. environmental temperature d. height e. amount of lean body tissue 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

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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 120pound 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

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Chapter 08: Energy Balance and Body Composition 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 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

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Chapter 08: Energy Balance and Body Composition 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 39. A high risk of weight-related health problems is seen in women whose waist circumference begins to exceed a. 26

inches.

b. 29 c. 35 d. 42 e. 55 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

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Chapter 08: Energy Balance and Body Composition 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 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

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Chapter 08: Energy Balance and Body Composition 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 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

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Chapter 08: Energy Balance and Body Composition 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 associated with increased mortality for both sexes b. is less common in women past menopause c. lowers the risk for diabetes d. is related directly to exercise e. is related to heart disease risk but not cancer

.

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

b. hydrodensitometry c. air-displacement plethysmography d. skinfold measures e. DXA scan ANSWER: c

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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

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Chapter 08: Energy Balance and Body Composition 57.

Fat that accumulates outside of adipose tissue is called “ a. dual fat

.”

b. subcutaneous fat c. ectopic fat d. visceral fat e. waist fat ANSWER: c 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. immunological disease

b. ectopic cluster syndrome c. progressive inflammatory disease d. normal-weight obesity syndrome e. metabolic syndrome ANSWER: e 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

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

lives.

a. less than 1% b. 2% c. 3.5% d. 5% e. 10% ANSWER: a

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Chapter 08: Energy Balance and Body Composition 61. Which term describes the combination of disordered eating, amenorrhea, and osteoporosis? a. high stress tertiary disorder b. female athlete triad c. triathlete medical disorder d. nonadaptable training syndrome e. athletic hormonal disruption ANSWER: b 62. Which of the following represents the most common eating disorder among men and women of any age? a. binge-eating disorde b. athlete triad c. bulimia nervosa d. carbohydrate addiction e. anorexia nervosa ANSWER: a 63. Which term refers to a psychiatric disorder characterized by a preoccupation with building body mass? a. bulimia b. cathartic disordered eating c. amenorrhea d. orthorexia nervosa e. muscle dysmorphia ANSWER: e 64. Which term refers to a relatively new food practice that uses restrictive diets, ritualized eating patterns, and rigid food avoidance? a. bulimia

b. cathartic disordered eating c. amenorrhea d. orthorexia nervosa e. muscle dysmorphia ANSWER: d

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Chapter 08: Energy Balance and Body Composition 65. An agent that causes vomiting is a/n a. dysmorphic b. steroid 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 67. What is the first treatment objective when treating a patient with anorexia nervosa? a. decrease fat intake b. eat foods with a lower energy density at first c. eat foods with higher fiber content d. decrease physical activity e. stop weight loss ANSWER: e 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

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Chapter 08: Energy Balance and Body Composition 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 “

.”

a. hunger b. appetite c. digestion d. satiety e. satiation ANSWER: b 71. Which of the following is a cognitive influence on eating? a. the sight of food b. social influences c. GI hormones d. endorphins e. the smell of food ANSWER: b 72. Which energy-yielding nutrient is considered the most satiating? a. carbohydrates b. alcohol c. protein d. fiber e. fats ANSWER: c

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Chapter 08: Energy Balance and Body Composition 73. The generation of heat is a. composition b. thermogenesis c. basal metabolism d. resting heart rate e. energy expenditure

.

ANSWER: b 74. he energy needed to maintain life when a body is at complete digestive, physical, and emotional rest is called “ .” a. body composition

b. thermogenesis c. basal metabolism d. resting heart rate e. energy expenditure ANSWER: c 75. The body minus its fat is called “ a. bone mass b. lean body mass c. body water percentage d. organ mass e. body composition

.”

ANSWER: b 76. A person with a body mass index less than 18.5 has which classification? a. underweight b. overweight c. obesity d. malnutrition e. starvation ANSWER: a

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Chapter 08: Energy Balance and Body Composition 77. The proportions of muscle, bone, fat, and other tissue that make up a person’s total body weight is the . a. body composition

b. body fat percentage c. basal metabolism d. body mass index e. bomb calorimetry ANSWER: a 78. Which of the following is an immunological response to cellular injury characterized by an increase in white blood cells? a. cancer

b. inflammation c. obesity d. adiposity e. dysmorphia ANSWER: b 79. Metabolic syndrome is a risk factor combination that increases heart disease risk. a. True b. False ANSWER: True 80. What is the approximate number of kcalories in 1 pound of body fat? a. 35 b. 70 c. 350 d. 7000 e. 3500 ANSWER: e

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Chapter 08: Energy Balance and Body Composition 81.

The percentage of fat per pound of weight gained over time is a. 10%

.

b. 15% c. 25% d. 50% e. 75% ANSWER: d 82. The percentage of fat per pound of weight lost via starvation is a. 10%

.

b. 15% c. 25% d. 50% e. 75% ANSWER: e 83. A bomb calorimeter is an instrument used to measure a food’s energy value. a. True b. False ANSWER: True 84. Indirect calorimetry is the technique used to measure the amount of oxygen consumed when a food burns.

a. True b. False ANSWER: True 85. The response to the thought of a favorite food is called a. hunger b. appetite c. satiety d. satiation e. starvation

.

ANSWER: a

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Chapter 08: Energy Balance and Body Composition 86. Appetite is the painful sensation that initiates food-seeking behavior. a. True b. False ANSWER: False 87. Satiety is the feeling that says “do not start eating again.” a. True b. False ANSWER: True 88. Satiation is the feeling that says “stop eating.” a. True b. False ANSWER: True 89. The energy expended while resting quietly is a person’s basal metabolism. a. True b. False ANSWER: True 90. Sleep is one factor that lowers basal metabolism. a. True b. False ANSWER: True 91. Malnutrition is one factor that raises basal metabolism. a. True b. False ANSWER: False 92. The percentage of energy expended during digestion and absorption of protein is 30%. a. True b. False ANSWER: True

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Chapter 08: Energy Balance and Body Composition 93. The thermic effect is the estimate of energy needed to process food. a. True b. False ANSWER: True 94. Adaptive thermogenesis refers to changes in energy expenditure due to physiological events. a. True b. False ANSWER: True 95. A BMI of 22 indicates a healthy weight. a. True b. False ANSWER: True 96.

Intra-abdominal fat is referred to as ectopic fat.

a. True b. False ANSWER: False 97. Fat stored directly under the skin is referred to as visceral fat. a. True b. False ANSWER: False 98. Fat in locations other than adipose tissue is referred to as subcutaneous fat. a. True b. False ANSWER: False

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Chapter 08: Energy Balance and Body Composition 99. Discuss factors that make some people need more body fat and some people need less body fat.

ANSWER: For many athletes, a lower percentage of body fat may be ideal—just enough fat to provide fuel, insulate and protect the body, assist in nerve impulse transmissions, and support normal hormone activity, but not so much as to burden the body with excess bulk. The best percentage of body fat for athletes, then, might be 7 to 16 percent for young men and 15 to 22 percent for young women. For an Alaska fisherman, a higher percentage of body fat is probably beneficial because fat provides an insulating blanket to minimize the loss of body heat in cold climates. A woman starting a pregnancy needs sufficient body fat to support conception and fetal growth. Below a certain threshold for body fat, hormone synthesis falters, and individuals may become infertile, develop depression, experience abnormal hunger regulation, or become unable to keep warm.

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.

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Chapter 08: Energy Balance and Body Composition 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.”

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 lifesustaining 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 resTrue/Falseul 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.

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Chapter 08: Energy Balance and Body Composition 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.

104.

Define body mass index, and describe its limitations as a health assessment.

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.

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. BMI reflects height and weight measures and not body composition. Consequently, muscular athletes, including every quarterback in the NFL, may be classified as overweight by BMI standards and not be overfat. Differences in body composition are also apparent at different ages, in various racial and ethnic groups, and in different disease conditions, making BMI guidelines inappropriate for some populations.

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Chapter 08: Energy Balance and Body Composition 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.

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.

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Chapter 08: Energy Balance and Body Composition 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 high-fat 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.

Beulah is a teenaged competitive gymnast who has spent years restricting her eating habits to appear lean in her team leotard. What adverse consequences of Beulah’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 binge-eating disorder report higher rates of selfloathing, 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 self-control. When the reward of delicious foods tempts a person, the ability to resist depends on self-control. 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 weight-control 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. When energy out exceeds energy in, the number and size of fat cells decrease. b. While fat cells grow and shrink in size, their number is fixed. 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. An obese person has more and larger fat cells than does a healthy-weight person.

ANSWER: e 3. Which of the following removes triglycerides from the blood for storage in fat and muscle cells? a. adipose lipase b. lipoprotein synthetase c. cellulite synthetase d. lipoprotein lipase e. glucagon ANSWER: d 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. set points. b. the activity of lipoprotein synthetase . c. blood insulin levels . d. the activity of lipoprotein lipase. e. patterns of physical activity.

ANSWER: d

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 5. Which of the following defines the body’s set point? a. a person’s maximum healthy weight b. a person’s minimum healthy weight c. point at which a person’s weight plateaus before dropping again quickly d. point at which all LPL activity ceases e. point above which the body tends to lose weight and below which it tends to gain weight ANSWER: e 6. What is Prader–Willi syndrome? a. a genetic disorder resulting in obesity b. altered receptor activity for ghrelin c. fat accumulation in the liver of leptin-resistant patients d. a genetic disorder characterized by loss of appetite e. a failure to adapt to alternating periods of excess and inadequate energy intake ANSWER: a 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. Adopted children tend to have body weights more like their biological parents than their adoptive parents. b. Exercise has little, if any, effect on the genetic influence on weight gain. c. Most cases of obesity stem from a single gene. d. Obese people can change their genome and influence their epigenome. e. Fraternal twins are more likely to weigh the same than are identical twins.

ANSWER: a

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 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. ghrelin b. leptin c. elastin d. collagen e. cholecystokinin ANSWER: b 10.

Leptin acts as a hormone, primarily in the a. liver

.

b. pancreas c. intestines d. hippocampus e. hypothalamus ANSWER: e 11. Which of the following is a protein that stimulates appetite and decreases energy expenditure? a. leptin b. elastin c. ghrelin d. cholecystokinin e. collagen ANSWER: c 12. Ghrelin is secreted by cells in the a. stomach b. pancreas

.

c. liver d. hypothalamus e. small intestine ANSWER: a

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 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 size of fat cells

.

b. reduce the number of fat cells c. increase the number of fat cells d. lower basal metabolism e. increase the amount of energy released as heat ANSWER: e 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. brown b. white c. ectopic d. visceral e. abdominal ANSWER: a 16.

Which of the following statements accurately describes the “browning” of white fat cells? a. Interestingly, physical activity stops the browning process. b. After much study, researchers have found little connection between GI microbiota and the browning process. c. Brown fat cells are more abundant than brite fat cells in adults. d. White fat cells with brown fat cell characteristics are sometimes called “beige adipocytes.” e. White fat cells undergo browning when they take on the activity of coupled proteins.

ANSWER: d

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 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. visceral b. ectopic c. WAT d. BAT e. brite ANSWER: e 18. Of the following, which provides an example of an obesogenic environment? a. Celebrations often involve cake and alcoholic drinks. b. Many companies provide employees with free memberships to local exercise facilities. c. Airlines have increased the length of all seatbelts. d. Advertisements for weight-loss products and gyms frequently run in January. e. Some high-end designers refuse to sell clothing in plus sizes.

ANSWER: a 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. Diet histories do not factor into the energy balance equation. c. Obese people tend to overestimate energy intake, while others tend to underestimate it. 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

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 21. Which statement about perceptions of obesity is FALSE? a. Obese people often are judged more on their appearance than on their character. b. Many people assume that every obese person can and should achieve slenderness. c. Most weight-loss programs focus on willpower, hard work, and tending psychological issues. d. In parts of society, overweight is embraced as a sign of health and beauty. e. People are born and raised with various weight tendencies.

ANSWER: c 22. A reputable weight-loss program will provide customers with honest predictions of success and a. give testimonials from previous, successful users

.

b. will explain the associated risks c. give statistics on weight cycling d. will list the psychological benefits of weight loss e. give testimonials from medical professionals ANSWER: b 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

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 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 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

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 29. The prescription drug orlistat acts by a. increasing metabolism

.

b. releasing ghrelin and leptin c. inhibiting pancreatic lipase d. regulating the utilization of norepinephrine e. regulating brain serotonin receptors ANSWER: c 30. Your patient, Mr. Song, 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. Song? a. olestra b. orlistat c. serotonin d. phentermine e. Belviq ANSWER: d 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

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 33. Which of the following procedures is more cosmetic and has little effect on body weight? a. liposuction b. gastric banding c. spot reducing d. gastric bypass e. sleeve gastrectomy ANSWER: a 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 36. Improvements in physical capabilities and quality of life begin with a a. 5%

weight loss.

b. 10% c. 15% d. 25% e. 30% ANSWER: a

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 37. Which of the following is true regarding environmental influences on weight? a. People tend to eat less when socializing with others. b. Keep high calorie snack foods on hand so they lose their appeal. c. People who use media while eating tend to eat more and feel less full. d. When offered a large assortment of foods, or several flavors of the same food, people tend to eat less. e. The larger the serving container, the less we tend to eat.

ANSWER: c 38. In general, weight-loss diets need to provide a minimum of a. 500 b. 800 c. 1200 d. 1600 e. 1800

kcalories per day for women.

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

of kcalories per day for men.

ANSWER: d 40. According to the National Weight Control Registry, which of the following is NOT one of the behaviors most people who have maintained weight loss do regularly? a. skip breakfast b. engage in regular physical activity c. eat a low-kilocalorie diet d. limit screen time e. monitor weight frequently ANSWER: a

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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 physical activity each week. a. 30–60 b. 60–90 c. 90–120 d. 120–200 e. 200–300

minutes of moderately intense

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 d. 10,000 e. 15,000

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

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

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 53. 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 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

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 57. When people give up cigarettes, they gain an average of a. 5

pounds in the first year.

b. 10 c. 15 d. 25 e. 30 ANSWER: e 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 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 . 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

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 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. 0.2% b. 2% c. 5% d. 10% e. 15% ANSWER: b 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

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 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 e. 1200

extra

ANSWER: c 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

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 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. Which of the following involves maintaining body mass in a healthy range by preventing gradual weight gains over time and losing weight if overweight? a. yo-yo dieting b. gene expression c. behavioral modification d. fad dieting e. weight management ANSWER: e 72. Which of the following relates to body weight and proposes that the body tends to maintain a certain weight by means of its own internal controls? a. homeostasis b. obesogenic environment c. epigenetics d. set-point theory e. yo-yo dieting ANSWER: d Page 18

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 73. The influence of environmental factors, such as diet and physical activity, on gene expression is called “ .” a. genetic sequencing b. epigenetics c. the gene pool d. the genome e. genetic susceptibility ANSWER: b 74. In leptin sensitivity, leptin levels are increased and a. leptin sensitivity is increased

.

b. leptin sensitivity is decreased c. insulin sensitivity is increased d. insulin sensitivity is decreased e. adipocytes increase in number ANSWER: b 75. White fat cells with brown fat cell characteristics are called a. ectopic fat

.

b. visceral fat c. brite adipocytes d. extra adipocytes e. large adipocytes ANSWER: c 76. All the genetic information of a population at a given time is called a. genetic sequencing b. epigenetics

.

c. the gene pool d. the genome e. genetic susceptibility ANSWER: c

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 77. An eating plan that promises quick weight loss if an individual never eats any dairy products would be called . a. yo-yo dieting b. a fad diet c. an elimination diet d. a balanced diet e. caloric deficit ANSWER: b 78. Which term means pertaining to the field of medicine that specializes in treating obesity? a. gastric b. bariatric c. endoscopic d. metabolic e. ischemic ANSWER: b 79. Which technique uses a tube to empty the contents of the stomach after every meal? a. liposuction b. gastric aspiration c. intragastric balloon d. gastric bypass e. sleeve gastrectomy ANSWER: b 80. Which of the following involves the changing of antecedents, behaviors, and consequences? a. spot reducing b. yo-yo dieting c. behavior modification d. mindful eating e. intuitive eating ANSWER: c

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 81. An estimated 70% of adults in the United States are overweight or obese. a. True b. False ANSWER: True 82. Which enzyme participates in the development of obesity? a. ghrelin b. lipoprotein lipase c. cholecystokinin d. salivary amylase e. protease ANSWER: a 83. Daily circumstances that push people toward fatness are referred to as the obesogenic environment. a. True b. False ANSWER: True 84. The set point theory states that the body tends to maintain a certain weight by internal controls. a. True b. False ANSWER: True 85. Weight cycling resulting from sporadic restrictive dieting is termed yo-yo dieting. a. True b. False ANSWER: True 86. Ghrelin is nicknamed the satiety hormone. a. True b. False ANSWER: False 87. Leptin is nicknamed the hunger hormone. a. True b. False ANSWER: False Page 21

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 88. Stomach cells secrete ghrelin. a. True b. False ANSWER: True 89. Brown fat is adipose tissue that primarily stores fat for other cells to use as energy. a. True b. False ANSWER: False 90. White fat is adipose tissue that primarily releases stored energy as heat. a. True b. False ANSWER: False 91. Brite adipocytes are white fat cells with brown fat cell characteristics. a. True b. False ANSWER: True 92. The attempt to lose weight in “problem areas” of the body is called spot reducing. a. True b. False ANSWER: True 93. Underweight is the classification for body weight below what is considered healthy. a. True b. False ANSWER: True 94. Orlistat is an FDA-approved drug that inhibits pancreatic lipase a. True b. False ANSWER: False

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 95. Phentermine is an FDA-approved drug with no known GI side effects. a. True b. False ANSWER: True 96. The minimum BMI of a person classified as clinically severe obese is 40. a. True b. False ANSWER: True 97. Which of the following is a cosmetic weight-loss procedure? a. Orlistat b. Phentermine c. liposuction d. lipoprotein lipase e. spot reducing ANSWER: c 98. Which of the following is a saline-filled silicone device in the stomach to limit food intake? a. intragastric balloon b. orlistat c. spot reducing d. liposuction e. phentermine ANSWER: a 99. What is the minimum number of minutes per week of moderately intense physical activity to prevent weight gain a. 50-100 b. 100-200 c. 200-300 d. 300-400 e. 400-500 ANSWER: c

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 100.

Identify at least five environmental influences on weight loss and describe how they can support a healthy weight.

ANSWER: 1. Atmosphere: after completing a meal, remove food from the table and enjoy the ambience— without the presence of visual cues to stimulate additional eating. 2. Accessibility: For people wanting to eat fewer empty-kcalorie or high-kcalorie foods, keep them out of sight in an inconvenient place, or better yet, don’t even bring them home. In contrast, a bowl of fruit on the counter and vegetables in the refrigerator promote healthy eating options. 3. Socializing: People tend to eat more when socializing with others Paying attention to portion sizes can help. 4. Distractions: If distractions are a part of the eating experience, extra care is needed to control portion sizes. 5. Multiple Choices: To limit intake, then, focus on a limited number of foods per meal. 6. Package and Portion Sizes: To keep from overeating, repackage snacks into smaller containers or eat a measured portion from a plate, not directly from the package. 7. Serving Containers: To control portion sizes, use small bowls and plates, small serving spoons, and tall, narrow glasses

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 healthyweight 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 injections 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.

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 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.

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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.”

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Chapter 09: Weight Management: Overweight, Obesity, and Underweight 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 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 weight-loss 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.

111. The percentage of underweight U.S. adults is 2%. a. True b. False ANSWER: True

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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. They are considered macronutrients. b. Some yield energy. c. Structurally, they are linked together. d. They help enzymes participate in the release of energy from carbohydrates, proteins, and fats e. They are not as readily available in food as carbohydrates, fats, and proteins.

ANSWER: b 2. Which term describes vitamins that are inactive in food but become active once inside the body? a. cofactors b. coenzymes c. precursors d. equivalents e. antioxidants ANSWER: c 3. The bioavailability of vitamins in food . a. refers to the number of neutrons in the cells of vitamins. b. depends on many factors, such as how the food was prepared c. is easy to determine d. is the ratio of vitamin intake to calorie intake. e. refers to a vitamin’s molecular structure.

ANSWER: b 4. One difference between water-soluble vitamins and fat-soluble vitamins is that a. fat-soluble vitamins outnumber water-soluble vitamins.

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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

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Chapter 10: The Water-Soluble Vitamins: B Vitamins and Vitamin C 5. Vitamins can readily be destroyed during processing because they a. are precursors.

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b. contain nitrogen c. are organic d. support growth e. support digestion ANSWER: c 6. B vitamins have a major role in a. energy metabolism

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b. antibody stabilization c. collagen formation d. anticoagulation e. antioxidation ANSWER: a 7. Which of the following is NOT a role of thiamin? a. energy metabolism b. ATP production c. participation in the TCA cycle d. DNA synthesis e. conversion of pyruvate to acetyl CoA ANSWER: d 8. What is the name of the coenzyme form of thiamin? a. thiamin pyrophosphate b. thiaminacide c. thiamin mononucleotide d. thiamin flavin e. thiamin adenine dinucleotide ANSWER: a

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Chapter 10: The Water-Soluble Vitamins: B Vitamins and Vitamin C 9. What disease can result from prolonged thiamin deficiency? a. pernicious anemia b. scurvy c. cheilosis d. pellagra e. beriberi ANSWER: e 10. What is the richest source of folate? a. white rice b. broccoli c. pork d. potatoes e. corn ANSWER: b 11. The risk of thiamin deficiency is doubled in a. cigarette smokers

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b. alcoholics c. infants d. pregnant women e. adults over 65 years old 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

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Chapter 10: The Water-Soluble Vitamins: B Vitamins and Vitamin C 13.

Of these foods, which is the 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 both a. are found in abundant amounts in pork.

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b. serve as coenzymes in energy metabolism. c. are easily destroyed by heat. d. are easily destroyed by ultraviolet light. e. can be toxic when consumed in high amounts.

ANSWER: b 16. Which of the following is a symptom of riboflavin deficiency? a. edema b. purplish tongue c. anemia d. constipation e. diarrhea ANSWER: b

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Chapter 10: The Water-Soluble Vitamins: B Vitamins and Vitamin C 17.

Of these foods, which is the best source of riboflavin per kcalorie? a. tofu b. eggs c. strawberries d. potatoes e. clams ANSWER: b

18. A deficiency of riboflavin can cause a disease known as a. pernicious anemia

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b. pellagra c. riboflavinosis d. beriberi e. ariboflavinosis ANSWER: e 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. Milk is sold in cardboard or opaque plastic containers, instead of clear glass bottles, to prevent which of the following from being destroyed by UV light? a. amino acids. b. vitamin A. c. thiamin d. riboflavin e. vitamin C ANSWER: d

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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. tofu b. liver c. carrots d. oranges e. potatoes ANSWER: b

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

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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. glycine c. tryptophan d. phenylalanine e. valine ANSWER: c 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

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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

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Chapter 10: The Water-Soluble Vitamins: B Vitamins and Vitamin C 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 30. Which of the following vitamins is known to be toxic in large doses? a. biotin b. niacin c. thiamin d. vitamin B12 e. riboflavin ANSWER: b 31. Of these foods, which is the best source of niacin? a. egg white b. chicken breast c. broccoli d. oranges e. strawberries ANSWER: b 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

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

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

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

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Chapter 10: The Water-Soluble Vitamins: B Vitamins and Vitamin C 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 44. With which B vitamin does folate have a close relationship? a. thiamin b. biotin c. vitamin B6 d. vitamin B1 e. ascorbic acid ANSWER: d

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Chapter 10: The Water-Soluble Vitamins: B Vitamins and Vitamin C 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 48.

Which of the following is NOT an effect of folate deficiency? a. impaired red blood cell replacement b. impaired protein synthesis c. impaired GI tract cell turnover d. impaired B12 absorption ANSWER: d

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

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

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

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

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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

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

71.

Thiamin deficiency causes beriberi. a. True b. False ANSWER: True

72.

Which is the richest food source of thiamin? a. pork b. Broccoli c. milk d. eggs e. pinto beans ANSWER: a

73. Riboflavin is also known as vitamin B2. a. True b. False ANSWER: True

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Chapter 10: The Water-Soluble Vitamins: B Vitamins and Vitamin C 74.

Which food source is the greatest contributor of riboflavin for most Americans? a. pork b. Broccoli c. milk d. eggs e. pinto beans ANSWER: c

75. Cheilosis is a condition caused by riboflavin deficiency and is characterized by cracks and redness at corners of mouth. a. True b. False ANSWER: True 76. The precursor of niacin is threonine. a. True b. False ANSWER: False 77. A low-protein diet centered on soy once caused widespread pellagra in the U.S. South. a. True b. False ANSWER: False 78. Large doses of niacin can raise HDL cholesterol. a. True b. False ANSWER: True 79. Deficiency of biotin is induced by feeding raw egg whites. a. True b. False ANSWER: True

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Chapter 10: The Water-Soluble Vitamins: B Vitamins and Vitamin C 80. The principal active form of pantothenic acid is part of coenzyme A (CoA). a. True b. False ANSWER: True 81.

Toxicity from vitamin B6 is known to cause nerve damage and inability to walk. a. True b. False ANSWER: True

82. Prevention of neural tube defects is related to increased intake of folate by pregnant women. a. True b. False ANSWER: True 83. Anemia is one of the first two symptoms of folate deficiency. a. True b. False ANSWER: True 84. Vitamin B6 is required to maintain the nerve fiber sheath. a. True b. False ANSWER: False 85.

Intrinsic factor is required for absorption of which vitamin? a. B6 b. thiamin c. riboflavin d. B12 e. niacin ANSWER: d

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Chapter 10: The Water-Soluble Vitamins: B Vitamins and Vitamin C 86. Which vitamin is made in the body from methionine? a. pyridoxine b. thiamin c. riboflavin d. choline e. niacin ANSWER: d 87. Which vitamin is also known as antiscorbutic factor? a. Vitamin C b. vitamin b6 c. vitamin b12 d. vitamin d e. vitamin a ANSWER: a 88. Vitamin C is required for the synthesis of a. myelin sheath

.

b. hair and nails c. collagen d. histamine e. red blood cells ANSWER: c 89.

Citrus fruits are a significant source of vitamin C. a. True b. False ANSWER: True

90. Antioxidants are substances that neutralize free radicals and may play role in disease prevention. a. True b. False ANSWER: True

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Chapter 10: The Water-Soluble Vitamins: B Vitamins and Vitamin C 91. Which B vitamin 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 . a. thiamin b. riboflavin c. choline d. biotin e. pyridoxine ANSWER: d 92. Niacin can be made in the body by its precursor methionine. a. True b. False ANSWER: False 93. Folate consumed in the diet from supplements is not included when calculating dietary folate equivalents. a. True b. False ANSWER: False 94. Which type of anemia is characterized by large, immature red blood cells and caused by deficiencies of folate and vitamin B12? a. sickle cell b. microcytic c. megaloblastic d. hemolytic e. aplastic ANSWER: c 95. Hydrochloric acid and intrinsic factor are need for the absorption of which vitamin? a. vitamin c b. vitamin b6 c. vitamin b12 d. pantothenic acid e. nicotinic acid ANSWER: c

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Chapter 10: The Water-Soluble Vitamins: B Vitamins and Vitamin C 96. Substances like vitamin C that significantly decrease the adverse effects of free radicals on normal physiological functions are known as . a. anti-inflammatories b. antioxidants c. cofactor d. coenzymes e. micronutrients ANSWER: b 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. Explain why niacin intake recommendations are given in terms of niacin equivalents.

ANSWER: Niacin is unique among the B vitamins in that the body can make it from the amino acid tryptophan.

This use of tryptophan occurs only after protein synthesis needs have been met. Approximately 60 milligrams of dietary tryptophan is needed to make 1 milligram of niacin. For this reason, recommended intakes are stated in niacin equivalents (NE). A food containing 1 milligram of niacin and 60 milligrams of tryptophan provides the equivalent of 2 milligrams of niacin, or 2 niacin equivalents. The RDA for niacin allows for this conversion and is stated in niacin equivalents; average niacin intakes in the United States exceed recommendations.

99. 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 100.

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.

101.

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.

102.

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 103.

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).

104.

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 105.

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 106.

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.

107.

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 108.

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 breasTrue/Falseeeding 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 breasTrue/Falseed 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. chylomicrons b. albumin c. cholesterol d. osteocalcin e. calbindin

before entering the

ANSWER: a 2. Fat soluble vitamins have a greater risk for toxicity because they are not easily a. absorbed

.

b. destroyed c. excreted d. hydrolyzed e. converted ANSWER: c 3. Which of the following nutrients did researchers recognize first? a. vitamin A b. vitamin K1 c. vitamin K2 d. vitamin E e. vitamin D ANSWER: a 4. Which of the following is NOT a form of vitamin A? a. retinoic acid b. retinol c. retinal d. beta-carotene e. retinoquinone ANSWER: e

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 5. What is the alcohol form of vitamin A? a. beta-carotene b. retinal c. retinoic d. retinol e. alpha-carotene ANSWER: d 6. Retinol-binding protein picks up vitamin A from the a. kidneys

and carries it to the blood.

b. pancreas c. intestines d. gallbladder e. liver ANSWER: e 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

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 9. Which part of the eye contains billions of molecules of vitamin A? a. sclera b. cornea c. choroid d. retina e. macula ANSWER: d 10. Which of the following is a light-sensitive pigment found within the retina? a. xanthophylls b. melanin c. chlorophyll d. opsin e. rhodopsin ANSWER: e 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

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 13. About what percentage of the body’s vitamin A stores are found in the liver? a. 20% b. 30% c. 50% 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 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 a. skin

.

b. tumors c. hair d. nails e. lungs ANSWER: a

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 17. The World Health Organization and UNICEF recommend supplements of which of the following for all measlesinfected infants and children? a. iron b. vitamin A c. folic acid d. phylloquinone e. vitamin E ANSWER: b 18. Worldwide, vitamin A deficiency causes about how many children to go blind each year? a. 125,000 b. 250,000 c. 500,000 d. 750,000 e. 1,000,000 ANSWER: c 19. Of the following, which is rapidly corrected when treated with vitamin A supplements? a. rickets b. osteomalacia c. acne d. scurvy e. night blindness ANSWER: e 20. Progressive blindness caused by severe vitamin A deficiency is called “ a. osteomalacia b. xerophthalmia

.”

c. xanthophyllia d. keratinization e. keratomalacia ANSWER: b

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 21. Vitamin A deficiency causes the epithelial cells of the skin to change shape and to secrete the protein a. beta globulin

.

b. collagen c. opsin d. elastin e. keratin ANSWER: e 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. retinol b. retinal c. retinyl esters d. Retin-A e. retinoic acid ANSWER: a 24. Which food is a rich source of retinoids? a. cantaloupe b. liver c. spinach d. broccoli e. sweet potato ANSWER: b

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 25.

Which of the following is true of vitamin A in foods? a. Plant foods contain carotenoids but no retinoids. b. Xanthophylls are an indication of vitamin A content in plant foods. c. Vitamin A is not known to cause toxicity at any intake level. d. Skim milk is a good source of dietary vitamin A. e. The body can covert retinoids but not carotenoids to vitamin A. ANSWER: a 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. Xanthophylls 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 28. What is the RDA for vitamin A in women? a. 100 μg RAE/day b. 300 μg RAE/day c. 500 μg RAE/day d. 700 μg RAE/day e. 900 μg RAE/day ANSWER: d

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 29. Vitamin D2 is derived from plant foods and also is known as a. foliocalciferol

.

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

.

b. beta-carotene c. tryptophan d. cholesterol e. eicosapentaenoic acid ANSWER: d 32. Diseases affecting the liver or which other organ can interfere with the activation of vitamin D and produce symptoms of deficiency? a. skin b. pancreas c. intestines d. kidneys e. stomach ANSWER: d

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 33. What is the name of the type of reaction required to activate vitamin D? a. hydroxylation b. hydrogenation c. hydration d. gluconeogenesis e. glycation ANSWER: a 34. Vitamin D’s specific role in bone health is to assist in a. the secretion of calcitriol

.

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

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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. B 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

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 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 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.

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 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 46. What is the RDA for vitamin D for a 20-year-old person? a. 5 mg b. 10 mg c. 15 mg d. 20 mg e. 50 mg 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

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 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 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

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 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 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

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 57. What is the name of the disease that can result from absence of clotting factors due to vitamin K deficiency? 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 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

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 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

is given by intramuscular injection.

b. D2 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

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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

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 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 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 found in plants and animals, some of which have vitamin A activity are a. carotenoids

.

b. chlorophylls c. xanthophylls d. retinoids e. quinones ANSWER: a 72. The transparent membrane covering the outside of the eye is called the “ a. sclera

.”

b. iris c. pupil d. cornea e. lens ANSWER: d

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 73. Which of the following is the normal protein of the hair and nails? a. biotin b. keratin c. collagen d. choline e. pancreatin ANSWER: b 74. Pigments found in plants responsible for the color changes in autumn leaves are a. chlorphylls

.

b. xanthophylls c. sporophylls d. mesophylls e. cataphylls ANSWER: b 75. The highest attainable bone density for an individual is called a. total bone mass

.

b. ideal bone mass c. peak bone mass d. absolute bone mass e. optimal bone mass ANSWER: c 76. Calbindin is a calcium-binding transport protein that requires which vitamin for its synthesis? a. A b. E c. D d. K1 e. K2 ANSWER: c

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 77. Which of the following is a bone disease characterized by softening of the bones and occurs most often in adult women? a. osteoporosis b. osteopenia c. osteoarthritis d. osteomalacia e. osteomyelitis ANSWER: d 78. The active vitamin E compound is a. alpha-tocopherol

.

b. beta-tocopherol c. gamma-tocopherol d. delta-tocopherol e. theta-tocopherol ANSWER: a 79. The condition of having too few red blood cells related to vitamin E deficiency is which type of anemia? a. aplastic b. hemolytic c. microcytic d. megaloblastic e. macrocytic ANSWER: b 80. Phylloquinone is the vitamin K2 form produced by gut bacteria. a. True b. False ANSWER: False 81. The alcohol form of vitamin A is retinol. a. True b. False ANSWER: True

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 82. Vitamin A plays an important role in promoting vision. a. True b. False ANSWER: True 83. Which term refers to blindness caused by severe vitamin A deficiency? a. osteomalacia b. hemophilia c. xerophthalmia d. rickets e. cheilosis ANSWER: c 84. The green pigment of plants is known as xanthophyll. a. True b. False ANSWER: False 85. Abnormal drying of the skin due to vitamin A deficiency is known as a. cheilosis b. xerosis c. ketosis d. melanosis

.

e. alkalosis ANSWER: b 86. Beta carotene is the vitamin A precursor found in plants. a. True b. False ANSWER: True 87. Another name for vitamin D is calciferol. a. True b. False ANSWER: True

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 88. Xerosis is a disease characterized by bowed legs and beaded ribs. a. True b. False ANSWER: False 89. Rickets refers to soft bones caused by vitamin D deficiency in adults. a. True b. False ANSWER: False 90. A vitamin D–dependent transport protein is known as a. calciferol b. calbindin c. phylloquinone d. chlorophyll e. osteocalcin

.

ANSWER: b 91. Vitamin E defends the body against free radicals. a. True b. False ANSWER: True 92. The breaking open of red blood cells due to vitamin E deficiency is known as macrocytic anemia. a. True b. False ANSWER: False 93. Which food source is richest in vitamin E? a. wild fatty fish b. wheat germ oil c. leafy green vegetables d. liver e. mushrooms ANSWER: b

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 94. Tocopherols are a subgroup of vitamin E. a. True b. False ANSWER: True 95. Vitamin K helps promote blood clotting. a. True b. False ANSWER: True 96. Hemophilia is a hereditary disease that cannot be caused or cured by vitamin K. a. True b. False ANSWER: True 97. Antibiotics kill vitamin K–producing bacteria in the intestine. a. True b. False ANSWER: True 98. Osteocalcin is the calcium-binding protein in bones. a. True b. False ANSWER: True 99. Menaquinone is the vitamin K1 form found in food. a. True b. False ANSWER: False

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 100. Define how recommended intakes of vitamin A are expressed and why.

ANSWER: Because the body can derive vitamin A from both retinoids and carotenoids, its content in foods and its recommendations are expressed as retinol activity equivalents (RAE). One microgram of retinol counts as 1 RAE, as does 12 micrograms of dietary beta-carotene.*** This difference recognizes that beta-carotene’s absorption and conversion are significantly less efficient than those of the retinoids. Food and supplement labels sometimes report vitamin A contents using International Units (IU), a measure of vitamin activity used before direct chemical analysis was possible.

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

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 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.

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.

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 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.

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 longsleeved 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.

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Chapter 11: The Fat-Soluble Vitamins: A, D, E, and K 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 low-density 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.

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 diseasecausing 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 pH of the blood is maintained at which of the following ranges? a. 7.05-7.15 b. 7.15-7.25 c. 7.35-7.45 d. 7.45-7.55 e. 7.55-7.65 ANSWER: c 2. Water constitutes about what percentage of an adult’s body weight? a. 35% b. 40% c. 55% d. 60% e. 75% ANSWER: d 3. What term describes water that resides between cells? a. interstitial fluid b. diuretic fluid c. intravascular fluid d. avascular fluid e. intracellular fluid ANSWER: a 4. Where is intracellular fluid found? a. within the lungs b. within cells c. between cells d. within the digestive system e. within blood vessels ANSWER: b

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Chapter 12: Water and the Major Minerals 5. Ions that carry a negative charge are called a. prions

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b. valence ions c. cations d. mineralytes e. anions ANSWER: e 6. Salts that dissociate into ions are called a. osmolytes

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b. diuretics c. antidiuretics d. angiotensinogens e. electrolytes ANSWER: e 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. hypertension b. hypotension c. centripetal pressure d. osmotic pressure e. solute pressure ANSWER: d

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Chapter 12: Water and the Major Minerals 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 11. It is released by the glomerulus on a signal from the hypothalamus. 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. epinephrine b. angiotensinogen c. angiotensin d. aldosterone e. renin ANSWER: e

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Chapter 12: Water and the Major Minerals 13. Aldosterone and renin each promote a. electrolyte balance

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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. adrenal glands

.

b. kidneys c. pituitary gland d. hypothalamus e. liver ANSWER: a 16. The body’s total acid burden remains nearly constant, and the acidity of which of the following substances fluctuates to accommodate that balance? a. Blood b. Urine c. Stool d. Sweat e. Breath ANSWER: b

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Chapter 12: Water and the Major Minerals 17. The acidity of the body’s fluids is determined by the concentration of a. sodium

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b. glucose c. potassium d. hydrogen ions e. alcohol ANSWER: c 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 lung 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 how many milliliters of water each day? a. 75 b. 125 c. 250 d. 500 e. 1000 ANSWER: d

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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. hyponatremia

.

b. hypertension c. hypodiuresis d. hyperkalemia e. water intoxication ANSWER: a 23. Water derived daily from beverages, food, and metabolism averages about how many milliliters? a. 750 b. 1000 c. 1500 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

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Chapter 12: Water and the Major Minerals 25. Which of the following is present in highest concentration in hard water? a. magnesium b. sodium c. potassium d. manganese e. phosphorus ANSWER: a 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. potassium b. iron c. calcium d. phosphorus e. sodium 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

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Chapter 12: Water and the Major Minerals 29. Of the following, which food contains a phytate? a. rhubarb b. spinach c. legumes d. beet greens e. sweet potatoes ANSWER: c 30. What is the principal extracellular cation? a. sodium b. chloride c. potassium d. magnesium e. phosphorus ANSWER: a 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

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Chapter 12: Water and the Major Minerals 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. cancer

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b. osteoporosis c. dementia d. constipation e. diabetes ANSWER: b 35. The greatest source of sodium in the diet is a. processed foods

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b. unprocessed foods c. natural salt content of foods d. salt added during cooking e. salt added at the table ANSWER: a 36. What is the main extracellular anion? a. phosphorus b. potassium c. chloride d. sodium e. magnesium ANSWER: c

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Chapter 12: Water and the Major Minerals 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

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Chapter 12: Water and the Major Minerals 41. The AI for potassium is how many mg per day? a. 1200 b. 2700 c. 3500 d. 4000 e. 4700 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 it 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. Sulfur is a mineral present in the body as part of some proteins. a. True b. False ANSWER: True Page 11

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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. weaker bones and teeth

.

b. stronger bones and teeth c. calcium rigor d. calcium tetany e. calcium surplus ANSWER: c 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

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Chapter 12: Water and the Major Minerals 50. Which of the following helps make the calcium-binding protein needed for calcium absorption? a. vitamin D b. fiber c. oxalic acid d. glucose e. phytic acid ANSWER: a 51. On average, adults absorb what percentage of the calcium they ingest? a. 20% b. 30% c. 50% d. 65% e. 80% 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 one of the best sources of dietary calcium per kilocalorie? a. sardines with bones b. cottage cheese c. peanut butter d. eggs e. almonds ANSWER: a

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Chapter 12: Water and the Major Minerals 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 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

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Chapter 12: Water and the Major Minerals 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 61. Which nutrient provides a major source of dietary sulfur? a. fats b. protein c. fat-soluble vitamins d. carbohydrates e. water ANSWER: b

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Chapter 12: Water and the Major Minerals 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

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c. 35 d. 40 e. 50 ANSWER: a

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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. Which type of water is generated as an end product during condensation reactions and the oxidation of energy yielding nutrients? a. Artesian b. Purified c. Mineral d. Metabolic e. Well 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

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Chapter 12: Water and the Major Minerals 70. What toxic substance may be contained in calcium supplements made form bone meal, oyster shell, or dolomite? a. lead b. cyanide c. hydrazine d. BPA e. ricin ANSWER: a 71. Fluid within blood vessels is called a. intracellular fluid

..

b. intravascular fluid c. extracellular fluid d. extravascular fluid e. total body fluid ANSWER: b 72. Positively charged ions are called “ a. anions

.”

b. protons c. neutrons d. cations e. exions ANSWER: d 73. Which term describes substances that are dissolved in a solution? a. solutes b. ions c. buffers d. solids e. minerals ANSWER: a

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Chapter 12: Water and the Major Minerals 74. Compounds that keep a solution’s pH constant when acids or bases are added are called “ a. solutes

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b. buffers c. ions d. anions e. cations ANSWER: b 75. Water drawn from a well that taps a confined aquifer in which the water is under pressure is called a. natural water

.

b. purified water c. spring water d. artesian water e. mineral water ANSWER: d 76. The process in which calcium, phosphorus, and other minerals crystallize on the collagen matrix of a growing bone is termed “ .” a. hydrolyzation b. mineralization c. concentration d. activation e. dehydration ANSWER: b 77. Which hormone is secreted by the thyroid gland that regulates blood calcium by lowering it when levels rise too high? a. calbindin b. calcitonin c. aldosterone d. antidiuretic hormone e. parathyroid hormone ANSWER: b

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Chapter 12: Water and the Major Minerals 78. Which of the following is NOT true about drinking caffeinated beverages? a. They cause significantly more fluid loss than water. b. They contribute about the same amount of fluid as noncaffeinated beverages. c. They may contribute to weight gain if sweeteners are added. d. They enhance the absorption of some minerals. e. They are a better beverage choice than plain water for most people.

ANSWER: b 79. Which of the following is a risk related to soft water in the home? a. Excessively high concentrations of calcium. b. Excessively high concentrations of magnesium. c. Residues in bathtubs and washing machines. d. More contaminant minerals like cadmium and lead in drinking water. e. Insufficient levels of sodium and potassium.

ANSWER: d 80.

A bone condition in which bone loss is significant, but not as severe as in osteoporosis is termed a. osteomalacia

.

b. osteoarthritis c. osteopenia d. osteomyelitis e. osteoplasia ANSWER: c 81. What is the typical amount of water lost from the GI tract every day? a. 50 b. 100 c. 150 d. 200 e. 250 ANSWER: c 82. Extracellular fluid accounts for two-thirds of the body’s water. a. True b. False ANSWER: False Page 20

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Chapter 12: Water and the Major Minerals 83. Extracellular fluid includes interstitial fluid and intravascular fluid. a. True b. False ANSWER: True 84. Antidiuretic hormone signals kidneys to retain sodium. a. True b. False ANSWER: False 85. Aldosterone signals kidneys to retain water. a. True b. False ANSWER: False 86. Sodium in solution is a cation. a. True b. False ANSWER: True 87. Chloride in solution is an anion. a. True b. False ANSWER: True 88. What percentage of lean tissue weight consists of water? a. 15% b. 25% c. 50% d. 60% e. 75% ANSWER: a 89. Osmosis is the movement of water toward concentrated solutes. a. True b. False ANSWER: True Page 21

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Chapter 12: Water and the Major Minerals 90. Oral hydration therapy is a simple solution of sugar, salt, and water. a. True b. False ANSWER: True 91. Hydroxyapatite consists of crystals of calcium and phosphorus. a. True b. False ANSWER: True 92. Parathyroid hormone regulates blood calcium. a. True b. False ANSWER: True 93. At what age is peak bone mass typically reached? a. 8 years b. 13 years c. 20 years d. 30 years e. 40 years ANSWER: d 94. How many milligrams of chloride are in 1 gram of table salt? a. 200 b. 300 c. 400 d. 500 e. 600 ANSWER: e 95. Potassium is the most prevalent major mineral in the body. a. True b. False ANSWER: False

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Chapter 12: Water and the Major Minerals 96. Oxalate is a binder found in rhubarb. a. True b. False ANSWER: True 97. Phytate is a binder found in nuts and seeds. a. True b. False ANSWER: True 98. Phosphorus is a mineral found in milk protein. a. True b. False ANSWER: True 99. Vitamin D enhances the absorption of calcium. a. True b. False ANSWER: True 100.

Describe why an Upper Level of sodium is not defined and identify which alternative is used.

ANSWER: Because the risk of sodium toxicity cannot be separated from its risk of chronic disease, a UL was not established. Chronic diseases associated with excess sodium include hypertension and osteoporosis. Therefore, a chronic disease risk reduction (CDRR) intake was established instead.

This intake level is set at 2300 milligrams per day based on evidence that reducing sodium intake lowers the risk of hypertension and heart disease.

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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.

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Chapter 12: Water and the Major Minerals 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.

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.

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Chapter 12: Water and the Major Minerals 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: oFoods prepared in brine, such as pickles, olives, and sauerkraut oSalty or smoked meats, such as bologna, corned or chipped beef, bacon, frankfurters, ham, luncheon meats, salt pork, sausage, and smoked tongue oSalty or smoked fish, such as anchovies, caviar, salted and dried cod, herring, sardines, and smoked salmon oSnack items such as potato chips, pretzels, salted popcorn, salted nuts, and crackers oCondiments such as bouillon cubes; seasoned salts; MSG; soy, teriyaki, Worcestershire, and barbeque sauces oPrepared horseradish, ketchup, and mustard oCheeses, especially processed types oCanned and instant soups oPackaged instant or flavored rice, pasta, and cereal mixes Page 27

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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 does 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 weightbearing 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 does 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. myoglobin b. transferrin c. cytochrome d. oxyglobin e. hemoglobin ANSWER: a 4. What is transferrin? a. an iron storage protein b. an enzyme c. a muscle protein d. An oxygen-carrying protein e. an iron transport protein ANSWER: e

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Chapter 13: The Trace Minerals 5. Iron balance is maintained in the body mainly through a. respiration

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b. absorption c. excretion d. gluconeogenesis e. glycolysis ANSWER: b 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

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Chapter 13: The Trace Minerals 9. The amount of selenium found in vegetables depends on which factor? a. selenium content of their soil b. how they are cooked c. how they are stored d. the color of the vegetable e. whether they are organically grown ANSWER: a 10. Copper helps in the formation of which of the following? a. hepcidin b. hemoglobin c. MFP factor d. parathyroid hormone e. metallothionein ANSWER: b 11. Which one of these foods contains a substance that inhibits absorption of nonheme iron? a. fish b. milk c. pork d. chicken e. orange juice ANSWER: b 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

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Chapter 13: The Trace Minerals 13. What is the name of the hormone that regulates iron balance in the body? a. hepcidin b. ferritin c. MFP facto d. transferrin e. hemosiderin ANSWER: a 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 16. About what percentage of the US population is deficient in iron? a. 5% b. 10% c. 20% d. 33% e. 42% ANSWER: b

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Chapter 13: The Trace Minerals 17. In developing countries, blood loss is often brought on by a. lack of sufficient intake of foods

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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

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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

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

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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. red blood cell count b. hematocrit c. serum iron level d. transferrin saturation e. serum ferritin ANSWER: e

23. Which of these groups is vulnerable to iron overload? a. pregnant women b. female athletes c. cigarette smokers d. breastfed infants e. alcoholics ANSWER: e 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

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Chapter 13: The Trace Minerals 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 26. About how much iron does the usual US diet provide per 1000 kcalories? a. 3 to 4 mg b. 6 to 7 mg c. 10 to 11 mg d. 15 to 16 mg e. 18 to 19 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. milk b. honey c. yogurt d. cashews e. apples ANSWER: d

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Chapter 13: The Trace Minerals 29. Of these foods, which is the best source of iron? a. tuna b. pinto beans c. peanut butter d. tofu e. parsley ANSWER: e 30. What is the lifespan of the average red blood cell? a. 1 month b. 2 months c. 3 months d. 4 months e. 5 months ANSWER: d 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

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Chapter 13: The Trace Minerals 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. albumin

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

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b. lipase c. lactase d. CCK e. oxidoreductase ANSWER: a 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

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Chapter 13: The Trace Minerals 37. Of these foods, which is the best source of zinc? a. tomato juice b. oysters c. potatoes d. eggs e. watermelon ANSWER: b 38. Zinc toxicity a. is unknown

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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 reduces 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. diarrhea b. anemia c. purplish tongue d. goiter e. skin lesions ANSWER: d

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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. estrogen b. insulin c. thyroid hormone d. antidiuretic hormone e. testosterone ANSWER: c

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. iron b. calcium c. vitamin d d. vitamin c e. zinc ANSWER: a

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Chapter 13: The Trace Minerals 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 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

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Chapter 13: The Trace Minerals 49. To avoid iodine toxicity, the UL is set at a. 75 µg/day

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b. 500 µg/day c. 1100 µg/day d. 1200 µg/day e. 1500 µg/day ANSWER: c 50. The baking industry uses which of the following as dough conditioners? a. sugars b. alcohol c. carbon dioxide d. iodates e. triglycerides ANSWER: d 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. selenium b. iron c. zinc d. copper e. molybdenum ANSWER: a

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Chapter 13: The Trace Minerals 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 56. Which of these diseases is a possible cause of copper toxicity? a. Menkes disease b. Huntington’s disease c. Wilson’s disease d. Keshan disease e. Parkinson’s disease ANSWER: a

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Chapter 13: The Trace Minerals 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. beefsteak b. chicken c. shellfish d. lamb e. hamburger ANSWER: c 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

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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

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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. hyperglycemia

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b. hypertension c. hypothyroidism d. weight loss e. hyperparathyroidism ANSWER: a

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Chapter 13: The Trace Minerals 65. Characteristics of molybdenum toxicity as reported in animal studies include? 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 66. Which of the following substances is a contaminant mineral? a. boron b. nickel c. copper d. cadmium e. bromine ANSWER: d 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. Heavy metals have a relatively high a. bioavailability b. atomic weight c. number of double bonds d. toxicity e. incidence of exposure ANSWER: b

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Chapter 13: The Trace Minerals 69.

Lycopene may help protect against a. osteoporosis b. heart disease c. dementia d. diabetes e. anemia 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 71.

Essential mineral nutrients needed in amounts of less than 100 milligrams a day are known as a. contaminant minerals b. major minerals c. micronutrients d. trace minerals e. heavy metal minerals ANSWER: d

72. Most of the body’s iron is found in the proteins hemoglobin and myoglobin. a. True b. False ANSWER: True 73. Pica, or the desire to eat nonfood substances, is a symptom of iron deficiency. a. True b. False ANSWER: True

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Chapter 13: The Trace Minerals 74. Enzymes that contain one or more minerals as part of their structures are known as a. coenzymes

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b. metalloenzymes c. cofactor enzymes d. pancreatic enzymes e. nonessential enzymes ANSWER: b 75. For which category have DRIs not yet been determined? a. essential trace minerals b. nonessential trace minerals c. essential major minerals d. nonessential major minerals e. contaminant minerals ANSWER: b 76. Which of the following terms describes the iron-storage protein that captures iron from food and stores it in cells of small intestine? a. ferritin b. heme iron c. non-heme iron d. transferrin e. myoglobin ANSWER: d 77. Which form of iron is found only in meat, fish, and poultry? a. heme iron b. non-heme iron c. ferrous iron d. ferric iron e. ferritin ANSWER: a

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Chapter 13: The Trace Minerals 78. Which form of iron is found in both plant and animal foods? a. heme iron b. non-heme iron c. ferrous iron d. ferric iron e. ferritin ANSWER: b 79. Which term refers to the oxygen-carrying protein in muscle? a. hemoglobin b. myoglobin c. transferrin d. protoglobin e. myosin ANSWER: b 80. Hemoglobin is the iron-containing protein in erythrocytes. a. True b. False ANSWER: True 81. MFP factor is a peptide that enhances absorption of heme iron. a. True b. False ANSWER: False 82. Calcium inhibits the absorption of nonheme iron. a. True b. False ANSWER: True 83. Iron is the mineral most often deficient in diets. a. True b. False ANSWER: True

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Chapter 13: The Trace Minerals 84.

Hepcidin is a hormone that regulates iron balance. a. True b. False ANSWER: True

85. Milk is a notoriously poor source of iron. a. True b. False ANSWER: True 86. Iron deficiency is related to stunted growth and immature sexual development. a. True b. False ANSWER: False 87. Metallothionein is a zinc-binding protein of the intestine a. True b. False ANSWER: True 88. A goiter is the enlargement in the neck caused by iodine deficiency. a. True b. False ANSWER: True 89. The fortification of iodized salt has helped reduce incidence of goiter and cretinism a. True b. False ANSWER: True 90. Keshan disease is associated with deficiency of which minerals? a. iron b. zinc c. iodine d. selenium e. chromium ANSWER: d Page 21

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Chapter 13: The Trace Minerals 91. Fluoride is a trace mineral that reduces dental caries. a. True b. False ANSWER: True 92. Chromium deficiency leads to a diabetes-like condition. a. True b. False ANSWER: True 93. Molybdenum is a nutrient whose amount is as little as 0.1 parts per million parts of body tissue. a. True b. False ANSWER: True 94. Examples of contaminant minerals include lead, mercury, and cadmium. a. True b. False ANSWER: True 95. Which congenital disease caused by severe iodine deficiency during pregnancy results in severe mental impairment and stunted growth? a. goiter b. cretinism c. keshan disease d. Menkes disease e. Wilson’s disease ANSWER: b 96. Which genetic disorder interferes with copper metabolism and creates a copper toxicity? a. goiter b. cretinism c. keshan disease d. Menkes disease e. Wilson’s disease ANSWER: e

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Chapter 13: The Trace Minerals 97.

Describe how iron is recycled in the body, including where it is used and how it is lost ANSWER: Transferrin carries iron in blood. Some iron is delivered to myoglobin of muscle cells. Bone marrow incorporates iron into hemoglobin of red blood cells and stores excess iron in ferritin. Iron-containing hemoglobin in red blood cells carries oxygen. Some losses occur if bleeding occurs. The liver and spleen dismantle red blood cells, packages iron into transferrin, and stores excess iron in ferritin (and hemosiderin). Some losses occur via sweat, skin, and urine

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 plantderived 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 wellabsorbed 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 result 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.

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Chapter 13: The Trace Minerals 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: Fitness: Physical Activity, Nutrients, and Body Adaptations 1. Which of the following describes an individual who has the endurance to engage in daily activities, as well enough reserve energy to handle added challenges? a. conditioned

b. moderately fit c. moderately active d. physically fit e. sedentary ANSWER: d 2. Which of the following is the correct statement about the U.S. adult population’s physical activity? a. Half of adults get physical activity, but no exercise. b. Approximately 80 percent of adults do not meet physical activity guidelines. c. Approximately 20 percent of adults get no physical activity. d. One‐fourth of adults are sedentary. e. Approximately 60 percent of adults don’t exercise regularly.

ANSWER: b 3. What is the minimum recommended amount of time to spend during a session of aerobic physical activity, moderate or vigorous? a. 5 minutes

b. 10 minutes c. 15 minutes d. 30 minutes e. 45 minutes ANSWER: b 4. Which of the following refers to an increase to the size and strength of muscles in response to use? a. muscle hypertrophy b. muscle overload c. muscle atrophy d. muscle conditioning e. muscle fitness ANSWER: a

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 5. Activity that is a 7 or 8 on a scale of perceived exertion where an individual can talk, but it is difficult, is . a. overload

b. vigorous c. light d. moderate e. anaerobic ANSWER: b 6. Putting a demand on muscles repeatedly by making them work harder is . a. effective for increasing muscle tissue when combined with tripling protein intake b. only effective for increasing muscle endurance c. the most effective, safe way for athletes to add muscle tissue d. only effective for increasing muscle strength e. causes overtraining and is an ineffective method for adding muscle tissue ANSWER: c 7. According to ACSM guidelines, resistance or strength exercise should be incorporated on a. two to four nonconsecutive days b. five to seven nonconsecutive days c. one to three nonconsecutive days d. two to three nonconsecutive days e. three to five nonconsecutive days

per week.

ANSWER: d 8. To improve cardiorespiratory endurance, activities that use most of the large‐muscle groups of the body and elevate heart rate should be sustained for at least a. 20 minutes

.

b. 40 minutes c. 1 hour d. 1½ hours e. 2 hours ANSWER: a

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 9. The maximum rate of oxygen consumption by an individual at sea level is known as a. VO2 max b. one‐half VO2 max c. cardiac output d. cardiac conditioned index e. cardiac volume

.

ANSWER: a 10. Regular aerobic workouts gradually improve heart and lung function that causes which of the following for more efficient oxygen delivery?

a. blood pressure to increase b. resting heart rate to increase c. cardiac output to increase d. stroke volume to decrease e. anaerobic capacity to increase ANSWER: c 11. Which of the following is an example of a flexibility activity? a. pilates b. power walking c. swimming d. lifting free weights e. yoga ANSWER: e 12. In weight training, muscle strength can best be emphasized by performing a a. low number of repetitions with heavy weight b. low number of repetitions with lighter weight

.

c. high number of repetitions with heavy weight d. high number of repetitions with lighter weight e. sufficient repetitions with any weight to induce exhaustion ANSWER: a

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 13. Which of the following is a good indicator of an older adult’s physical abilities? a. posture b. body composition c. arm strength d. walking endurance e. overall flexibility ANSWER: d 14. A moderate‐intensity activity lasting for which duration uses the aerobic system? a. 5 to 10 sec b. 10 to 20 sec c. 20 sec to 2 min d. 2 to 20 min e. >20 min ANSWER: e 15.

What is the amount of blood pumped out of the heart each minute? a. cardiac output

b. pulse rate c. vo2max d. stroke volume e. blood pressure ANSWER: a 16. An athlete getting ready to compete in the 100‐meter dash will rely primarily on which of the following for quick energy in this event?

a. adenosine diphosphate b. fat c. glucose d. creatine phosphate e. lactate ANSWER: d

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 17. What reaction can supply ATP quickly for up to three minutes anaerobically? a. fatty acid oxidation b. glucose to pyruvate c. glycogen to glucose d. conversion of ADP to ATP e. release of phosphate from creatine phosphate ANSWER: b 18. The body’s primary source of glucose during physical activity is a. glycogen b. NAD c. ATP d. lactate e. creatine phosphate

.

ANSWER: a 19. Which of the following is a correct statement about the energy systems and fuels used by the body? a. After 20 minutes of sustained activity, fuel for the muscles primarily comes from glucose that is broken down by glycolysis.

b. About 90 percent of the fuel is derived from fat at rest. c. All energy systems are used at all times, but one system dominates depending on intensity and conditioning of athlete.

d. An anaerobic energy system is the most efficient way to fuel the body for prolonged activity. e. The lactic acid system is the predominant source of energy after 3 minutes of activity and until activity has reached 20 minutes in length.

ANSWER: c 20. What type of diet does research suggest can provide endurance athletes with ability to go longer without fatigue? a. mixed diet

b. low carbohydrate diet c. no‐carbohydrate diet d. low‐fat diet e. high‐carbohydrate diet ANSWER: e

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 21. Which dietary nutrients are most effective at raising muscle glycogen concentrations? a. proteins b. carbohydrates c. fats d. chromium and iron e. sodium and potassium ANSWER: b 22. What is the name of the process by which glucose is regenerated from lactate? a. TCA cycle b. fatty acid oxidation c. glycolysis d. Cori cycle e. metabolism ANSWER: d 23. Which activity is most likely to be fueled primarily by lactic acids? a. 400‐meter run b. 100‐meter run c. A tennis serve d. 2‐hour hike e. 5‐mile run ANSWER: a 24. Activities lasting longer than twenty minutes will gradually start using less glucose and more a. oxygen b. lactate c. glycogen

.

d. creatine phosphate e. fat ANSWER: e

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 25. Consuming a sports beverage to obtain carbohydrates is recommended a. during all vigorous‐training activities b. during exhausting endurance activities lasting more than one hour c. only during competition d. once activities continue past 40 minutes e. just before an athlete “hits the wall”

.

ANSWER: b 26.

It’s recommended that an athlete consume what percentage of calories from fat?

a. 15 to 35 percent b. less than 20 percent c. 25 to 50 percent d. 20 to 35 percent e. 45 to 65 percent ANSWER: d 27. The phenomenon known as “hitting the wall” occurs in athletes when which of the following is depleted? a. water b. protein c. glucose d. fatty acids e. lactate ANSWER: c 28. Which of the following will best accelerate glycogen storage after physical activity? a. a high‐carbohydrate snack within two hours of exercise completion b. a high‐fat meal taken within two hours of exercise completion c. a high‐protein snack taken midway through exercise and another 30 minutes after exercise d. sports drinks taken throughout exercise and repeated small, high protein snacks for two hours after exercise

e. a high‐protein meal taken within two hours of exercise completion ANSWER: a

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 29. What cellular structure is responsible for producing ATP for energy? a. cell membrane b. nucleus c. cytoplasm d. mitochondria e. ribosomes ANSWER: d 30. Which of the following is not a property of conditioned muscles? a. They can store more glycogen. b. Glycogen breakdown occurs more slowly. c. They contain more mitochondria. d. They rely less on glucose and more on fat breakdown for energy. e. They are resistant to lactate build‐up.

ANSWER: e 31. Dietary protein needs of an athlete can best be met by consuming . a. Moderate amounts of high‐quality protein in four to five small meals each day b. 1 gram of protein per kilogram of body weight c. supplements in addition to a healthy diet d. meat, poultry, or fish at every meal e. over 2.2 grams of protein per kilogram of body weight ANSWER: a 32. Intake of which of the following enhances protein synthesis following physical activity? a. carbohydrate b. protein c. fat and water d. carbohydrate and protein e. protein and water ANSWER: d

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 33.

signals the fat cells to begin releasing their fatty acids during physical activity.

a. Leptin b. Glucagon c. Epinephrine d. Neuropeptide Y e. Norepinephrine ANSWER: c 34. The increased energy demands from regular, strenuous activity typically . a. requires nutrient supplementation b. decreases appetite so intake of adequate energy and nutrients is difficult c. increases food intake to meet energy needs but not usually nutrient needs d. increases food intake so that additional nutrient needs are met if nutrient‐dense foods are selected e. responds better to nutrients in supplements, rather than food ANSWER: d 35.

is an important nutrient for the transport of oxygen in blood and in muscle tissue and in energy transformation reactions.

a. Iron b. Calcium c. Thiamin d. Vitamin C e. Sodium ANSWER: a 36. Which of the following is a correct statement about taking vitamin and mineral supplements directly before competition? a. Performance is usually enhanced.

b. Absorption of vitamins and minerals occurs immediately so the body can use them during competition if needed.

c. Supplements are only suggested for athletes who have nutrient deficiencies. d. They are useless for improving performance. e. Most athletes do not believe in the ability of them to enhance performance.

ANSWER: d

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 37.

is considered a temporary, adaptive response to strenuous activity that is noticeable in blood hemoglobin values but does not impair physical performance. a. Iron‐deficiency anemia

b. Amennorhea c. Vitamin E deficiency d. Pernicious anemia e. Sports anemia ANSWER: e 38.

Glycogen stores are limited to how many calories?

a. <100 kcalories b. <200 kcalories c. <500 kcalories d. <1000 kcalories e. <2000 kcalories ANSWER: e 39. Which of the following is NOT usually a factor that puts an athlete at higher risk for developing iron‐deficiency anemia? a. being female

b. practicing an endurance sport c. being vegetarian d. drinking orange juice when consuming iron‐rich foods e. menstruation ANSWER: d 40. Mary is 15 years old and has just joined her high school swim team. After the first three months of training and competing, her coach sends the team for mandatory physical examinations and routine blood tests. When Mary got home, she told her mom that the team physician prescribed her a daily iron supplement to take.

What condition does Mary most likely have? a. iron‐deficiency anemia

b. amenorrhea c. vitamin E deficiency d. pernicious anemia e. sports anemia ANSWER: a

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 41. The body’s need for which nutrient surpasses the need for any other? a. iron b. water c. glucose d. glycogen e. sodium ANSWER: b 42. Dehydration greater than what percent of body weight can impair physical performance? a. one percent b. two percent c. three percent d. five percent e. seven percent ANSWER: b 43. Sweat evaporates by routing blood supply by which of the following to cool the skin and underlying blood? a. blood vessels near the kidneys b. arteries in the cooler extremities of the body c. capillaries just under the skin d. deep veins in the cooler areas of the body e. blood vessels surrounding the lungs ANSWER: c 44.

An individual is at risk of collapsing if what percent of body weight is due to water loss?

a. 2 b. 7 c. 15 d. 25 e. 33 ANSWER: b

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 45. Diego is a marathon runner training for his next competition. He normally weighs 167 pounds, and he admits to forgetting to hydrate adequately during long‐training runs. What weight suggests Diego is very close to becoming dehydrated?

a. 150 b. 156 c. 164 d. 170 e. 178 ANSWER: c 46.

An athlete’s first sign of dehydration is typically a. fatigue

.

b. dizziness c. intense thirst d. intense sweating e. mental confusion ANSWER: a 47.

Heat stroke shares all of the following symptoms with hypothermia except a. mental changes

.

b. confusion c. loss of consciousness d. clumsiness e. slow heart rate ANSWER: e 48. The best way to stay adequately hydrated and prevent dehydration in an active individual is to a. hydrate before, during, and after activity

.

b. consume a fluid with carbohydrates during activity c. limit fluid intake in the days prior to activity for maximum absorption d. drink two cups of fluid every 15 minutes e. consume fluid with electrolytes ANSWER: a

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 49. Demetrius weighs 170 pounds at the start of his workout, but weighs 167 pounds after his competition. How much fluid does he need to consume? a. 2 cups

b. 3 cups c. 4 cups d. 6 cups e. 8 cups ANSWER: d 50.

can occur when an athlete involved in a prolonged activity lose electrolytes through sweating and rehydrate with only water. a. Hypothermia

b. Hyponatremia c. Hypernatremia d. Heat stroke e. Dehydration ANSWER: b 51. A sudden cessation of sweating in a person engaged in outdoor sports activities may be a sign of a. heat stroke b. dehydration c. hypothermia d. exertional distress e. heat stress

.

ANSWER: a 52. What is an easy way to quickly estimate water loss and fluid needs following physical activity? a. Multiply body weight (kg) by one percent to determine liters of water loss. b. Multiply duration of activity (min) by body weight (kg) to determine mL of water loss. c. Subtract air temperature (°F) from body weight (lbs) and then multiply by 5 to determine mL of water loss.

d. Take the difference in body weight (lbs) before and after the event and multiply by 2 to determine cups of water loss.

e. Take the difference in body weight (lbs) before and after the event and divide by the relative humidity.

ANSWER: d

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 53. Low blood levels of a. water b. sodium c. glucose d. potassium e. calcium

is referred to as hyponatremia.

ANSWER: b 54. Which of the following is a correct statement about athletes and hydration? a. Untrained or beginner athletes lose greater amounts of electrolytes. b. Sports drinks that contain sodium polymers can more quickly replace sodium losses from severe sweating.

c. The sodium lost through heavy sweating can be easily replaced by consuming any of the common sports drinks.

d. Hyponatremia is more likely to develop when water intake during intense exercise in hot weather is withheld and salted snacks are consumed.

e. Salt tablets can aid in rehydration to enhance performance.

ANSWER: a 55. Two cups of a typical sports drink have approximately a. 5–10 b. 10–50 c. 50–100 d. 100–200 e. 200–400

calories.

ANSWER: d 56.

is usually the best choice for physically active people who need to replace lost fluids. a. Cool water

b. “Sweat” replacers c. Salt tablets and tap water d. Water warmed to body temperature e. Very cold water ANSWER: a

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 57. All of the following are situations where a sports beverage may be a better choice over water except when . a. the athlete is trying to gain weight

b. the athlete does not drink much water because he/she does not like the taste c. the athlete is competing for over one hour d. the athlete is trying to avoid taking in excess calories e. the athlete wants to carbohydrate load ANSWER: d 58. Energy drinks are not recommended to be used as fluid replacement because they contain a. carbonation b. excessive amount of vitamins c. alcohol d. enhanced water e. caffeine

.

ANSWER: d 59. All of the following are reasons that alcohol should not be used to rehydrate the body except when a. it has a diuretic effect b. it inhibits glycogen breakdown c. it slows reaction time d. it impairs the body’s ability to regulate temperature e. it can lead to sports‐related injuries

.

ANSWER: b 60. A diet composed of can typically provide adequate energy and nutrients for an athlete. a. nutrient‐dense foods and sports beverages b. nutrient‐dense foods and protein powders c. nutrient‐dense foods d. nutrient‐dense foods, protein powders, and vitamin and mineral supplements e. nutrient‐dense foods, protein powders, and sports beverages ANSWER: c

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 61. Which of the following describes an ideal pre‐game meal? a. high‐protein, providing 30 kcal per kg body weight b. vegetable and fruit juices, providing 100–200 kcal c. high‐carbohydrate, low‐fiber, and low‐fat providing 300–800 kcal d. high‐fiber, providing 200–300 kcal and liberal amounts of fluid e. bulky, fiber‐rich foods providing at least 800 kcal ANSWER: c 62. Which food would be an ideal pre‐game food? a. black beans b. steak c. pasta d. cheese e. ice cream ANSWER: c is a postexercise snack that has been shows to increase muscle glycogen stores and protein

63. synthesis.

a. Almonds b. Bananas c. Cheese d. Chocolate milk e. Whole‐grain tortillas ANSWER: d 64. Ready‐to‐eat‐or‐drink supplements can be ideal when a. the athlete only has 30 minutes before competition b. the athlete can’t eat solid food due to a nervous stomach

.

c. the athlete wants a meal that provides “complete nutrition” d. substituted for regular meals e. the athlete wants a low‐carbohydrate pre‐game meal ANSWER: b

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 65. Supplementation of

may enhance performance of weight lifters and sprinters, but the safety of large doses and long‐term use has not been confirmed. a. caffeine

b. carnitine c. creatine d. steroids e. human growth hormone ANSWER: c 66. Though some may experience unpleasant side effects, all of the following supplements have some demonstrated research findings that they may perform to some extent as claimed except a. carnitine

.

b. dietary nitrate c. sodium bicarbonate d. creatine e. beta‐alanine ANSWER: a 67. Which of the following is NOT a correct statement about ergogenic aids? a. Some supplements may be contaminated with illegal substances not listed on the label. b. The majority of ergogenic aids have research findings that support claims made on the label. c. When performance does improve after use of an ergogenic aid, the improvement is often due to the placebo effect.

d. Ergogenic ads may feature references to scientific journals to give the illusion of endorsement. e. Some ergogenic aids may have little health effect on the body, while others may increase harm or put one at increased risk of death.

ANSWER: b 68. All of the following are effects of caffeine when taken to enhance endurance or performance except it

. a. may enhance alertness

b. may reduce the perception of fatigue c. may raise blood pH to counteract the buildup of lactate d. may improve concentration e. acts as a stimulant in the body ANSWER: c

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 69.

is an ergogenic aids that increases the risk for acromegaly.

a. HMB b. Creatine c. Octacosanol d. Growth hormone e. DHEA ANSWER: d 70. All of the following are supplements that are dangerous to health and are banned by most professional sports organizations except

.

a. HMB b. anabolic steroids c. hGH d. DHEA e. androstenedione ANSWER: a 71. A substance or treatment that purportedly improves athletic performance above and beyond what is possible through training is called a(n) a. anabolic steroid

.

b. ergogenic aid c. stimulant d. banned substance e. depressant ANSWER: b 72. Which of the following is a nonessential amino acid that has been shown to raise the concentration of muscle carnosine, which enhances the muscles’ buffering capacity? a. creatine

b. caffeine c. androstenedione d. beta‐alanine e. carnitine ANSWER: d

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 73. Walking at a pace of 4.0 mph that requires some increase in breathing and heart rate would be classified as a(n) . a. light‐intensity activity

b. moderate‐intensity activity c. vigorous‐intensity activity d. aerobic activity e. anaerobic activity ANSWER: b 74. Which of the following is the principle of training that states for a body system to improve it must be worked at frequencies, durations, or intensities that increase by increments? a. resistance

b. hypertrophy c. endurance d. conditioning e. overload ANSWER: e 75. The length of time that a person can remain active with an elevated heart rate defines the person’s a. flexibility b. muscle endurance c. cardiovascular endurance d. cardiac output e. fitness

.

ANSWER: c 76. Which of the following builds and maintains muscle mass, strength, power, and endurance, as well as maintains bone mass and enhances psychological well‐being? a. resistance training

b. aerobic activity c. anaerobic activity d. stretching e. cooling down ANSWER: a

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 77. The muscle cells call upon which system after the first ten seconds or so of intense activity as energy from the phosphagen system diminishes? a. phosphagen

b. creatine phosphate c. lactic acid d. aerobic e. fatty acid ANSWER: c 78. The muscles rely on which system to provide ATP for muscle contraction to meet the more prolonged demands of sustained activity? a. phosphagen

b. creatine phosphate c. lactic acid d. aerobic e. anaerobic ANSWER: d 79. Training the muscles to store as much glycogen as they can while also supplying the dietary glucose to enable them to do so is a technique referred to as a. progressive overload

.

b. carbohydrate loading c. muscle conditioning d. high intensity training e. muscle endurance ANSWER: b 80. Which condition signaled by low hemoglobin in the blood that is associated with strenuous activity typically does not require the use of iron supplementation? a. sports anemia

b. hemolytic anemia c. sickle cell anemia d. macrocytic anemia e. megaloblastic anemia ANSWER: a

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 81. Fitness is defined as the body’s ability to meet routine physical demands and to withstand stresses of all kinds.

a. True b. False ANSWER: True 82.

Flexibility allows the joints to move freely and through a full range of motion.

a. True b. False ANSWER: True 83. Overload is the decrease in muscle size and strength. a. True b. False ANSWER: False 84. Creatine is a high‐energy compound in muscle cells that can provide immediate energy. a. True b. False ANSWER: True 85. Oxygen is required for sustained physical activity in addition to a fuel source. a. True b. False ANSWER: True 86. Malate is the product of anaerobic glycolysis. a. True b. False ANSWER: False 87. Lactate is released into the bloodstream when the liver breaks down glycogen. a. True b. False ANSWER: False

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 88. Muscle endurance is the ability of a muscle to contract repeatedly without becoming exhausted. a. True b. False ANSWER: True 89. Glycogen is the stored form of fuel in the muscles and liver. a. True b. False ANSWER: True 90.

Which of the following is the increase in muscle size and strength? a. atrophy

b. hypertrophy c. flexibility d. overload e. fitness ANSWER: b 91. Which of the following are signaling proteins secreted by the skeletal muscles? a. myokines b. cytokines c. adipokines d. adenines e. nervines ANSWER: a 92. A temporary state of low blood hemoglobin in athletes is sports anemia. a. True b. False ANSWER: True 93. Hyperthermia is a build‐up of heat that increases the body’s temperature. a. True b. False ANSWER: True

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 94. Flexibility is a training principle that involves incrementally increasing intensity, frequency, and/or duration. a. True b. False ANSWER: False 95. Hypothermia is a concern for athletes in cold weather. a. True b. False ANSWER: True 96. Hydration involves regularly providing the body adequate fluids. a. True b. False ANSWER: True 97. The accepted measure of a person’s cardiorespiratory fitness is VO2max. a. True b. False ANSWER: True 98. Caffeine is a stimulant used to enhance performance during exercise. a. True b. False ANSWER: True 99. Which of the following is a depressant and diuretic? a. creatine b. alcohol c. caffeine d. glucose e. sodium ANSWER: b

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 100.

Marquis is 50 years old, has been sedentary most of his adult life, and wants to begin a fitness regimen.

However, he is concerned about injuries. Provide Marquis with at least four ways he can prevent injuries while building fitness.

ANSWER:

Be active all week, not just on the weekends. ●● Use proper equipment and wear proper attire. ●● Perform exercises using proper form. ●● Include warm‐up and cool‐down activities in each session. Warming up helps prepare muscles, ligaments, and tendons for the upcoming activity and mobilizes fuels to support strength and endurance activities. Cooling down reduces muscle cramping and allows the heart rate to slow gradually. ●● Train hard enough to challenge your strength or endurance a few times each week rather than every time you work out. Between challenges, do moderate workouts and include at least one day of rest each week. ●● Pay attention to body signals—symptoms such as abnormal heartbeat, dizziness, lightheadedness, cold sweat, confusion, or pain or pressure in the middle of the chest, teeth, jaw, neck, or arm demand immediate medical attention. ●● Work out wisely. Do not start with activities so demanding that pain stops you within a day or two. Learn to enjoy small steps toward improvement. Fitness builds slowly.

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 101. Liam is 50 years old and his BMI is within the “healthy” range. He eats a pretty healthy diet, but his doctor has been telling him that he needs to incorporate regular physical activity into his daily life. Liam doesn’t understand why the doctor wants him to do this since he is at a healthy weight. Describe for Liam at least five benefits that physically fit individuals enjoy, other than improved body composition.

ANSWER:

Restful sleep. Rest and sleep occur naturally after periods of physical activity.

Nutritional health. Physical activity expends energy and thus allows people to eat more food. If they choose wisely, active people will consume more nutrients and be less likely to develop nutrient deficiencies.

Improved bone density. Weight‐bearing physical activity builds bone strength and protects against osteoporosis.

Resistance to colds and other infectious diseases. Fitness enhances immunity.

Low risks of some cancers. Lifelong physical activity may help to protect against colon cancer, breast cancer, and some other cancers.

Strong circulation and lung function. Physical activity that challenges the heart and lungs strengthens the circulatory system.

Low risk of cardiovascular disease. Physical activity lowers blood pressure, slows resting pulse rate, and lowers blood cholesterol, thus reducing the risks of heart attacks and strokes. Some research suggests that physical activity may reduce the risk of cardiovascular disease in another way as well by reducing visceral fat stores.

Low risk of type 2 diabetes. Physical activity normalizes glucose tolerance. Regular physical activity reduces the risk of developing type 2 diabetes and improves glucose control.

Reduced risk of gallbladder disease. Regular physical activity reduces the risk of gallbladder disease perhaps by facilitating weight control and lowering blood lipid levels.

Low incidence and severity of anxiety and depression. Physical activity may improve mood and enhance the quality of life by reducing depression and anxiety.

Strong self‐image. The sense of achievement that comes from meeting physical challenges promotes self‐confidence.

Long life and high quality of life in the later years. Active people live longer, healthier lives than sedentary people do. Even as little as 15 minutes a day of moderate‐intensity activity can add years to a person’s life. In addition to extending longevity, physical activity supports independence and mobility in later life by reducing the risk of falls and minimizing the risk of injury should a fall occur.

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 102. Describe the American College of Sports Medicine’s guidelines for physical fitness, and create an activity plan that meets these guidelines over the time period of a week.

ANSWER: The American College of Sports Medicine’s guidelines for physical fitness include all of the following: Aerobic activity that uses large muscle groups and can be maintained continuously should be done five to seven days per week for at least 30 minutes per day at moderate activity.

Resistance activity that enhances muscle strength and improves body composition should be done on 2 to 3 nonconsecutive days per week and should include two to four sets of eight to twelve repetitions involving the major muscle groups.

Stretching or a flexibility activity should be done two to seven days per week.

Weekly Activity Plan that Meets Guidelines: Answers will vary among students but should meet the minimum amounts of aerobic, resistance, and stretching activities listed above.

103. Describe at least four effects of cardiorespiratory conditioning.

ANSWER:

Increases cardiac output and oxygen delivery Increases blood volume per heart beat (stroke volume) Slows resting pulse rate Increases breathing efficiency Improves circulation Reduces blood pressure

104. Salimah has been doing the same physical activity routine for three years now, and it is as follows: Walking five days per week for 35 minutes at 4 mph, performing strength exercises two times per week that use her body weight for resistance such as push‐ups, sit‐ups, and stretching during her cool down of each workout.

Give three examples of how she might apply the progressive overload principle to improve her physical fitness.

ANSWER: Answers will vary among students but should be specific suggestions that do the following: Increase the type, duration, intensity, and/or frequency of her current cardiorespiratory activities; Incorporate new types of resistance training and/or use weights in combination with body weight resistance; Incorporate new types of stretching exercises.

The muscles adapt and build only the proteins they need to cope with the work performed.

Muscles engaged in activities that require strength develop more of the proteins needed for greater muscle mass; body builders have large, well‐developed muscles. By comparison, those engaged in endurance activities develop more of the proteins needed to combat muscle fatigue; distance cyclists can pedal for many hours before fatigue sets in.

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 105. Explain what it means to be physically fit, and then list the components that it includes.

ANSWER: An individual who is physically fit has the ability to perform physical activity, and more specifically, the ability to meet routine physical demands with enough reserve energy to rise to a physical challenge. Physical fitness can also be described as the ability to withstand stress.

To be physically fit, a person must develop enough flexibility, muscle strength and endurance, cardiorespiratory endurance, and achieve a healthy body composition. Flexibility allows the joints to move freely, reducing the risk of injury. Cardiorespiratory endurance supports the ongoing activity of the heart and lungs. Muscle strength and endurance enable muscles to work harder and longer without fatigue. Body composition improves as physical activity supports lean body tissues and reduces excess body fat.

106. What energy system is required for sustained activity, and why can the other energy systems not support sustained activity?

ANSWER: The muscles rely on the aerobic system to provide ATP for muscle contraction to meet the more prolonged demands of sustained activity. This is the one system that uses oxygen, and therefore is able to provide ATP more efficiently and for sustained periods far beyond the capabilities of the phosphagen system and the lactic acid system. In addition, after 20 minutes of sustained activity, the aerobic system starts to use a higher percentage of fat for fuel and less glucose which conserves the body’s glycogen stores.

The phosphagen system relies on the immediate breakdown of creatine phosphate. When creatine phosphate is split anaerobically, it releases phosphate which can be used to replenish ATP. However, creatine phosphate amounts are very limited and require rest for more to be produced, making it an energy source for approximately 10 seconds.

The lactic acid system is called on by muscle cells to produce more ATP as the phosphagen system diminishes. The lactic acid system involves the anaerobic breakdown of glucose to pyruvate (and then of pyruvate to lactate). The primary source of glucose is muscle glycogen. This system can generate a small amount of ATP quickly for high‐intensity activity lasting up to 3 minutes, but when the rate of lactate production exceeds the rate of clearance, intense activity can be maintained for only 1 to 3 minutes (as in a 400‐ to 800‐meter race or a boxing match).

107. What affects the amount of glycogen that the muscles can store?

ANSWER: The amount of glycogen that is stored in the body is affected by the individual’s carbohydrate intake and training. Eating plenty of carbohydrate‐rich foods fills glycogen stores, and ensures that an individual has ample glycogen stores when active. When compared to other mixed diets, a high‐carbohydrate diet allowed endurance athletes to go longer before becoming exhausted.

In addition, training affects how much glycogen that muscle cells have the capacity to store.

Muscle cells that repeatedly deplete their glycogen through hard work adapt to store greater amounts of glycogen to support that work. This is one of several reasons why adequate training before an endurance event or competition is so important.

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 108. Gia is a college athlete, and her RDA for protein is 50 grams of protein. What would her protein needs be when she is training, and what is suggested as the best way to meet these goals?

ANSWER: Based on her protein RDA, we can assume that Jennifer weighs approximately 62.5 kg (50 kg ÷ 0.8 g/kg of body weight). Athletes need approximately 1.2–2.0 g of protein/kg of body weight which means that Jennifer’s protein needs as an athlete are 75–125 grams (62.5 kg ´ 1.2 g/kg of body weight = 75 grams; 62.5 kg ´ 2.0 g/kg of body weight = 125 grams).

Daily protein intake goals are best met by a meal plan that includes moderate amounts (20–30 grams) of high‐quality protein in 4–5 small meals throughout the day, including within 2 hours following strenuous training sessions. Even the highest protein recommendations can be met without protein supplements, or even excessive servings of meat.

109. Why is water needed for peak physical performance, and how should someone adequately hydrate before, dur ANSWER: The body’s need for water is greater than any other nutrient, and water is the medium in which all occur. If too much water is lost and not replaced, the body’s well‐being is compromised and cannot peak physical performance. Full hydration is imperative for every athlete both in training and in co who arrives at an event even slightly dehydrated begins with a disadvantage. Athletes who are pre often advised to drink extra fluids in the days immediately before the event, especially if they are water is not stored in the body, but drinking extra water ensures maximum hydration at the start o To prepare for fluid losses, a person must hydrate before activity; to replace fluid losses, the perso and after activity. Hydration guidelines for before, during, and after events are listed below.

Time

Recommended Intake

>4 hours before activity

1 oz/10 lb

2 hours before activity, if heavy sweating is expected

Add 0.6 oz/10 lb

Every 15 minutes during activity

Drink enough to minimize loss of body weigh much.

After activity

>2 cups for each pound of body weight lost

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Chapter 14: Fitness: Physical Activity, Nutrients, and Body Adaptations 110. Explain caffeine’s effect on the body and both the positive and negative impacts it can have on physical performance.

ANSWER: Caffeine is a stimulant that elicits a number of physiological and psychological effects in the body.

Caffeine may enhance alertness and reduce the perception of fatigue. Caffeine‐containing beverages should be used in moderation, if at all, and in addition to other fluids, not as a substitute for them. Carbonated soft drinks that contain caffeine may make a person feel fuel quickly and limit their fluid intake; this could potentially put an athlete or individual at risk for dehydration when active.

Some research supports the use of caffeine to enhance endurance and, to some extent, to enhance short‐term, high‐intensity exercise performance. However, the possible adverse effects from caffeine intake includes stomach upset, nervousness, irritability, headaches, and diarrhea must be weighed against any potential benefits. Caffeine is a restricted substance by the National Collegiate Athletic Association, which allows urine concentrations of 15 milligrams per liter or less (equivalent to about five cups of coffee consumed within a few hours before testing). Urine tests that detect more caffeine than this disqualify athletes from competition.

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Chapter 15: 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. Which organ provides the infant with nourishment? a. placenta b. umbilical cord c. amniotic sac d. blastocyte e. zygote ANSWER: a 4. A developing infant from 2 to 8 weeks is known as a(n) a. fetus b. zygote c. ovum

.

d. blastocyst e. embryo ANSWER: e

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 5. A healthy full-term infant weighs approximately how many pounds? a. 5½ to 7 b. 6 to 7 c. 6½ to 8 d. 8 to 9 e. over 7 ANSWER: c 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. During which time period can irreversible damage to the fetus 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

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 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. fertilization b. malnutrition c. overnutrition d. fetal programming e. critical periods ANSWER: d 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. maternal use of certain medications ANSWER: c 12. An infant born at 39 weeks would be described as a. pre-term b. complete

.

c. full-term d. post-term e. after due date ANSWER: c

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 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. umbilical cord

.

b. uterus c. blastocyte d. placenta e. amniotic sac ANSWER: a 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 three 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

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 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: e 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 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

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 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 pre-pregnancy 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 24. Why is the fiber recommendation for lactating women higher? a. Since kcalorie intake increases during lactation, increased fiber intake follows. b. Hormones related to lactation increase the likelihood of constipation. c. Fiber directly supports breastmilk production. d. Maternal fiber intake supports healthy bowel movements in the infant. e. Fiber increases satiety, which helps the mother lose weight after pregnancy.

ANSWER: a

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 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

28. For the normal-weight woman, how much weight is ideally gained in the first trimester? a. 4 lb b. 3.5 lb c. 2 lb d. 1 lb e. 5.5 lb ANSWER: b

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 29. The increased needs for which nutrient during pregnancy cannot be met by diet or existing stores so supplements are recommended? a. protein b. calcium c. iron d. zinc e. vitamin B12 ANSWER: c 30. A pregnant woman needs to increase her intake by approximately how many kilocalories to account for increased energy need in the second trimester of pregnancy? a. 200 b. 340 c. 450 d. 540 e. 600 ANSWER: b 31.

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

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

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 33. Which nutrient does the body show a dramatic increase in absorption during pregnancy? a. sodium b. magnesium c. thiamin d. calcium e. protein ANSWER: d 34. The developing brain depends heavily on which nutrient(s) and the mother’s intake of during pregnancy may improve an infant’s brain function and cognition? a. essential amino acids 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 for bone calcium over that of the fetus.

ANSWER: a 36. Pregnant women younger than age 25 who receive less than how many mg of dietary calcium daily need to increase their intake of milk, cheese, yogurt, and other calcium rich foods? a. 800 mg b. 600 mg c. 900 mg d. 500 mg e. 1000 mg ANSWER: b

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 37. Maternal bones lose some density during lactation if intake of which nutrient is inadequate? a. vitamin B12 b. protein c. omega-3 fatty acids d. calcium e. magnesium ANSWER: d 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 deficiency of a. calcium

.

b. sodium c. iron d. protein e. glucose ANSWER: e 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

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 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 WIC program b. the March of Dimes c. the SNAP program d. food stamp e. the OAA program ANSWER: a 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

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 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. An 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 48. To reduce risk of the development of type 2 diabetes after pregnancy, health professionals 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

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 49. What pregnancy condition can also be an early indicator of preeclampsia? a. gestational diabetes b. chronic hypertension c. slow but excessive weight gain d. gestational hypertension e. preexisting diabetes ANSWER: d 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 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

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 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. pre-term 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 are acceptable.

ANSWER: a 55. Which is NOT true regarding fetal alcohol syndrome? a. Alcohol exposure during the first trimester may cause developing organs such as the brain, heart, and kidneys to be malformed b. Alcohol exposure during the second trimester, the risk of spontaneous abortion increases. c. Alcohol exposure during the third trimester may cause body and brain growth to be impaired d. An association between paternal alcohol intake prior to conception and low infant birthweight has been reported e. One quarter of all pregnant women admit to engaging in binge drinking.

ANSWER: e 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

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Chapter 15: 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

at birth.

b. 4 lb or less c. 5 ½ lb or less d. 6½ lb or less e. 9 lb or less 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

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 61. A nursing mother needs at least how many kilocalories a day to receive all the nutrients required for successful lactation? a. 1200 kcal b. 1400 kcal c. 1800 kcal d. 2000 kcal e. 2400 kcal ANSWER: c 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 how much water per day? a. 6 to 7 cups b. 8 cups c. 10 to 11 cups d. 13 cups e. 16 cups ANSWER: d 64. Preparation for breastfeeding includes acquiring and learning how to a. weigh the baby

.

b. use a breast-pump c. measure the quantity of milk d. test the nutritional quality of milk e. bottle feed the baby ANSWER: b

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 65. In the United States and other developed countries, breastfeeding is not recommended when the mother has . a. hepatitis b. the common cold c. tuberculosis d. sinus infection e. HIV ANSWER: e 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: a

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 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 70. What level of alcohol consumption does the U.S. Surgeon General advise 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 six 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 a. preterm

.

b. full term c. macrosomic d. microsomic e. past term ANSWER: b

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 73. Which condition normally develops in the second half of pregnancy and can increase risk of developing type 2 diabetes after pregnancy if overweight? a. preeclampsia b. eclampsia c. gestational diabetes d. iron-deficiency anemia e. obesity ANSWER: c 74. Which term refers to strong desires to avoid particular foods and are thought to be due to hormonal changes? a. food cravings b. food sensitivities c. food aversions d. food allergies e. food preferences ANSWER: c 75. A woman who is which of the following at the time of conception is advised to gain 15 to 20 pounds during pregnancy? a. underweight b. healthy weight c. overweight d. class I obese e. class II obese ANSWER: c 76.

is the ability of a man and women to reproduce. a. Compatibility b. Fertility c. Chemistry d. Sexuality e. Teratogenicity ANSWER: b

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 77. Which of the following is a genetic abnormality that causes metal impairment, short stature, and flattened facial features? a. Fetal alcohol spectrum disorders b. Down syndrome c. alcohol-related neurodevelopmental disorder d. spina bifida e. anencephaly ANSWER: b 78. The temporary absence of menstrual periods immediately following childbirth is referred to as a. perinatal anemia

.

b. postpartum amenorrhea c. postpartum depression d. malnutrition e. diabetes ANSWER: b 79. Which term refers to the influence of substances during fetal growth on the development of diseases in later life? a. genetic predisposition b. epigenetics c. fetal programming d. teratogenicity e. chronic disease ANSWER: c 80. A health care provider who specializes in helping new mothers establish a healthy breastfeeding relationship with their infant is called a(n) . a. doula b. certified nurse midwife c. certified lactation consultant d. certified professional midwife e. obstetrician ANSWER: c

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 81. Which of the following is an infection caused by eating unpasteurized juice and dairy products, soft cheeses, or certain ready-to-eat foods like hot dogs and deli meats? a. meningitis b. salmonella c. norovirus d. listeriosis e. botulism ANSWER: d 82. Pica is associated with which type of anemia? a. hemolytic b. sickle cell c. iron deficiency d. megaloblastic e. microcytic ANSWER: c 83. The “bag of waters” in the uterus, in which the fetus floats is known as the amniotic sac. a. True b. False ANSWER: True 84. The developing infant is referred to as a zygote from 2 to 8 weeks after conception. a. True b. False ANSWER: False 85. An infant with a birthweight at the 90th percentile or higher for gestational age has a condition known as macrosomia. a. True b. False ANSWER: True 86. The embedding of the blastocyst in the inner lining of the uterus is known as implantation. a. True b. False ANSWER: True Page 21

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 87. Heavy use of caffeine during pregnancy may increase the risk of miscarriage or low birthweight. a. True b. False ANSWER: True 88. Heartburn is a common discomfort during pregnancy caused by relaxed digestive muscles and pressure on the stomach. a. True b. False ANSWER: True 89. An infant born before 38 weeks is referred to as preterm. a. True b. False ANSWER: True 90. The developing infant from eight weeks after conception until birth is referred to as a fetus. a. True b. False ANSWER: True 91. The perinatal period occurs between the 28th week of gestation and one month after birth. a. True b. False ANSWER: True 92. Prolactin is a hormone that stimulates the mammary glands to eject milk. a. True b. False ANSWER: False 93. Gestational age is the best indicator of an infant’s health. a. True b. False ANSWER: False

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 94. Oxytocin is a hormone secreted by the pituitary gland that promotes the production of milk. a. True b. False ANSWER: False 95. Cigarette smoking increases the risk of sudden infant death syndrome. a. True b. False ANSWER: True 96. A newly fertilized ovum is referred to as which of the following? a. fetus b. embryo c. sac d. zygote e. infant ANSWER: d 97. Eclampsia is a condition characterized by seizures. a. True b. False ANSWER: True 98. Preeclampsia is a condition characterized by high blood pressure and protein in the urine. a. True b. False ANSWER: True 99. Something that causes abnormal fetal development or birth defects is referred to as teratogenic. a. True b. False ANSWER: True

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 100.

Excess intake of which substance in pregnancy is known to result in mental retardation of the child? a. tobacco b. caffeine c. alcohol d. fish e. cured meats ANSWER: c

101.

You are educating a nursing student on postpartum depression. Identify three key points to include.

ANSWER: (1) An estimated 10 to 20 percent of women experience postpartum depression. (2) Several dietary factors have been studied in an effort to find a nutritional link. Findings have been intriguing, but limited. A healthy, well-balanced diet supports a mother’s mental and physical health, which can influence her relationships with her children. (3) maternal depression and a an unhealthy diet often go hand in hand, and together—as well as independently—contribute to a child’s emotional and behavioral problems.

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 one 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 seven 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.

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 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.

105.

Marta was physically active before becoming pregnant, and she has continued doing regular exercise during her pregnancy based on her doctor’s recommendations and guidelines. Marta’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 Marta 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.

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Chapter 15: Life Cycle Nutrition: Pregnancy and Lactation 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 carbohydrates (ideally, 175 grams or more per day and certainly no less than 135 grams) are necessary to fuel the fetal brain. Sufficient carbohydrates also ensure 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 protein-containing plant foods such as legumes, whole grains, nuts, and seeds. Because use of highprotein 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 15: 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 nine 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 eight 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 three hours after eating before lying down, and waiting two 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. Pre-term infants are born before they are fully developed; they are often underweight and have trouble breathing because their lungs are immature. Pre-term 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 normalweight 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 also for their future cognitive development and abilities as well.

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Chapter 15: 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 pregnancyrelated 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 15: Life Cycle Nutrition: Pregnancy and Lactation 110. Tao 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 Tao 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 Tao 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 15: 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, healthcare 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 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 1. A healthy infant that weighs 7 pounds at birth likely will weigh how many pounds by their first birthday? a. 14 b. 21 c. 28 d. 35 e. 42 ANSWER: b 2. During the second year, a healthy infant gains less than how many pounds? a. 5 b. 10 c. 15 d. 20 e. 25 ANSWER: b 3. A healthy adult requires less than 40 kcal per kilogram of body weight. A healthy infant requires about how many 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 percent of the day’s total energy intake? a. kidney b. liver c. brain d. skeletal muscle e. small and large intestines ANSWER: c

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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 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 what percentage of body weight? a. 2% b. 4% c. 10% d. 12% e. 12% ANSWER: d 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

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 9. Which of the following supplements are recommended for infants who are breastfed exclusively? a. fluoride b. DHA c. sodium d. calcium e. vitamin D ANSWER: e 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 milk-like substance secreted right after delivery e. a vitamin in breast milk ANSWER: d 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. lactoferrin b. colostrum c. lysozyme d. TGF-β e. bifidus factor ANSWER: d

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 13. As compared to breast milk or infant formula, cow’s milk contains too much a. protein; carbohydrate

and too little

.

b. protein; fat c. fat protein 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 six 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. soy b. egg c. hydrolyzed protein d. goat’s milk e. barley ANSWER: a 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

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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 six months of age b. after one year of age c. after two years of age d. as soon as complementary foods are introduced e. when the diet supplies 30 percent 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. corn b. wheat c. barley d. rice e. oat ANSWER: d 20. Breastfeeding may also reduce the risk of a. arrythmias

.

b. contamination c. sudden infant death syndrome d. eating disorders e. pica ANSWER: b

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Chapter 16: 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. gum b. rice milk c. peanut butter d. fruit juice e. honey ANSWER: e 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. folate b. iron c. vitamin A d. vitamin C e. vitamin D ANSWER: b 24. Each year from age 1 to adolescence, a child typically grows taller by 2 to 3 inches and heavier by how many 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 16: 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 one to five 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 how many kcalories per day to meet energy needs? a. 400 b. 800 c. 1600 d. 2400 e. 3200 ANSWER: c 27. Which of the following is the most prevalent nutrient deficiency among U.S. toddlers one to three years of age? a. vitamin C b. calcium c. fiber d. iron e. protein ANSWER: d 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

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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 who are two to six 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 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

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 33. Children absorb more lead if their stomachs are empty and when they have low intakes of a. glucose and water

.

b. selenium and magnesium c. calcium and vitamin d d. lycopene and folate e. magnesium and molybdenum ANSWER: c 34. Pica, a craving for nonfood items like dirt and old paint, can lead to which of the following in children? a. hyperactivity b. lead poisoning c. food allergies d. obesity e. type 2 diabetes ANSWER: b 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 four 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

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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 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. Jamal is allergic to peanuts. In the school cafeteria, he begins to have difficulty breathing, his tongue and face swell, and he begins vomiting. Jamal most likely is in immediate need of a lifesaving injection of . a. cortisone b. serotonin c. epinephrine d. dopamine e. histamine ANSWER: c

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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 . a. 75th percentile b. 85th percentile c. 90th percentile d. 65th percentile e. 55th percentile ANSWER: b 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

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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 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 how many 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. high sodium intake b. obesity c. potassium deficiency d. high HDL cholesterol e. insufficient calcium intake ANSWER: b

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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 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

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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. The use of weight-loss drugs to treat obesity in children merits special concern because a. these drugs may carry a risk of dependence. b. this teaches children to take a pill for any problem. c. long-term effects on growth and development have not been studied. d. studies show these drugs increase the risk for ADHD. e. studies show these drugs may affect future fertility.

ANSWER: c 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. Which type of vegetables are children most likely to prefer? a. colorful b. well cooked c. raw. d. mixed e. starchy ANSWER: c

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 57. At what age might a child be expected to spear food with a fork? a. 1 year b. 2 years c. 3 years d. 4 years e. 5 years ANSWER: c 58. Approximately how many children participate in the School Breakfast Program? a. 1 million b. 2 million c. 12 million d. 21 million e. 21 million ANSWER: c 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 percent 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

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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 d. 14 to 16; 14 to 18 e. None of these are correct.

for females and at

for males.

ANSWER: b 62. Energy and nutrient needs are greater during and lactation. a. infancy

than at any other time of life, except during pregnancy

b. early childhood 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 64. Caitlin is a 12-year-old girl and has started to menstruate. Caitlin needs an additional day. a. 1.9

mg of iron per

b. 2 c. 2.5 d. 3.1 e. 4 ANSWER: c

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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 for girls. a. 10%; 20% b. 20%; 10%

for boys and

c. 30%; 40% d. 40%; 30% e. 50%; 75% ANSWER: c

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 69. On any given day, how many adolescents smoke a cigarette for the first time? a. 1,000 b. 2,000 c. 3,000 d. 4,000 e. 5,000 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. During the second year, a healthy infant grows about how many inches taller? a. 3 b. 5 c. 7 d. 9 e. 11 ANSWER: b 72. The energy-yielding nutrient that makes up 55 percent of breast milk is a. fat

.

b. protein c. carbohydrate d. sugar e. colostrum ANSWER: a

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 73. An often-fatal foodborne illness caused by the ingestion of foods containing a bacteria that grow without oxygen is . a. listeriosis b. norovirus c. salmonella d. botulism e. E. coli ANSWER: d 74. As compared to breast milk or infant formula, cow’s milk contains too little a. protein

.

b. calcium c. Vitamin D d. fat e. carbohydrate ANSWER: e 75.

is inattentive and impulsive behavior that is more frequent and severe than is typical of others a similar age. a. Hyperactivity b. Obsessive c. Compulsive d. Aggression e. Defiance ANSWER: a

76. Based on data from the BMI-for-age growth charts, children and adolescents are categorized as obese at the . a. 75th percentile b. 80th percentile c. 85th percentile d. 90th percentile e. 95th percentile ANSWER: e

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 77. What term refers to the maximum amount of residue permitted in a food when a pesticide is used according to the label directions? a. upper limit b. tolerance level c. allowable level d. acceptable level e. highest limit ANSWER: b 78. Key people who control other people’s access to foods and thereby exert profound impacts on their nutrition are called “ .” a. influencers b. gatekeepers c. controllers d. gurus e. trendsetters ANSWER: b 79. The period from the beginning of puberty until maturity is called “ a. preteen b. tween c. teen d. adolescence e. young adulthood

.”

ANSWER: d 80.

is a type of artery disease characterized by plaques on the inner walls of the arteries. a. Hypertension b. Hyperlipidemia c. Diabetes d. Atherosclerosis e. Aneurysm ANSWER: d

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 81. What is the expected weight at 5 months, in pounds, of an infant with a birthweight of 7 lb? a. 12 lbs b. 14 lbs c. 16 lbs d. 18 lbs e. 20 lbs ANSWER: b 82. Corn syrup is a possible source of infant botulism. a. True b. False ANSWER: True 83. EPA is a structural component of the brain found in breast milk and fortified infant formulas. a. True b. False ANSWER: False 84. Alpha-lactalbumin is the main protein in human breast milk. a. True b. False ANSWER: True 85. Whey is the main protein in cow’s milk. a. True b. False ANSWER: False 86. Vitamin D is typically low in breast milk and should be supplemented. a. True b. False ANSWER: True 87. Colostrum is a milk-like secretion from the breast, present during first few days after delivery. a. True b. False ANSWER: True Page 21

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 88. Fluoride is a mineral found in drinking water and infant formulas made with tap water. a. True b. False ANSWER: True 89. Prolonged contact with carbohydrate-rich liquids in baby bottles may result in nursing bottle tooth decay. a. True b. False ANSWER: True 90. Excessive milk intake replacing iron-rich foods in the diet may result in milk anemia. a. True b. False ANSWER: True 91. Weaning is the process of gradually replacing breast milk with formula or other foods. a. True b. False ANSWER: True 92. Which of the following nutrients is notably lacking in goat’s milk? a. protein b. calcium c. iodine d. folate e. phosphorus ANSWER: d 93. Food intolerances are adverse reactions to food involving an immune response. a. True b. False ANSWER: False 94. Food allergies are adverse reactions to food that do not involve antibody production. a. True b. False ANSWER: False Page 22

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 95. Children who eat dirt or chips of old paint are at risk for high levels of lead in the blood. a. True b. False ANSWER: True 96. Approximately what percentage of children younger than four years are diagnosed with food allergies? a. 1-2 b. 4-8 c. 12-15 d. 18-20 e. 20-23 ANSWER: b 97. Which substance prevents anaphylactic shock after exposure to a food allergen? a. antihistamine b. amphetamine c. epinephrine d. norepinephrine e. analgesic ANSWER: c 98. An overweight teen with one obese parent has about an 80 percent chance of becoming an obese adult. a. True b. False ANSWER: True 99. A child with normal-weight parents has about a 25 percent chance of becoming an obese adult. a. True b. False ANSWER: False

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 100.

Describe at least five of the standards the Academy of Nutrition and Dietetics has established for child-care providers and parents to ensure that meals and snacks meet children's nutrition needs and promote optimal growth in safe and healthy environments.

ANSWER: ● Provide children with a variety of healthy foods and beverages. ● Limit less-healthy foods that contribute little to meeting nutrition needs. ● Be mindful of food safety, foodborne illness, and food allergies. ● Create healthy physical and social eating environments. ● Respect children's hunger and satiety cues. ● Encourage child-care provider role modeling. ● Work with parents to encourage healthy foods brought from home. ● Respect culture and encourage cultural foods. ● Be mindful of food security and family resources. ● Facilitate nutrition education for children and families. ● Consider barriers to serving health foods and beverages from the provider perspective. ● Provide training and technical assistance to child-care providers.

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Chapter 16: 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 helps 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 are mixed. 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 16: 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, ready-tofeed 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 six 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.

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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.

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 wellnourished 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 16: 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.

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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.

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 percent 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.

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Chapter 16: Life Cycle Nutrition: Infancy, Childhood, and Adolescence 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 16: 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 16: 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 16: 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 percent for boys and 40 percent 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 17: 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

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 5. The maximum potential human life span is currently about how many years? a. 110 b. 120 c. 130 d. 140 e. 150 ANSWER: c 6. In the United States, women who live to the age of 85, can expect to survive an additional how many years, on average? a. 3 b. 5 c. 7 d. 9 e. 11 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. Nalah says her grandfather acts like a 25-year-old man. Nalah is referring to her grandfather’s a. chronological age b. physiological age c. ephemeral age

.

d. transient age e. historical age ANSWER: b

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 9. Bo says his grandmother celebrated her 93rd birthday. Bo 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. To support flexibility, for how long should an older adult hold each stretch? a. 10 seconds b. 30 seconds c. 60 seconds d. 90 seconds e. 120 seconds ANSWER: a 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 how many 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 what percentage of normal? a. 90% b. 85% c. 80% d. 75% e. 70% ANSWER: e

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 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 percent 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 15. Reducing energy intake by a minimum of what percentage brings about measurable improvements in body fat, blood pressure, insulin response, and blood lipids? a. 10% b. 15% c. 20% d. 25% e. 30% ANSWER: a 16. Using animal data to extrapolate to humans, researchers estimate that it would take a person how many years of restricting energy intake to 30 percent of normal, to increase life expectancy by three years? a. 5 b. 7 c. 10 d. 15 e. 30 ANSWER: e

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 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 what percentage of older adults in the United States are deemed obese? a. 40% b. 35% c. 37% d. 55% e. 50% ANSWER: b 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 and gain body fat b. lose body fat and gain bone mass c. lose lean muscle and gain bone mass d. lose bone mass and gain muscle e. lose bone mass and body ANSWER: a

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 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 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

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 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 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

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 29. Even with the help of Social Security, what percentage of 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 and pressure ulcers

.

b. memory loss and dementia c. Alzheimer’s and blood loss d. weight gain and polyuria e. bulimia and 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

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Chapter 17: 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. two b. four c. six d. eight e. ten ANSWER: c 34. Betina 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 by what percentage per decade due to lean muscle mass and diminishing thyroid hormones? a. 1 to 2% b. 2 to 4% c. 4 to 8% d. 8 to 16% e. 16 to 24% ANSWER: a 36. Klaus 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

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 37. Older adults with atrophic gastritis are vulnerable to deficiency of which nutrient? a. folate b. calcium c. vitamin D d. vitamin B12 e. zinc ANSWER: d 38. Adults aged 51 to 70 who engage in minimal outdoor activity, need how many micrograms of vitamin D daily? a. 15 b. 20 c. 25 d. 30 e. 35 ANSWER: a 39. During aerobic activity, an older adult should stop if which of the following occurs? a. heart rate increases b. sweating c. dizziness d. breathing slightly harder than usual e. cramp in side ANSWER: c 40. The DRI recommends how many milligrams of calcium for women over 50 and older and men over 70? a. 600 b. 800 c. 1000 d. 1200 e. 1400 ANSWER: d

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 41. Which of the following statements describes the mineral nutrition of older adults? a. Zinc intake is adequate for about 95 percent 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 43. The reduction in oxidative damage that occurs with energy restriction in animal studies also occurs in people whose diets are rich in which of the following? a. grass-fed animal proteins b. tropical oils c. heme and nonheme iron d. omega-6 fatty acids e. antioxidants and phytochemicals ANSWER: e 44. Which term refers the clouding of the eye lenses that impairs vision and can lead to blindness? a. glaucoma b. retinitis c. keratoids d. cataracts e. rhodolipids ANSWER: d

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 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 48. Which type of arthritis most commonly disables older people? a. psoriatic arthritis b. osteoarthritis c. rheumatoid arthritis d. gout e. fibromyalgia ANSWER: b

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 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 person of what age? a. 62 years b. 65 years c. 67 years d. 70 years e. 72 years ANSWER: d 52. One in a. two

U.S. adults is affected by Alzheimer’s disease after age 65.

b. five c. eight d. twelve e. fifteen ANSWER: c

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Chapter 17: 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. Large doses of liquid medications containing sorbitol may cause a. constipation

.

b. diarrhea c. GERD d. nausea e. vomiting ANSWER: b 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 17: 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 17: 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. treats dementiaThe medication megestrol acetate a. relieves depression b. promotes weight loss c. enhances appetite

.

d. stimulates insulin production e. treats dementia ANSWER: c

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 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 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

supplement.

b. vitamin D c. iron d. potassium e. sodium ANSWER: d

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 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 71. A person’s perceived physical and mental well-being is referred to as a. life span

.

b. health span c. quality of life d. longevity e. life expectancy ANSWER: c 72. The age in years from the date of birth is the a. gestational age b. real age

.

c. life expectancy d. chronological age e. physiological age ANSWER: d

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years is a general term referring to any threat to a person’s well-being.

73. a. Danger

b. Stress c. Fear d. Phobia e. Trauma ANSWER: b 74.

is a deterioration of the macular area of the eye that can lead to loss of central vision and eventual blindness. a. Night blindness b. Macular degeneration c. Retina detachment d. Glaucoma e. Cataract ANSWER: b

75.

is inflammation of a joint, usually accompanied by pain, swelling, and structural changes. a. Sprain b. Tear c. Tendonitis d. Arthritis e. Bursitis ANSWER: d

76. Compounds of nitrogen-containing bases such as adenine, guanine, and caffeine are called “ a. amino acids b. proteins

.”

c. peptides d. purines e. amines ANSWER: d

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 77.

initiate and conduct nerve impulse transmissions. a. Neurons b. Axons c. Synapses d. Neurotransmitters e. Dendrites ANSWER: a

78. The loss of brain function beyond the normal loss of physical adeptness and memory that occurs with aging is called “ .” a. Alzheimer’s disease b. senile dementia c. cognitive impairment d. cognitive decline e. Lewy bodies disease ANSWER: b 79.

are clumps of beta-amyloid protein pieces, commonly found on the brains of people with Alzheimer’s disease a. Senile plaques b. Senile blockages c. Senile clots d. Senile tears e. Senile stoppages ANSWER: a

80. Snarls of threadlike strands that extend from the nerve cells, commonly found on the brains of people with Alzheimer’s disease are called “ .” a. beta-amyloid proteins b. senile plaques c. neurofibrillary tangles d. Lewy bodies e. ketone bodies ANSWER: c

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 81. Life span refers to the maximum number of years of life for a species. a. True b. False ANSWER: False 82. Life expectancy refers to the average number of years lived in a given society. a. True b. False ANSWER: False 83. Sarcopenia is the loss of skeletal muscle mass, strength, and quality. a. True b. False ANSWER: True 84. Intake of grapefruit juice interferes with the utilization of many cholesterol-lowering drugs. a. True b. False ANSWER: True 85. One reason infectious diseases are a major cause of death in older adults is that antibiotics a. are not as effective in people who have taken them before

.

b. are not as effective in people with compromised immune systems c. are often contraindicated with their other medications d. lead to further loss of muscle mass e. lead to further loss of bone mass ANSWER: b 86. Pressure ulcers are damage to the skin commonly seen in people who are bedridden. a. True b. False ANSWER: True 87. Atrophic gastritis is characterized by inadequate amounts of hydrochloric acid. a. True b. False ANSWER: True Page 21

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 88. In the elderly, elevated stores of calcium are more likely than deficiencies. a. True b. False ANSWER: False 89. Breakdown of purines can lead to gout. a. True b. False ANSWER: True 90. Deficiency of iron blunts the sense of taste. a. True b. False ANSWER: False 91. Vitamin D deficiency is caused, in part, by the elderly’s low intake of milk. a. True b. False ANSWER: True 92. Cataracts are age-related cloudy areas of the eye lenses. a. True b. False ANSWER: True 93. Osteoarthritis is also called “degenerative arthritis.” a. True b. False ANSWER: True 94. Omega-3 fatty acids may reduce inflammation in joints of those with rheumatoid arthritis. a. True b. False ANSWER: True

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 95. Rheumatoid arthritis is joint inflammation involving a defective immune system. a. True b. False ANSWER: True 96. Gout is a form of arthritis characterized by deposits of uric acid crystals. a. True b. False ANSWER: True 97. Which of the following substances is essential to memory? a. beta-amyloid proteins b. vitamin D c. purines d. acetylcholine e. zinc ANSWER: d 98. Clumps of which substance make up senile plaques? a. purines b. beta-amyloid proteins c. omega-3 fatty acids d. hydrochloric acid e. acetylcholine ANSWER: b 99. The anticoagulant warfarin acts by blocking the enzyme that activates vitamin K. a. True b. False ANSWER: True 100. Based on exercise guidelines for older adults, develop a weeklong exercise program for a 65-year-old woman ANSWER: Thirty minutes of moderate intensity aerobic activity 5 days per week, 8 strength-training exercises at 10-15 repetitions on 2 nonconsecutive days per week; 20-30 minutes of balance exercises 2-3 days per week; stretch for at least 20 minutes at least three times per week

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Chapter 17: 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. Daily activities can be as simple as gardening and doing household chores.

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Chapter 17: 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 percent 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 energy-restricted, 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.

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.

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 intakes by 15 percent, their body weight decreases, metabolism slows (more than would be expected for a lower body weight), and oxidative stress declines — favorable changes for preventing chronic diseases and supporting longevity. Some research suggests that fasting on alternative days may provide similar benefits.

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Chapter 17: 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-or-flight 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, nine percent of the people older than age 65 live in poverty; without the help of Social Security, it would be 40 percent. 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.

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 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.

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 17: 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 weightbearing joints. Importantly, walking and other weight-bearing exercises do not worsen arthritis. In fact, low-impact 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 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 sugar-sweetened 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 ten years older. In other words, the brain degeneration of an overweight 50-year-old adult is comparable to that of a 60-year-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 17: 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.

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Chapter 17: Life Cycle Nutrition: Adulthood and the Later Years 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 percent of adults aged 65 years and older take at least one prescription medicine; almost 40 percent 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.

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Chapter 18: Disease Prevention 1. Which of the following is NOT an antigen? a. allergens b. toxins c. macrophages d. bacteria e. viruses ANSWER: c 2. Phagocytes are a white blood cells that . a. are the last resort for fighting off foreign substances in the body b. initiate the release of lymphocytes when foreign substances enter the body c. secrete cytokines d. consist of neutrophils and macrophages e. are involved with production of lymphocytes ANSWER: d 3. The process in which immune cells engulf and then destroy foreign antigens is known as a. metastasis.

.

b. antigenesis. c. phagocytosis. d. cytotoxicosis. e. inflammation.

ANSWER: c 4. Of these body organs and glands, which one is involved in immunity? a. spleen b. liver c. pancreas d. parathyroid gland e. kidneys ANSWER: a

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Chapter 18: Disease Prevention 5. Which of these substances is NOT part of the immune system? a. antibodies b. lipoproteins c. cytokines d. B‐cells e. neutrophils ANSWER: b 6. Of the following nutrients, which one has a known specific role in immunity? a. molybdenum b. selenium c. vitamin K d. thiamin e. copper ANSWER: b 7. What is the role of omega-3 fatty acids in immune function? a. Maintain healthy skin and other epithelial tissues as barriers to infection b. Regulate T-cell responses c. Help resolve inflammation when it is no longer needed for the immune response d. Protect against oxidative damage e. Help maintain an effective immune response.

ANSWER: c 8. Of the ten leading causes of death in the United States, how many have some relationship with diet? a. two b. four c. five d. six e. eight ANSWER: b

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Chapter 18: Disease Prevention 9. Which of the following is NOT a risk factor for type 2 diabetes? a. genetics b. sedentary lifestyle c. age d. diets high in added sugars e. high saturated fat and/or trans fat diets ANSWER: d 10.

The most common form of cardiovascular disease is

.

a. coronary heart disease b. hypertension c. congestive heart failure d. elevated blood cholesterol e. myocardial infarction ANSWER: a 11. What is the name for the accumulation of fatty deposits, smooth muscle cells, and fibrous connective tissue in the artery walls?

a. plaque b. fatty streaks c. emboli d. aneurysm e. thrombus ANSWER: a 12. What is the earliest age by which most people have well‐developed arterial plaque? a. 30 b. 40 c. 50 d. 55 e. 60 ANSWER: a

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Chapter 18: Disease Prevention 13. The type of disease that is characterized by arterial plaque and that is the major cause of cardiovascular disease is . a. metabolic syndrome

b. thrombosis c. hypertension d. atherosclerosis e. cholesterolemia ANSWER: d 14. A typical symptom of coronary heart disease is a. high blood pressure b. pallor c. angina d. sore throat e. jaundice

.

ANSWER: c 15. C‐reactive protein is a marker for . a. extent of heart damage following a heart attack b. future risk for heart attack or stroke c. degree of arterial wall damage d. extent of plaque buildup e. hypertension risk ANSWER: b 16. Which of the following is NOT one of the four conditions that account for more than half of the deaths in the United States each year? a. heart disease

b. cancers c. chronic lung diseases d. accidents e. diabetes ANSWER: e

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Chapter 18: Disease Prevention 17. Which of the following measurements puts a person at high risk for coronary heart disease? a. total blood cholesterol below 200 mg/dL b. body mass index between 25 and 29.9 c. fasting triglycerides of 150 to 199 mg/dL d. blood pressure of 140/90 or higher e. LDL cholesterol under 100 mg/dL ANSWER: d 18. Which of the following substances is NOT involved in the inflammation process? a. minerals b. free radicals c. macrophages d. ldl cholesterol e. cytokines ANSWER: a 19. A heart attack is a. severe angina

.

b. an aneurysm in the chest c. sudden tissue death caused by blockages of vessels that feed heart muscle d. a heart valve malfunction e. an abnormal surge of blood into the heart’s left ventricle ANSWER: c 20. A stroke is . a. an aneurysm in the brain b. a myocardial infarction c. a cerebrovascular accident d. the 15th leading cause of death in the United States e. not related to hypertension ANSWER: c

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Chapter 18: Disease Prevention 21. What percentage of people in the United States has at least one major risk factor for coronary heart disease by age 20?

a. 10 b. 20 c. 30 d. 40 e. 50 ANSWER: e 22. What is a difference in the incidence of coronary heart disease between men and women? a. Men’s risk for coronary heart disease goes up significantly at age 45; women’s at age 55 to 60. b. Men are more likely to die from coronary heart disease than women. c. After age 60, women are more likely to die from coronary heart disease than men d. Women have a higher risk for developing coronary heart disease but men have a higher risk of dying from it.

e. Women’s overall risk for coronary heart disease may be higher because they have higher homocysteine levels.

ANSWER: a 23. What proportion of adults in the United States has high blood triglycerides? a. 1/10 b. 1/4 c. 1/3 d. 1/2 e. 2/3 ANSWER: c 24. With which of these factors is high blood triglycerides known to be associated? a. type 2 diabetes b. high alcohol intake c. smoking d. underweight e. postmenopausal estrogen therapy ANSWER: a

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Chapter 18: Disease Prevention 25. Which of the following is NOT considered a risk factor for heart disease? a. hypertension b. diabetes c. high LDL cholesterol d. low blood pressure e. low HDL cholesterol ANSWER: d 26. Which substance has the biggest role in the development of atherosclerosis? a. HDL cholesterol b. LDL cholesterol c. hemoglobin d. calcium e. sodium ANSWER: b 27. What is a desirable blood level for triglycerides? a. <125 mg/dL b. <150 mg/dL c. 150 to180 mg/dL d. 180 to 200 mg/dL e. <240 mg/dL ANSWER: b 28. Which of the following is NOT a characteristic of metabolic syndrome? a. insulin resistance b. abdominal obesity c. abnormal blood lipids d. macrocytic anemia e. high blood pressure ANSWER: d

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Chapter 18: Disease Prevention 29. What level of HDL cholesterol puts a person at high risk for coronary heart disease? a. <40 mg/dL b. 30–40 mg/dL c. 40–50 mg/dL d. 50–60 mg/dL e. ≥59 mg/dL ANSWER: a 30. What is a characteristic of an atherogenic diet? a. moderate calcium b. low saturated fat c. plant based d. high trans fat e. high fiber ANSWER: d 31. What is a lifestyle change that cardiac experts recommend for reducing cardiovascular disease risk? a. Avoid exposure to second‐hand smoke. b. Use solid fats made with canola or safflower oil. c. Exercise at least twice weekly. d. If you use alcohol, drink one glass of red wine daily. e. Consume low‐fat milk products, especially yogurt, at least five times weekly.

ANSWER: a 32. If lifestyle changes fail to lower LDL cholesterol or blood pressure, what is the next course of action? a. medicines b. bariatric surgery, if overweight c. liquid diet d. angioplasty e. severe kcalorie restriction diet ANSWER: a

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Chapter 18: Disease Prevention 33. About what proportion of US adults does high blood pressure affect? a. 1/10 b. 1/4 c. 1/3 d. 1/2 e. 1/5 ANSWER: c 34. Low blood pressure is generally a sign of a. lung disease b. anemia c. kidney failure d. long‐life expectancy e. short‐life expectancy

.

ANSWER: d 35. Which of the following is NOT a risk factor for hypertension? a. low calcium intake b. high salt intake c. aging d. genetics e. more than two alcoholic drinks a day ANSWER: a 36. Physically, people with untreated hypertension will a. have headaches b. feel dizzy c. experience ringing in the ears

.

d. fatigue easily e. not feel anything ANSWER: e

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Chapter 18: Disease Prevention 37. About what percentage of people with hypertension are overweight or obese? a. 50 b. 60 c. 70 d. 80 e. 85 ANSWER: c 38. Obesity raises blood pressure by . a. constricting blood vessels, thereby restricting blood flow b. inhibiting secretion of hormones that help regulate blood pressure c. altering kidney function d. causing the heart to work harder e. promoting inflammation of arterial walls, thereby reducing their elasticity ANSWER: c 39. Peripheral resistance is the resistance blood encounters in the a. heart

.

b. veins c. arteries d. capillaries e. arterioles ANSWER: e 40. Which of the following is a risk factor for cancers, hypertension, type 2 diabetes, stroke, obesity, and atherosclerosis?

a. diets high in added sugars b. excessive alcohol intake c. diets high in saturated fat d. sedentary lifestyle e. smoking and tobacco use ANSWER: d

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Chapter 18: Disease Prevention 41. Compared to the typical American diet, what is one nutrient that the DASH eating pattern provides more of? a. calcium b. iron c. vitamin B12 d. vitamin C e. thiamin ANSWER: a 42. Some diuretics can lead to a deficiency of what nutrient? a. manganese b. sodium c. calcium d. potassium e. phosphorous ANSWER: d 43. Diuretics lower blood pressure by a. decreasing fluid loss

.

b. increasing fluid loss c. removing calcium ions d. promoting blood homeostasis e. reducing bile salts ANSWER: b 44. Which of the following is true of hypertension treatments? a. Treatment with medicine often includes more than one drug. b. A low‐sodium diet is more beneficial to women than men. c. Weight loss alone rarely achieves significant results. d. Almost always, medicines are the most effective treatment. e. Research results on the effectiveness of the DASH eating plan are still inconclusive.

ANSWER: a

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Chapter 18: Disease Prevention 45. Which of the following is a recommendation of the DASH eating plan? a. Eat 6 ounces of grains daily. b. Consume at least 3 cups of fat‐free or low‐fat milk daily. c. Eat only poultry and fish. d. Eat 4 to 5 ounces of nuts, seeds, and legumes a week. e. Consume the equivalent of 1 cup of fruit daily.

ANSWER: d 46. Where does diabetes rank among the top ten leading causes of death in the United States? a. No. 2 b. No. 3 c. No. 5 d. No. 7 e. No. 10 ANSWER: d 47. Which of the following may be a symptom of transient ischemic attack? a. feeling of tightness around the heart b. inability to swallow c. pain between shoulder blades d. pain in the leg e. weight gain ANSWER: b 48. The most dramatic increase in the incidence of type 2 diabetes over the past two decades has occurred in .

a. children and adolescents b. African Americans c. Hispanic Americans d. premenopausal women e. postmenopausal women ANSWER: a

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Chapter 18: Disease Prevention 49. One difference between type 1 and type 2 diabetes is that in type 1 diabetes a. insulin therapy is always required b. obesity is a factor c. only children are affected d. the diagnosis is based on a fasting plasma glucose of 150 mg/dL or higher e. there are few, if any, symptoms.

.

ANSWER: a 50. Unlike type 1 diabetes, type 2 diabetes . a. affects only adults. b. is much more likely to be associated with obesity c. has a different set of complications d. does not have the same symptoms. e. is diagnosed with a fasting plasma glucose of 100 to 125 mg/dL ANSWER: b 51.

About what percentage of diabetes cases are diagnosed as type 1? a. 1 to 2

b. 3 to 5 c. 5 to 10 d. 10 to 12 e. 15 ANSWER: c 52. The A1C is a test to measure . a. fasting plasma glucose b. non‐fasting blood glucose c. percentage of hemoglobin with glucose attached d. cumulative values for hemoglobin, hematocrit, and blood glucose e. the amount of glucose in the urine ANSWER: c

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Chapter 18: Disease Prevention 53. Which of the following groups is at higher risk for type 2 diabetes? a. Hispanics b. women c. men d. Caucasians e. Native Americans ANSWER: e 54. What is prediabetes? a. another name for gestational diabetes b. a consistent fasting plasma glucose of 100 to 125 mg/dL c. an AIC below 5.7% d. a condition similar to metabolic syndrome except that blood pressure is normal e. a disorder in which some complications of diabetes have developed but a diagnosis of diabetes has not yet been made

ANSWER: b 55. What is polydipsia, a common symptom of untreated diabetes? a. increased urge to urinate b. excessive fluid losses c. excessive thirst d. excessive hunger e. multiple electrolyte deficiencies ANSWER: c 56. Which of the following is NOT true of diabetic ketoacidosis? a. It results in ketonuria. b. It can lead to diabetic coma. c. Treatment is to correct low blood sugar. d. It causes changes in the odor of breath. e. It results from the production of ketones for energy since glucose cannot enter the cells.

ANSWER: c

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Chapter 18: Disease Prevention 57. Microangiopathies that develop in people with diabetes can lead to a. impaired nutrient absorption b. weight loss c. loss of liver function d. hypertension e. loss of kidney function

.

ANSWER: e 58. Carbohydrate intake for people with diabetes should a. be higher in the evening than in the morning b. be consistently spaced throughout the day c. exclude added sugars d. include limited amounts of fruits and fruit juices e. represent 60 percent of the day’s kcalorie intake

.

ANSWER: b 59.

The first step in carbohydrate counting is to . a. determine an appropriate carbohydrate allowance

b. figure out the amount of added sugar currently consumed c. determine the ideal body weight d. make a list of favorite foods e. determine the appropriate protein intake ANSWER: a 60. Which of the following is true of cancer? a. Although it can originate anywhere in the body, cancer is one single disorder. b. In almost all cases, the role of diet in cancer is to protect against its development. c. Among environmental risk factors, the two known to cause cancer are radiation and smoking. d. There are many cancers, and they have different characteristics. e. While not a risk factor for cancer, obesity increases the risk of dying from cancer because fat cells interfere with chemotherapy.

ANSWER: d

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Chapter 18: Disease Prevention 61. The development of cancer is called a. carcinogenesis b. malignancy c. tumor promotion d. tumor initiation e. synergism

.

ANSWER: a 62.

What proportion of cancers do some experts estimate may be linked to diet?

a. 1/10 b. 1/8 c. 1/4 d. 1/3 e. 1/2 ANSWER: d 63. Of the following foods, which is considered a cancer initiator? a. legumes b. grilled meat c. garlic d. fruit e. milk ANSWER: b 64. Which of the following is associated with autoimmune diseases and viral infections? a. type 1 diabetes b. stroke c. obesity d. breast cancer e. coronary heart disease ANSWER: a

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Chapter 18: Disease Prevention 65.

In atherosclerosis, what substance becomes trapped in the arterial walls? a. Lewy bodies

b. beta‐amyloid proteins c. malignant cells d. LDL cholesterol particles e. blood clots ANSWER: d 66. Which of the following dietary components may protect against cancer? a. Fiber b. Inositol and biotin c. Certain saturated fats d. Protein from animal sources e. Certain sugars ANSWER: a 67. What is the name of the potential carcinogen created in certain starchy foods, such as potatoes, when fired or baked at high temperatures?

a. aflatoxins b. lycopene c. acrylamide d. heterocyclic amines e. allium ANSWER: c 68.

To reduce the risk of cancer, the American Cancer Society recommends

.

a. taking dietary supplements b. eating whole grains c. engaging in 75 minutes of vigorous exercise daily d. excluding red meats from the diet e. avoiding potatoes and other starchy foods ANSWER: b

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Chapter 18: Disease Prevention 69. Which of the following is true about the association between diet and chronic diseases? a. A moderate weight loss can help improve blood glucose but rarely blood lipids or blood pressure. b. While heart disease, hypertension, diabetes, and cancer are four distinct diseases, they all have similar causes and treatments.

c. Quantity, not variety, is the key to getting the health benefits of fruits and vegetables. d. Chronic diseases are neither caused nor prevented by diet alone. e. People who follow dietary advice will likely eliminate most, if not all, of their risk for a chronic disease.

ANSWER: d 70. What is the Healthy Eating Plate? a. an alternative to the USDA’s MyPlate that focuses on the links between diet and health b. a vegetarian alternative to the USDA’s MyPlate c. a 1200 kcalorie weight reduction diet d. a phytochemical‐rich diet e. a carbohydrate counting plan ANSWER: a 71. The term that describes the body’s reaction to foreign antigens by neutralizing or eliminating them, thus preventing damage, is known as the a. innate immunity

.

b. acquired immunity c. inflammation d. immune response e. phagocytosis ANSWER: d 72. The name of the protein released during the acute phase of infection or inflammation that enhances immunity, among other things, and whose presence may be used to assess a person’s risk for an impending heart attack or stroke is . a. C‐reactive protein (CRP)

b. hemoglobin A1C c. high density lipoprotein d. homocysteine e. very low density lipoprotein ANSWER: a

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Chapter 18: Disease Prevention 73.

is a type of artery disease characterized by plaque on the inner walls of the arteries. a. Hypertension

b. Hyperlipidemia c. Diabetes d. Alzheimer’s disease e. Atherosclerosis ANSWER: e 74. The organ of the body that plays a key role in regulating blood pressure by controlling the secretion of hormones involved in vasoconstriction and retention of sodium and water is the

.

a. liver b. pancreas c. kidneys d. hypothalamus e. thyroid ANSWER: c 75. The term for elevated blood glucose is a. hypoglycemia b. hyperglycemia c. diabetes d. insulin resistance e. prediabetes

.

ANSWER: b 76. Dietary factors that may protect against the development of cancer are known as a. anti‐inflammatories b. antioxidants

.

c. anti‐promoters d. antibodies e. antigens ANSWER: c

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Chapter 18: Disease Prevention 77. Which type of vegetables, including cabbage, cauliflower, broccoli, and Brussel sprouts, contain a variety of phytochemicals that defend against certain cancers? a. starchy

b. non‐starchy c. fibrous d. root e. cruciferous ANSWER: e 78. Antibodies are substances that elicit the immune response once in the body. a. True b. False ANSWER: False 79. Neutrophils are the most common type of white blood cells. a. True b. False ANSWER: True 80. Inflammation is the immune response that underlies obesity and many chronic diseases. a. True b. False ANSWER: True 81. Lymphocytes are immune cells that practice phagocytosis. a. True b. False ANSWER: False 82. Heart disease is the primary cause of death in the United States. a. True b. False ANSWER: True

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Chapter 18: Disease Prevention 83. Atherosclerosis is a disease characterized by the accumulation of lipids on the inner arterial walls. a. True b. False ANSWER: True 84. Stroke is the fifth leading cause of death in the United States. a. True b. False ANSWER: True 85. The higher the amount of high‐density lipoprotein, the higher the risk for coronary heart disease. a. True b. False ANSWER: False 86. Atherogenic refers to anything that promotes atherosclerosis. a. True b. False ANSWER: True 87. Metabolic syndrome is the condition of having a combination of certain risk factors for cardiovascular disease. a. True b. False ANSWER: True 88. Excess salt intake is often implicated in the condition of a. stroke b. atherosclerosis

.

c. diabetes d. hypertension e. hyperlipidemia ANSWER: d

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Chapter 18: Disease Prevention 89. Which diet has strong research support for significantly lowering blood pressure? a. keto b. paleo c. vegan d. DASH e. Mediterranean ANSWER: d 90.

Type 1 diabetes is the less common form of diabetes.

a. True b. False ANSWER: True 91. Type 2 diabetes is commonly associated with obesity. a. True b. False ANSWER: True 92. Carb counting is a diet plan used by many people with diabetes. a. True b. False ANSWER: True 93.

is the term used to describe the condition of cancers spreading to other tissues of the body.

a. Remission b. Staging c. Metastasis d. Atherogenic e. Malignancy ANSWER: c 94. An anti‐promoter is something that protects against cancer development. a. True b. False ANSWER: True

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Chapter 18: Disease Prevention 95. Which term describes a substance or event that gives rise to a cancer? a. initiator b. antigen c. invader d. promoter e. anti‐promotor ANSWER: a 96. The term cruciferous describes a type of which of the following that may help defend against certain cancers? a. fruit b. vegetable c. protein d. fiber e. grain ANSWER: b 97. Which diet plan developed at Harvard focuses on the links between diet and health? a. DASH b. carb counting c. Healthy Eating Plate d. MyPlate e. Mediterranean ANSWER: c 98. Explain the difference between modifiable and nonmodifiable risk factors. Identify the three nonmodifiable risk factors and three modifiable risk factors for coronary heart disease.

ANSWER: Nonmodifiable risk factors for CHD are those that a person cannot change because they are not related to diet or lifestyle factors. These include increasing age, male gender, and family history of premature heart disease. Modifiable risk factors can be altered when a person makes diet or lifestyle changes. These include high blood LDL cholesterol, low blood HDL cholesterol, high blood triglycerides (VLDL), high blood pressure (hypertension), diabetes, obesity (especially abdominal obesity), physical inactivity, cigarette smoking, an “atherogenic” diet (high in saturated fats, and low in vegetables, fruits, and whole grains)

99. Explain the role nutrition has in maintaining a healthy immune system. Give three examples of nutrients that have well‐known, specific roles in immunity.

ANSWER: The immune system is sensitive to the subtle changes in nutrition status. Malnutrition—whether undernutrition or overnutrition—compromises both immune system tissues and immune Page 23

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Chapter 18: Disease Prevention responses. From day to day, the immune system requires adequate amounts of protein, fat, carbohydrate, vitamins, and minerals to maintain its tissues and mount a response. The immune response demands greater amounts of nutrients for the synthesis of antibodies and cytokines, for cell multiplication, for free radical generation, and for the active process of ending the response.

Exactly which nutrients are needed in greater quantities, and how much, is not yet fully known, but nutrients known to play key roles in immunity and their roles are: Protein, which maintains healthy skin and other epithelial tissues (barriers to infection) and participates in the synthesis and function of the organs and cells of the immune system and antibody production; Omega‐3‐fatty acids, which help resolve inflammation when it is no longer needed for the immune response through production of lipid mediators known as resolvins and protectins, which also play a role in enhancing host defense; Vitamin A, which maintains healthy skin and other epithelial tissues (barriers to infection) and participates in the cell replication and specialization that supports immune‐cell and antibody production and the anti‐inflammatory response; Vitamin D, which regulates cell (T‐cell) responses and participates in antibody production; Vitamins C and E, which protect against oxidative damage; Vitamin B6, which helps maintain an effective immune response and participates in antibody production; Vitamin B12 and folate, which assist in cell replication and specialization that support immune cell and antibody production; Selenium, which protects against oxidative damage; Zinc, which helps maintain an effective immune response and participates in antibody production; Also, impaired immunity opens the way for infectious diseases, which typically raise nutrient needs and reduce food intake. Consequently, nutrition status suffers further. Thus, disease and malnutrition create a synergistic downward spiral that must be broken for recovery to occur; So, optimal immunity depends on optimal nutrition—enough, but not too much, of each of the nutrients. People with weakened immune systems, such as older adults, benefit from a nutritious diet and supplements of selected nutrients.

100.

Name the ten leading causes of death in the United States, and describe in general how diet and other lifestyle choices contribute to their development.

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Chapter 18: Disease Prevention ANSWER: The ten leading causes of death in the United States, as of June 2016, are in descending order: Heart disease Cancers Chronic lung diseases Accidents Strokes Alzheimer’s disease Diabetes mellitus Influenza and pneumonia Kidney diseases Suicide

Many of these deaths reflect chronic diseases that developed in response to lifestyle factors, such as diet, physical inactivity, overweight, tobacco use, and alcohol and drug abuse. Four of these causes of death have some relationship with diet. Taken together, these four conditions account for more than 50 percent of the nation’s more than two million deaths each year. Worldwide, statistics are similar, with developing countries sharing many of the same chronic diseases as developed nations.

Valid links do exist between saturated fat and heart disease, calcium and osteoporosis, and antioxidant nutrients and cancer, but in reality, each nutrient may have connections with several diseases because its role in the body is not specific to a disease but to a body function. Further, each of the chronic diseases develops in response to multiple risk factors, including many nondietary factors, such as genetics, physical activity, and smoking.

This table presents some of the relationships between risk factors, including diet‐related and chronic diseases.

Dietary Risk Factor

CA HT T2 AT OB ST

Diets high in added sugars Diets high in salty or pickled foods Diets high in saturated and/or trans fat Diets low in fruits, vegetables, and foods rich in fiber and phytochemicals Diets low in vitamins and/or minerals Excessive alcohol intake

X X X X X X X X X X X X X X X X X X X

X X X X

Other Risk Factors Age

X X X X

X Page 25

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Chapter 18: Disease Prevention Environmental contaminants Genetics Sedentary lifestyle

X X X X X X X X X X X X

Nutrition therapy for type 1 diabetes focuses on maintaining optimal nutrition status, controlling blood glucose, achieving a desirable blood lipid profile, controlling blood pressure, and preventing and treating the complications of diabetes. In addition to meeting basic nutrient requirements, the diet must provide a fairly consistent carbohydrate intake from day to day and at each meal and snack to help minimize fluctuations in blood glucose. Further alterations in diet may be necessary for a person with chronic complications such as cardiovascular or kidney disease.

In overweight people with type 2 diabetes, even moderate weight loss (5 to 10 percent of body weight) can help improve insulin resistance, blood lipids, and blood pressure. Together with diet, a regular routine of moderate physical activity not only supports weight loss, but also improves blood glucose control, blood lipid profiles, and blood pressure.

101.

What is an atherogenic diet and what would be the opposite, or the recommended, diet to replace it?

ANSWER: An “atherogenic” diet—that is, one high in saturated fats, trans fats, and cholesterol and low in vegetables, fruits, and whole grains—is one that initiates or promotes atherosclerosis by elevating LDL cholesterol. Fortunately, a well‐chosen eating pattern, such as the healthy Vegetarian Eating Pattern, the Healthy Mediterranean‐Style Eating Pattern, and the DASH eating pattern, can often lower the risk of cardiovascular disease. A number of beneficial factors share the credit, including vitamins, minerals, fibers, phytochemicals, and omega‐3 fatty acids.

In general, dietary recommendations for reducing cardiovascular disease risk include: Choosing a dietary pattern that emphasizes vegetables, fruits, and whole grains; includes low‐fat dairy products, poultry, fish, legumes, non‐tropical vegetable oils, and nuts; and limits intake of sweets, sugar‐sweetened beverages, and red meats; Balancing energy intake and physical activity to prevent weight gain and to achieve or maintain a healthy body weight; Limiting saturated fat to less than 7 percent of total kcalories and trans fat to less than 1 percent of total kcalories. For those who have been advised to lower LDL cholesterol or those with diabetes, saturated fat should be limited to 5 to 6 percent of total kcalories; Limiting sodium intake to 1500 milligrams a day; Limiting alcohol intake to no more than one drink daily for women and two drinks daily for men.

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Chapter 18: Disease Prevention 102.

Explain the defining features and significance of the metabolic syndrome.

ANSWER: Metabolic syndrome refers to a combination of risk factors that greatly increases a person’s risk for coronary heart disease, type 2 diabetes, and underlies several chronic diseases. These risk factors are insulin resistance, high blood pressure, abnormal blood lipids, and abdominal obesity.

Abdominal obesity and insulin resistance are both considered primary factors contributing to the metabolic syndrome. Metabolic syndrome, like the chronic diseases associated with it, also includes markers of inflammation and thrombosis. Overeating and physical inactivity play major roles in the development of metabolic syndrome. The prevalence of metabolic syndrome among US adults is high, and treatment to reduce these risk factors for heart disease and diabetes should begin early and focus on changes in lifestyle.

103.

How does hypertension develop? How does obesity aggravate it?

ANSWER: The underlying causes of most cases of hypertension are not fully understood, but much is known about the physiological factors that affect blood pressure. Blood pressure arises from contractions in the heart muscle that pump blood away from the heart (cardiac output) and the resistance blood encounters in the arterioles (peripheral resistance). When either cardiac output or peripheral resistance increases, blood pressure rises. Cardiac output is raised when heart rate or blood volume increases; peripheral resistance is affected mostly by the diameters of the arterioles. Blood pressure is therefore influenced by the nervous system, which regulates heart muscle contractions and the arteriole’s diameters, and hormonal signals, which may cause fluid retention or blood vessel constriction. The kidneys play a key role in regulating blood pressure by controlling the secretion of the hormones involved in vasoconstriction and retention of sodium and water.

Most people with hypertension—an estimated 70 percent—are overweight or obese. Obesity is recognized as a major cause of high blood pressure, and the combination of obesity and hypertension greatly increases the risk for CVD. Obesity raises blood pressure by altering kidney function, increasing blood volume, and promoting blood vessel damage through insulin resistance.

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Chapter 18: Disease Prevention 104.

Describe the DASH eating plan, and discuss its effectiveness in meeting the desired health goals?

ANSWER: The DASH (Dietary Approaches to Stop Hypertension) eating pattern is rich in fruits, vegetables, low‐fat milk products, whole grains, and nuts, and low in total fat and saturated fat can. Compared with the typical American diet, DASH provides more fiber, potassium, magnesium, and calcium and less red meat, sweets, and sugar‐containing beverages.

Specifically, the DASH eating pattern calls for: 6 to 8 ounces of grains daily 2 to 2‐1/2 cups of vegetables daily 2 to 2‐1/2 cups of fruits daily 2 to 3 cups of fat‐free or low‐fat milk 6 ounces or less of lean meats, poultry, and fish daily 4 to 5 ounces of nuts, seeds, and legumes weekly.

Studies have found that the DASH eating pattern can significantly lower blood pressure. It also lowers total cholesterol and LDL cholesterol and reduces inflammation.

105.

Compare and contrast type 1 and type 2 diabetes and summarize the recommended nutrition therapy for each.

ANSWER: In type 1 diabetes, the less common type (about 5 to 10 percent of all diagnosed cases), the pancre ability to synthesize the hormone insulin. Type 1 diabetes is an autoimmune disorder. In most case individual inherits a defect in which immune cells mistakenly attack and destroy the insulin‐produ of the pancreas. The rate of beta cell destruction in type 1 diabetes varies. In some people, mainly children, destruction is rapid; in others (mainly adults), it is slow. Type 1 diabetes commonly occur and adolescence, but it can occur at any age, even late in life.

Type 2 diabetes is the most prevalent form of diabetes, accounting for 90 to 95 percent of cases. Th defect in type 2 diabetes is insulin resistance, a reduced sensitivity to insulin. Consequently, muscl cells cannot remove glucose from the blood, and blood glucose remains elevated. To compensate, secretes larger amounts of insulin, and plasma insulin concentrations can rise to abnormally high le time, the pancreas becomes less able to compensate for the cells’ reduced sensitivity to insulin, an hyperglycemia worsens. The high demand for insulin can eventually exhaust the beta cells of the p lead to impaired insulin secretion and reduced plasma insulin concentrations. Type 2 diabetes is th associated both with insulin resistance and with relative insulin deficiency; that is, the amount of i insufficient to compensate for its diminished action in cells.

This table summarizes the differences and similarities between type 1 and type 2 diabetes.

Characteristic

Type 1

Type 1

Prevalence in diabetic population

5–10% of cases

90–95% of cases Page 28

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Chapter 18: Disease Prevention Associated conditions

Autoimmune diseases, viral infections, inherited factors

Obesity, aging, inactivity, in

Major defect

Insulin resistance; insulin de Destruction of pancreatic beta cells; insulin (relative to needs) deficiency

Insulin secretion

Little or none

Requirements for insulin Always therapy

Varies; may be normal, incr decreased

Sometimes

Nutrition therapy for type 1 diabetes focuses on maintaining optimal nutrition status, controlling b achieving a desirable blood lipid profile, controlling blood pressure, and preventing and treating th complications of diabetes. In addition to meeting basic nutrient requirements, the diet must provi consistent carbohydrate intake from day to day and at each meal and snack to help minimize fluctu glucose. Further alterations in diet may be necessary for a person with chronic complications such a cardiovascular or kidney disease.

In overweight people with type 2 diabetes, even moderate weight loss (5 to 10 percent of body we improve insulin resistance, blood lipids, and blood pressure. Together with diet, a regular routine physical activity not only supports weight loss, but also improves blood glucose control, blood lipid blood pressure.

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Chapter 18: Disease Prevention 106.

What is carbohydrate counting?

ANSWER: Carbohydrate counting is an approach many people with diabetes use to maintain near‐normal blood glucose levels. It does this by enabling people to choose foods that will deliver the same amount of carbohydrate each day, spaced evenly throughout the day.

Success with carbohydrate counting requires knowledge about the food sources of carbohydrates and an understanding of portion control. That is why it is best to get the help of a registered dietitian nutritionist, who can provide education and support.

Carbohydrate counting can be done using a food lists approach to diet planning, or by counting the grams of carbohydrate in the foods eaten throughout the day. This often can be done by referring to the Nutrition Facts panel of food labels.

In both instances, the first step is to determine an appropriate carbohydrate allowance. The allowance may be described in terms of grams or as a percentage of total kcalories. If it’s the latter, it’s easy to convert the percentage to grams. Consider a 2000 kcal diet with a carbohydrate allowance of 50 percent. The number of grams allowed would be 250 per day (2000 × 50% = 1000 kcal/day; 1000 kcal divided by 4 kcal/g carbohydrate = 250 g carbohydrate/day.)

The second step is to determine how the carbohydrate allowance will be distributed throughout the day in meals and snacks. With food lists, the typical carbohydrate‐serving equivalent is 15 grams. The number of carbohydrate portions allowed per day can be determined by dividing the daily carbohydrate allowance by 15 g/carbohydrate portion. Using the example above, that would come to 16.7 carbohydrate portions/day. (Or, rounded off to 17 carbohydrate portions/day.)

The third step is to decide on a daily meal pattern that provides roughly the same amount of carbohydrate each day, spaced evenly throughout the day.

Once the basic carbohydrate‐counting method has been learned, any selection of foods can be made, as long as the foods do not exceed carbohydrate goals. It is important to choose foods that follow a healthy eating pattern so that other dietary needs are met, as well.

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Chapter 18: Disease Prevention 107.

Describe how cancer develops. Explain what carcinogens are, and cite some dietary examples.

ANSWER: The development of cancer, called carcinogenesis, begins as a single cell loses control of its normal growth and replication processes. A cancer arises from mutations in the genes that control cell division in a single cell. These mutations may promote cellular replication, interfere with growth restraint, or prevent cellular death. The affected cell thereby loses its built‐in capacity for halting cell division, and it produces daughter cells with the same genetic defects. As the abnormal mass of cells, called a tumor, grows, a network of blood vessels develops to supply the tumor with the nutrients it needs to support its growth. The tumor can disrupt the functioning of the normal tissue around it, and some tumor cells may metastasize to other regions of the body. In leukemia (cancer affecting the white blood cells) the cells do not form a tumor, but rather accumulate in blood and other tissues.

The reasons cancers develop are numerous and varied. Vulnerability to cancer is sometimes inherited, such as when a person is born with a genetic defect that alters DNA structure, function, or repair. A few cancers are linked with microbial infections. Certain metabolic processes may initiate carcinogenesis, as when phagocytes of the immune system produce oxidants that cause DNA damage or when chronic inflammation enhances the rate of cell division and the risk of a damaging mutation. More often, cancers are caused by interactions between a person’s genes and the environment. Exposure to cancer‐ causing substances, or carcinogens, may either induce genetic mutations that lead to cancer or promote proliferation of cancerous cells.

Some dietary factors may initiate cancer development. Examples include: Excessive alcohol, which is associated with cancers of the mouth, throat, breast, and colon.

Meats cooked at high temperatures, such as frying, broiling, and grilling. The high temperatures cause amino acids and creatine in the meats to react together and form carcinogens. Grilling meat, fish, poultry, or other foods over a direct flame cause fat and added oils to splash on the fire, creating carcinogens that vaporize onto the food. Eating grilled food introduces these carcinogens to the digestive system, where they may damage the stomach and intestinal linings.

Diets high in red meat and processed meat (meat preserved by smoking, curing, or salting, or by adding preservatives) can lead to colon cancer.

Fried foods, such as potato chips and French fries, which are associated with acrylamide, a potential carcinogen that is produced when certain starches, like potatoes, are fried or baked at high temperatures.

Also, obesity is a clear risk factor for certain cancers, such as colon, breast in postmenopausal women, endometrial, pancreas, kidney, esophageal and perhaps others, such as gallbladder.

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Chapter 18: Disease Prevention 108.

What is the Healthy Eating Plan developed by the Harvard School of Public Health. What type of recommendations does it offer?

ANSWER: The Healthy Eating Plan created by the nutrition faculty from the Harvard School of Public Health is an alternative to the USDA MyPlate. It is based on their critical review of the links between diet and health.

The Healthy Eating Plate contains six categories with specific recommendations for each. These categories are: Healthy oils. Use healthy oils (such as olive and canola oil) for cooking, on salad, and at the table.

Avoid trans fat.

Fruits. Eat plenty of fruits of all colors.

Vegetables. The more veggies—and the greater the variety—the better. (Potatoes and French fries don’t count.)

Water. Drink water, tea, or coffee (with little or no sugar). Limit milk/dairy (1–2 servings/day) and juice (1 small glass/day). Avoid sugary drinks.

Whole Grains. Eat a variety of whole grains (such as brown rice, whole‐wheat bread, and whole‐ grain pasta). Limit refined grains (such as white rice and white bread).

Healthy Protein. Choose fish, poultry, beans, and nuts; limit red meat and cheeses; avoid bacon, cold cuts, and other processed meats.

A final message on the Healthy Eating Plate is to Stay Active!

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Chapter 19: Consumer Concerns about Foods and Water 1. Which of the following terms refers to the potential for a substance to cause harm if enough is consumed? a. riskiness b. hazard c. toxicity d. bioinsecurity e. food insecurity ANSWER: c 2. Which of the following terms is defined as a measure of the probability and severity of harm? a. danger b. risk c. safety d. hazard e. toxicity ANSWER: b 3. Which of the following terms refers to the harm that is likely under real-life conditions? a. riskiness b. hazard c. toxicity d. bioinsecurity e. food insecurity ANSWER: b 4. What is the federal agency that is responsible for regulating the use of pesticides and establishing water quality standards? a. WHO b. EPA c. FDA d. CDC e. USDA ANSWER: b

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Chapter 19: Consumer Concerns about Foods and Water 5. According to the CDC, how many cases of foodborne illness occur in the United States every year? a. 12 million b. 24 million c. 36 million d. 48 million e. 60 million ANSWER: d 6. Which of the following is the leading cause of food contamination in the United States? a. deliberate contamination or sabotage b. naturally occurring toxicants c. food poisoning from microbes d. pesticide residues from farmers e. food additives from the food industry ANSWER: c 7. Approximately how many people in the United States die from foodborne illnesses each year? a. 3000 b. 5000 c. 7000 d. 9000 e. 11,000 ANSWER: a 8. Among foodborne infections, what organism is the leading cause of hospitalization? a. Staphylococcus aureus b. Listeria c. Clostridium perfringens d. Salmonella e. Campylobacter ANSWER: d

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Chapter 19: Consumer Concerns about Foods and Water 9. What organism produces the most common food toxin, affecting more than one million people each year? a. Clostridium perfringens b. Escherichia coli c. Vibrio vulnificus d. Staphylococcus aureus e. Lactobacillus acidophilus ANSWER: d 10. Which of the following is a characteristic of botulism? a. A chief symptom is progressive paralysis of the respiratory system. b. With immediate treatment, a full recovery takes 24 hours. c. It is caused by the organism Staphylococcus aureus. d. It is a toxicant produced in foods stored under aerobic conditions. e. Symptoms may take several weeks to appear.

ANSWER: a 11. What percentage of reported foodborne illnesses are caused by errors in a commercial setting? a. 10% b. 20% c. 50% d. 70% e. 80% ANSWER: e 12.

Pasteurization . a. inactivates all microorganisms in a food b. is a sterilization process c. involves the heat processing of food d. eliminates threat of spoilage e. increases the risk of Listeria ANSWER: c

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Chapter 19: Consumer Concerns about Foods and Water 13. What industry controls are in place to help prevent foodborne illnesses? a. The United States does not import foods from any countries that do not monitor food safety at the government level. b. Foods like fish, meats, and nuts must display the country of origin on the label. c. The Hazard Analysis Critical Control Points system identifies potential hazards with all domestic and imported foods. d. All countries that trade meats, seafood, and produce routinely monitor their products for safety. e. Because it comes with the knowledge growing location, the farm-to-table movement has eliminated nearly all food safety concerns.

ANSWER: b 14. Which of the following may cause Clostridium botulinum poisoning? a. unwashed fruits b. untreated water c. rotting vegetables d. unpasteurized milk e. improperly canned vegetables ANSWER: e 15. About how long must you wash your hands with warm water and soap to reduce the potential for microbial contamination? a. 10 seconds b. 20 seconds c. 45 seconds d. 1 minute e. 2 minutes ANSWER: b

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Chapter 19: Consumer Concerns about Foods and Water 16. While preparing fajitas for dinner, Devin uses his sharpest knife to slice a piece of beef steak and then uses the same knife to chop the raw red peppers, tomatoes, and onions for his dish. He heated the meat until it reached an internal temperature of 145°. Immediately after dinner, Devin put all leftovers in an airtight container in the refrigerator. A few hours later, Devin and his family became ill. Which of the following describes Devin’s neglect that led to his family’s illness? a. contamination b. cross-contamination c. hazard analysis critical control points d. improper refrigeration of leftovers e. improper cooking temperatures ANSWER: b 17. The seal on a package of red meat reads “Graded by USDA.” This means that the meat a. is safe to eat raw

.

b. is not hazardous c. is free of bacteria d. was assessed for tenderness e. was humanely slaughtered ANSWER: d 18. Labels on bottled water must identify the water’s a. pH

.

b. fluoride content c. source d. treatment method e. contaminant content ANSWER: c 19. When is sushi safe to eat? a. After the fish has been frozen for 6 hours b. After a master chef has examined it for harmful microbes c. When fresh fish is labeled of “sushi grade” d. When cooked seafood and other ingredients are combined e. When it is wrapped in seaweed and combined with fresh vegetables ANSWER: d

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Chapter 19: Consumer Concerns about Foods and Water 20. To minimize the possibility of foodborne illness, poultry, stuffing, and reheated leftovers should be cooked to an internal temperature of at least °F. a. 125 b. 140 c. 145 d. 165 e. 212 ANSWER: d 21. Which of the following foods is best known to carry the hepatitis A virus? a. alcohol b. raw chicken c. raw oysters d. peas e. sriracha sauce ANSWER: c 22. To prevent foodborne illnesses, all foods should be served at a minimum of a. 140 b. 152

°F.

c. 165 d. 180 e. 212 ANSWER: a 23. People who travel to other countries have a a. 15 percent b. 25 percent

chance of contracting travelers’ diarrhea.

c. 33 percent d. 50 percent e. 75 percent ANSWER: d

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Chapter 19: Consumer Concerns about Foods and Water 24. Uncooked steaks and opened packages of luncheon meats can be safely stored in the refrigerator for a. 3 to 5 days

.

b. 1 week c. 2 to 4 weeks d. 3 to 5 weeks e. 4 to 6 weeks ANSWER: a 25. Which statement accurately describes food irradiation? a. It allows milk to be kept shelf stable and in boxes. b. It is used exclusively in the United States. c. US consumers have embraced the idea of irradiated food because of the significant benefits to safety. d. If a food or any of its ingredients has been irradiated, a symbol appears on the label. e. It is sometimes called cold pasteurization.

ANSWER: e 26.

Which of the following nutrients are most vulnerable to losses during food preparation? a. simple carbohydrates b. trace minerals c. fat-soluble vitamins d. polyunsaturated fats e. water-soluble vitamins ANSWER: e

27. Which of the following statements accurately describes ways to minimize nutrient losses when storing or preparing foods? a. To minimize vitamin loss, cut fresh fruits and vegetables and then rinse in water. b. Most fruits should be stored at room temperature to prevent vitamin loss. c. Use frozen vegetables sparingly as the nutrient content is lower than that of fresh vegetables. d. Microwaving vegetables causes the greatest loss of nutrients over other cooking methods. e. Fruits that have been cut or juiced should be stored in airtight containers in the refrigerator.

ANSWER: e

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Chapter 19: Consumer Concerns about Foods and Water 28. The extent to which an environmental contaminant lingers in the environment or body is referred to as a. perseverance

.

b. persistence c. the degradation rate d. its binding capacity e. food chain constancy ANSWER: b 29. Which term refers to the increase in the concentration of contaminants in the flesh of animals high on the food chain? a. degradation rate b. bioaccumulation c. hyperconcentration d. evolutionary containment e. binding capacity ANSWER: b 30. Which of the following is the only significant source of human methylmercury exposure? a. rice oil b. seafood c. legumes d. unfiltered water e. undercooked poultry ANSWER: b 31. Carbon water filters are effective at removing which of the following? a. fluoride b. chlorine c. Giardia d. E. coli e. Salmonella ANSWER: b

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Chapter 19: Consumer Concerns about Foods and Water 32. Which of the following foods is known to carry trace amounts of arsenic when routinely tested by the FDA? a. eggs b. olive oil c. rice d. ground beef e. whole grain breads ANSWER: c 33.

Which of the following statements accurately describes environmental contaminants in the US food supply? a. Virtually all fish contain trace amounts of mercury. b. Typically, swordfish has the least mercury contamination of all seafood. c. Young children should avoid eating any seafood to avoid risks of toxicity. d. Contamination is usually greater in farm-raised fish than in ocean fish. e. Older fish are generally safer than younger fish, since they have had more time to excrete the mercury.

ANSWER: a

34. What is the best way to reduce the solanine concentration in potatoes? a. Boil them in salted water for at least 10 minutes. b. Choose only potatoes grown in Washington or Idaho. c. Peel the skins before cooking or eating. d. Store them in a warm, light environment. e. Cook them in oil, at very high temperatures.

ANSWER: c 35. Which of the following statements accurately describes naturally occurring food toxicants? a. Lima beans contain deadly cyanide compounds. b. Solanine poisoning is common in people who eat raw potatoes. c. The toxic laetrile in certain fruit seeds is a moderately effective cancer treatment. d. People with thyroid problems should eat mustard greens and radishes raw. e. Even small amounts of goitrogen-containing vegetables can cause thyroid problems.

ANSWER: a

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Chapter 19: Consumer Concerns about Foods and Water 36. Which of the following is a natural toxicant found in lima beans? a. narcotic-like substances b. cyanogens c. solanine d. goitrogens e. hallucinogens ANSWER: b 37. What term is used to describe the maximum amount of a residue that is allowed in a food when the pesticide is used according to label directions? a. adverse concentration b. toxicity level c. tolerance level d. residue maximization e. risk concentration ANSWER: c 38. Consumers depend on the FDA and which other agency to keep pesticide use within safe limits? a. EPA b. CDC c. USDA d. FTC e. WHO ANSWER: a 39. About how many varieties of fruits and vegetables does the United States import from other countries? a. 100 b. 200 c. 400 d. 800 e. 1600 ANSWER: c

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Chapter 19: Consumer Concerns about Foods and Water 40. When tested, what percentage of imported foods are found to be in violation of residue limits? a. 1 b. 5 c. 13 d. 20 e. 32 ANSWER: c 41. Which of the following are examples of heavy metals? a. manganese and magnesium b. mercury and lead c. iron and chromium d. carbon and nitrogen e. molybdenum and fluoride ANSWER: b 42. Which of the following statements accurately describes the Total Diet Study? a. The goal is to estimate the dietary intakes of pesticide residues for people in all age groups. b. The survey is conducted twice a year. c. Surveyors purchase about 100 foods in either New York or Los Angeles. d. The survey reports on hundreds of samples of food, all domestically grown. e. Fresh seafood and dairy products are studied most heavily.

ANSWER: a 43. About how many food samples are tested by the Total Diet Study each year? a. 300 b. 600 c. 3000 d. 6000 e. 36000 ANSWER: d

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Chapter 19: Consumer Concerns about Foods and Water 44. USDA regulations allow a food product to be labeled “organic” only if it a. has been irradiated

.

b. contains genetically engineered ingredients c. was made with at least 95 percent organic ingredients d. was grown with fertilizer made from sewer sludge e. was grown in the United States.

ANSWER: c 45. According to USDA regulations, packages containing foods made with at least 70 percent organic ingredients may a. use the “USDA organic” seal b. claim to be organic on the front panel c. list up to three organic ingredients on the front panel d. not make any claims about organic ingredients anywhere e. list the potential health benefits of organic eating on the side panel ANSWER: c 46. How much money do consumers spend each year on organic foods? a. $4 million b. $40 million c. $400 million d. $4 billion e. $40 billion ANSWER: e 47. Which of the following is the most pesticide-contaminated food? a. peaches b. grapefruit c. cherry tomatoes d. grapes e. strawberries ANSWER: e

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Chapter 19: Consumer Concerns about Foods and Water 48. Which of the following statements about the GRAS list is true? a. There are only three substances currently on the list: salt, sugar, and caffeine. b. Items on the list have never been removed; therefore, it is most trustworthy. c. It was established by the FDA in 1958. d. Substances on the list have no risk of causing cancer. e. Public outcry is not a sufficient reason to review a substance on the list.

ANSWER: c 49. The FDA deems additives safe if lifetime use presents no more than a 1 in beings. a. 100 b. 1000 c. 10,000 d. 1,000,000 e. 1,000,000,000,000

risk of cancer to human

ANSWER: d 50.

Bovine growth hormone may be given to cattle to produce a. fattier meats

.

b. fattier milk c. higher protein milk d. more milk e. more meat ANSWER: d 51.

Table salt has a margin of safety of 1/5. What does that mean? a. Food additives may use 1/5 of the RDA of dietary sodium. b. One in five people who consume the additive likely will experience health problems. c. People should strive to consume only 1/5 of the UL for table salt each day. d. Five times the amount normally used as a food additive would cause harmful effects. e. One in five forms of table salt have been found to cause health problems.

ANSWER: d

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Chapter 19: Consumer Concerns about Foods and Water 52. Sugar and salt are used as antimicrobial agents in foods because they capture a food’s unavailable to microbes. a. vitamins b. fat c. water d. protein e. carbohydrate

and make it

ANSWER: c 53. Which of the following is destroyed by bacteriophages added to processed meat and poultry? a. Clostridium perfringens b. Listeria monocytogenes c. Vibrio vulnificus d. Staphylococcus aureus e. Lactobacillus acidophilus ANSWER: b 54. What vitamin is destroyed in foods preserved with sulfites? a. folate b. thiamin c. vitamin D d. tocopherol e. vitamin K ANSWER: b 55. Which statement accurately describes sulfite food additives? a. They are frequently used in wines. b. They are antimicrobials. c. They may not be used on grapes. d. They are one of the few substances to have virtually no side effects. e. They are one of the most expensive additives.

ANSWER: a

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Chapter 19: Consumer Concerns about Foods and Water 56. Which of the following food additives decreases cancer formation when given in large amounts to animals exposed to carcinogens? a. BHA b. Sulfites c. Nitrites d. BHT e. MSG ANSWER: d 57. Michael and his friends dined at a hibachi chain restaurant where Japanese dishes were grilled tableside by theatrical chefs. Afterward, Michael experienced facial flushing, chest pain, and throbbing headaches. His symptoms most likely were caused by which food additive? a. BHA b. Sulfites c. Nitrites d. BHT e. MSG ANSWER: e 58. Nina is a 150-pound adult woman who drinks soft drinks sweetened with aspartame. According to the ADI, how many cans of soft drinks could Nina safely consume each day for the rest of her life? a. 5 b. 10 c. 20 d. 40 e. 60 ANSWER: c 59. Products with aspartame must contain a warning label for people with a. type 1 diabetes

.

b. PKU c. high cholesterol d. arthritis e. Crohn’s disease ANSWER: b

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Chapter 19: Consumer Concerns about Foods and Water 60. Which of the following foods likely contains acrylamide? a. raw potatoes b. French fries c. raw carrots d. grilled swordfish e. white rice ANSWER: b 61. Which chemical typically is used to decaffeinate coffee? a. nitric acid b. sodium propionate c. methylene chloride d. polybrominated biphenyl e. hydrochloric acid ANSWER: c 62. Which of the following accurately describes bovine growth hormone use in the United States? a. It is only biologically active in humans when injected. b. It cannot be detected in meat or milk of cows receiving it. c. If consumed from foods, it is digested by enzymes in the GI tract. d. If consumed from foods, it could potentially stimulate receptors for human growth hormone. e. Testing of BGH has indicated that its risks to human health are, at most, minor.

ANSWER: c 63. Which of the following defines potable water? a. Water fit for drinking b. Water that must be boiled before drinking c. Water that is filled with contaminants d. Water suitable only for use on lawns and gardens e. Water to which fluoride has been added ANSWER: a

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Chapter 19: Consumer Concerns about Foods and Water 64. What percentage of all the earth’s water is potable? a. 1 b. 5 c. 10 d. 15 e. 20 ANSWER: a 65. While Ellie filled her water bottle from a drinking fountain at a major Florida theme park, she noticed it smelled like “rotten eggs.” This means the water is most likely contaminated with . a. sulfur b. copper c. manganese d. calcium e. soap ANSWER: a 66. What is the chief purpose of using ozone as a commercial water treatment? a. It disinfects water. b. It complexes with heavy metals. c. It stabilizes carbon filtration. d. It removes chlorine and enhances taste. e. It softens the water.

ANSWER: a 67.

In the United States, annual sales of bottle water average to about a. 12 b. 35

gallons per person.

c. 50 d. 75 e. 90 ANSWER: b

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Chapter 19: Consumer Concerns about Foods and Water 68. Which of the following was among the first products of genetic engineering? a. Corn kernels grown without the cob b. Bananas that do not brown when peeled c. Firmer tomatoes that stay ripe longer d. Milk that does not spoil e. Strawberries without seedy skins ANSWER: c 69. Improvements in nutrient composition, such as when soybeans are genetically modified to upgrade its protein to a quality approaching that of milk, is a strategy known as . a. biofortification b. reverse DNA enrichment c. USDA-approved enrichment d. nutritional trans-biodevelopment e. artificial fortification ANSWER: a 70. “Golden rice” may treat worldwide deficiency of which nutrient? a. iron b. vitamin A c. vitamin E d. vitamin C e. potassium ANSWER: b 71. Two or more cases of a similar illness resulting from the ingestion of a common food are called a/an a. epidemic b. pandemic

.

c. endemic d. outbreak e. intoxication ANSWER: d

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Chapter 19: Consumer Concerns about Foods and Water 72. Microorganisms capable of producing disease are called a. antigens

.

b. viruses c. parasites d. bacteria e. pathogens ANSWER: e 73. What is true about the compounds being used to replace BPA in food packaging? a. They have the same toxic effects. b. They are made from edible substances. c. They are water soluble and better for the environment. d. They are cheaper to produce. e. They are made using biotechnology.

ANSWER: a 74. Substances that make a food impure and unsuitable for ingestion are a. residues

.

b. contaminants c. impurities d. minerals e. toxins ANSWER: b 75. The term defined as the sequence in which living things depend on other living things for food is a. food hierarchy

.

b. food flow c. food system d. food chain e. food complex ANSWER: d

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Chapter 19: Consumer Concerns about Foods and Water 76. An organic compound containing one or more atoms of fluorine, chlorine, iodine, or bromine is an organic . a. actinide b. halogen c. alkali metal d. chalgogen e. metalloid ANSWER: b 77. The amounts of pesticides that remain on foods when people buy and use them are called a. residues

.

b. contaminants c. impurities d. minerals e. toxins ANSWER: a 78. Mineral ions with relatively high atomic weight are called a. heavy metals b. halogens c. residues d. contaminants e. noble gases

.

ANSWER: a 79. The Delaney Clause amendment to the Food, Drug, and Cosmetic Act that states that a. additives may not be used to disguise faulty or inferior products

.

b. additives are permitted in foods in amounts 100 times below the lowest level that is found to cause any harmful effect c. substances may be generally recognized as safe, based either on their extensive, long-term use in foods or on current scientific evidence. d. absolutely no cancer-causing substances shall be added to foods e. intentional food additives may be added to foods to give them some desirable characteristic ANSWER: d

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Chapter 19: Consumer Concerns about Foods and Water 80.

are salts added to foods (often to preserve meats), which prevent botulism. a. Nitrites b. Antioxidants c. Antimicrobials d. Monosodium glutamates e. Emulsifiers ANSWER: a

81. Toxicity refers to a substance’s ability to harm living organisms at high concentrations. a. True b. False ANSWER: True 82. A hazard is a circumstance in which harm is possible under normal use conditions. a. True b. False ANSWER: True 83. E. coli is the organism producing the most common food toxin in the United States. a. True b. False ANSWER: False 84. The gradual gathering of contaminants in the flesh of animals high on the food chain is called bioaccumulation. a. True b. False ANSWER: True 85. A goitrogen is a toxic compound found in Brussels sprouts, broccoli, and Bok choy. a. True b. False ANSWER: True 86. Solanine is a narcotic-like substance found in potato sprouts. a. True b. False ANSWER: True Page 21

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Chapter 19: Consumer Concerns about Foods and Water 87. Preservatives are chemicals used to control insects and other organisms on plants, vegetables, fruits, and animals. a. True b. False ANSWER: False 88. Listeria is the organism responsible for the most foodborne infections resulting in death. a. True b. False ANSWER: True 89. Organic crops are grown and processed according to USDA regulations defining the use of synthetic fertilizers, herbicides, insecticides, fungicides, preservatives, and other chemical ingredients. a. True b. False ANSWER: True 90. Pesticides are antimicrobial agents, antioxidants, and other agents that retard spoil. a. True b. False ANSWER: False 91. Which of the following is an organization that ensures public water systems meet minimum health standards? a. BGH b. BHT c. BPA d. EPA e. FDA ANSWER: d 92.

Acrylamide is a compound formed when carbohydrate-rich foods are cooked at high temperatures. a. True b. False ANSWER: True

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Chapter 19: Consumer Concerns about Foods and Water 93. Nitrites combined with amines form nitrosamines. a. True b. False ANSWER: True 94. The FDA is the organization that certifies food colors. a. True b. False ANSWER: True 95. Saccharine is an artificial sweetener banned in the early 1980s. a. True b. False ANSWER: True 96. Which of the following is a preservative commonly used to slow the development of off-flavors, odors, and color changes? a. BGH b. BHT c. BPA d. EPA e. FDA ANSWER: b 97. A sodium salt is used as a flavor enhancer. a. True b. False ANSWER: True 98.

Which of the following is a hormone produced naturally in a cow that promotes growth and milk production? a. BGH b. BHT c. BPA d. EPA e. FDA ANSWER: a

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Chapter 19: Consumer Concerns about Foods and Water 99. Giardia is a microorganism in water flushed out by reverse osmosis. a. True b. False ANSWER: True 100.

You are considering buying a home water treatment system. Compare and contrast the benefits of the different available options.

ANSWER: To ease concerns about the quality of drinking water, some people purchase home water-treatment systems. Because the EPA does not certify or endorse these systems, consumers must shop carefully.

Manufacturers offer a variety of units for removing contaminants from drinking water. None of them removes all contaminants, and each has its own advantages and disadvantages. Choosing the right treatment unit depends on the kinds of contaminants in the water. For example, activated carbon filters are particularly effective in removing chlorine, heavy metals such as mercury, and organic contaminants from sediment. Reverse osmosis forces pressurized water through a membrane, flushing out minerals such as sodium and some microorganisms such as Giardia. Ozonation uses ozone gas to disinfect water, and distillation systems, which boil water and condense the steam to water, kill microorganisms but leave behind minerals such as lead. Therefore, before purchasing a home water-treatment unit, a consumer must first determine the quality of the water. In some cases, a state or county health department will test water samples or can refer the consumer to a certified laboratory. Consumers need to be aware that unscrupulous vendors may use scare tactics during home inspections to prompt sales.

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Chapter 19: Consumer Concerns about Foods and Water 101.

Commercial settings are responsible for a great many foodborne illnesses. What industry controls are in place to help prevent them? How are consumers made aware of potential problems?

ANSWER: All food producers use a Hazard Analysis Critical Control Point (HACCP) plan to help prevent foodborne illnesses at their source. Each slaughterhouse, packer, distributor, and transporter of susceptible foods must identify “critical control points” that pose a risk of contamination and then devise and implement verifiable ways to eliminate or minimize the risk. The HACCP system has proved a remarkable success for domestic products, but such programs do not apply to imported foods.

An estimated 15 to 20 percent of all food consumed in the United States is imported from 300,000 facilities located in more than 150 countries each year. As the number of imports has increased over the years, so has the number of foodborne illnesses associated with imported foods, most commonly fish and produce. Many countries cooperate with the FDA and have adopted many of the safe foodhandling practices used in the United States, but some imported foods come from countries with little or no regulatory oversight. To help consumers distinguish between imported and domestic foods, certain foods—including fish, shellfish, meats, fruits, vegetables, and some nuts—must display the country of origin on the label, specifying where they were produced.

Canned and packaged foods sold in grocery stores are easily controlled, but rare accidents do happen. Batch numbering makes it possible to recall contaminated foods through public announcements via the Internet, newspapers, television, and radio. In the grocery store, consumers can buy items before the expiration date and inspect the safety seals and wrappers of packages. A broken seal, bulging can lid, or mangled package fails to protect the consumer against microbes, insects, spoilage, or even vandalism.

102.

List and describe the four simple food-handling behaviors in the kitchen that can prevent most foodborne illnesses.

ANSWER: Clean. Keep a clean, safe kitchen by washing hands and surfaces often. Wash countertops, cutting boards, sponges, and utensils in hot, soapy water before and after each step of food preparation. To reduce bacterial contamination on hands, wash hands with soap and warm water; if soap and water are not available, use an alcohol-based sanitizing gel.

Separate. Avoid foodborne infections by keeping raw eggs, meat, poultry, and seafood separate from other foods. Wash all utensils and surfaces (such as cutting boards or platters) that have been in contact with these foods with hot, soapy water before using them again. Bacteria inevitably left on the surfaces from the raw meat can re-contaminate the cooked meat or other foods—a problem known as cross-contamination. Washing raw eggs, meat, and poultry is not recommended because the extra handling increases the risk of cross-contamination.

Cook. Keep hot foods hot by cooking to proper temperatures. Foods need to cook long enough to reach internal temperatures that will kill microbes and maintain adequate temperatures to prevent bacterial growth until the foods are served.

Chill. Keep cold foods cold by refrigerating promptly. Go directly home upon leaving the grocery store and immediately place foods in the refrigerator or freezer. After a meal, refrigerate any leftovers immediately.

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Chapter 19: Consumer Concerns about Foods and Water 103.

How can consumers minimize nutrient losses during food preparation?

ANSWER: In addition to selecting nutritious foods and preparing them safely, consumers can improve their nutrition health by learning to store and cook foods in ways that minimize nutrient losses. Watersoluble vitamins are the most vulnerable of the nutrients, but both vitamins and minerals can be lost when they dissolve in water that is then discarded.

Fruits and vegetables contain enzymes that both synthesize and degrade vitamins. After a fruit or vegetable has been picked, vitamin synthesis stops, but degradation continues. To slow the degradation of vitamins, most fruits and vegetables should be kept refrigerated until used. Because many vitamins are easily destroyed by oxygen, fruits and vegetables that have been cut and juice that has been opened should be stored in airtight containers and refrigerated. (Degradative enzymes are most active at warmer temperatures.)

Water-soluble vitamins readily dissolve in water. To prevent losses during washing, rinse fruits and vegetables before cutting. To minimize losses during cooking, steam, griddle, or microwave vegetables; pressure cooking and boiling cause the greatest nutrient losses. Alternatively, use the cooking water when preparing meals such as casseroles and soups.

Finally, keep in mind that most vitamin losses are not catastrophic and that a law of diminishing returns operates. Do not fret over small losses or waste time that may be valuable in improving your health in other ways. Be assured that if you start with plenty of fruits and vegetables and are reasonably careful in their storage and preparation, you will receive a sufficient supply of all the nutrients they provide.

104.

Why is arsenic detected in agricultural fields? At what point will the FDA take action regarding arsenic levels in foods?

ANSWER: Arsenic—whether naturally occurring or a result of industrial contamination—is found in the water, air, food, and soil. Arsenic-based pesticides were commonly used in the United States until 1970, and so low levels of arsenic can be detected in agricultural fields. For this reason, even organic foods may contain arsenic. The FDA routinely tests rice and juices and has found trace amounts of arsenic.11 After assessing the quantities of arsenic children commonly consume, the FDA is confident about the overall safety of rice products and apple juice. The FDA will take action when the arsenic level is at 10 parts per billion, or greater. (For perspective, 1 part per billion is equivalent to about 1 second in 32 years or 1 cent in $10 million.)

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Chapter 19: Consumer Concerns about Foods and Water 105.

Name three naturally occurring toxicants in foods and ways to minimize exposure to them.

ANSWER: Cabbage, Bok choy, turnips, mustard greens, kale, Brussels sprouts, cauliflower, broccoli, kohlrabi, and radishes contain small quantities of goitrogens—compounds that can enlarge the thyroid gland.

Eating exceptionally large amounts of goitrogen-containing vegetables can aggravate a preexisting thyroid problem, but it usually does not initiate one. Problems may develop when exceptionally large amounts (2 to 3 pounds a day) of these vegetables are eaten raw; cooking deactivates the enzyme that normally inhibits the uptake of iodine in the thyroid.

Lima beans and fruit seeds such as apricot pits contain cyanogens—inactive compounds that produce the deadly poison cyanide upon activation by a specific plant enzyme. For this reason, many countries restrict commercially grown lima beans to those varieties with the lowest cyanogen contents. As for fruit seeds, they are seldom deliberately eaten. An occasional swallowed seed or two presents no danger, but a couple of dozen seeds can be fatal to a small child. Perhaps the most infamous cyanogen in seeds is laetrile—a compound erroneously represented as a cancer cure. True, laetrile kills cancer, but only at doses that kill the person too. The combination of cyanide poisoning and lack of medical attention is life-threatening.

The humble potato contains many natural poisons, including solanine, a powerful narcotic-like substance. Most of a potato’s solanine is found in the sprouts and in the green layer that develops just beneath the skin. Solanine poisoning is extremely rare, however, because the small amounts of solanine (8 milligrams per 100 grams of potato) normally found in potatoes are harmless—even when the potato skin is eaten. Solanine can be toxic, however, and presents a hazard when consumed in large quantities (20 to 25 milligrams per 100 grams of potato). Cooking does not destroy solanine, but it can be removed by peeling the potato. Symptoms of solanine poisoning include gastrointestinal disturbances and neurological disorders.

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Chapter 19: Consumer Concerns about Foods and Water 106.

How are pesticides regulated in the US food supply? How are they regulated in foods from other countries?

ANSWER: Consumers depend on the EPA and the FDA to keep pesticide use within safe limits. If the pesticide is approved, the EPA establishes a tolerance level for its presence in foods, well below the level at which it could cause any conceivable harm. Tolerance regulations also state the specific crops to which each pesticide can be applied. If a pesticide is misused, growers risk fines, lawsuits, and destruction of their crops.

Once tolerances are set, the FDA enforces them by monitoring foods and livestock feeds for the presence of pesticides. Over the past several decades of testing, the FDA has seldom found residues above tolerance levels, so it appears that pesticides are generally used according to regulations.

Minimal pesticide use means lower costs for growers. In addition to costs, many farmers are also concerned about the environment, the quality of their farmland, and a safe food supply. Where violations are found, they are usually due to unusual weather conditions, use of unapproved pesticides, or misuse—for example, application of a particular pesticide to a crop for which it has not been approved.

A substantial and increasing amount of the fruits and vegetables consumed in the United States are imported from other countries. These countries have their own pesticide regulations—some more, and others less, stringent than those in the United States. To export into the United States, countries are required to comply with US pesticide tolerance limits and, for the most part, they do. The FDA finds violations of residue limits in about 13 percent of imported foods tested. Close to 200 member nations work together to develop international food standards through the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) to help protect consumer health and promote fair practices in food trade, but compliance is voluntary.

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Chapter 19: Consumer Concerns about Foods and Water 107.

Describe two antimicrobial intentional food additives.

ANSWER: Foods can go bad in many ways. One way is by becoming contaminated with microbes that cause foodborne illnesses, a hazard that justifies the use of antimicrobial agents. The most widely used antimicrobial agents are ordinary salt and sugar. Salt has been used throughout history to preserve meat and fish; sugar serves the same purpose in canned and frozen fruits and in jams and jellies. Both exert their protective effect primarily by capturing water and making it unavailable to microbes.

Other antimicrobial agents, the nitrites, are added to foods for three main purposes: to preserve color, especially the pink color of hot dogs and other cured meats; to enhance flavor by inhibiting rancidity, especially in cured meats and poultry; and to protect against bacterial growth. In amounts smaller than those needed to confer color, nitrites prevent the growth of the bacteria that produce the deadly botulinum toxin.

Nitrites clearly prevent food spoilage and bacterial contamination, but their use has been controversial. During the curing process and in the human body, nitrites can be converted to nitrosamines. Some nitrosamines are known to cause cancer in animals, but evidence is inconclusive in humans. In fact, limited evidence suggests that nitrites may actually be beneficial to human health.

The USDA and FDA regulate and monitor the use of nitrites in foods and beverages.

Another food additive used in processed meat and poultry products—such as sausages, hot dogs, and bologna—is a mixture of viruses known as bacteriophages. Bacteriophages destroy the bacterium Listeria monocytogenes, thus protecting consumers from the potentially life-threatening foodborne illness listeriosis. These additives are included in the ingredients list on food labels as a “bacteriophage preparation.”

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Chapter 19: Consumer Concerns about Foods and Water 108.

How can food packaging become indirect food additives?

ANSWER: The FDA ensures the safety of food packaging and assesses whether packaging materials might migrate into foods. These materials include coatings on can interiors, plastics, papers, and sealants.

Some microwave products are sold in “active packaging” that helps cook the food; for example, pizzas are often heated on a metalized film laminated to paperboard.

This film absorbs the microwave energy in the oven and reaches temperatures as high as 500°F. At such temperatures, packaging components migrate into the food. For this reason, manufacturers must perform specific tests to determine whether materials are migrating into foods. If they are, their safety must be confirmed by strict procedures similar to those governing intentional additives.

Most microwave products are sold in “passive packaging” that is transparent to microwaves and simply holds the food as it cooks. These containers don’t get much hotter than the foods, but materials still migrate at high temperatures. Consumers should not reuse these containers in the microwave oven. Instead they should use only glass or ceramic containers labeled as microwave safe; tiny air bubbles in some glass may expand when microwaved, causing the glass to break and glazes on some ceramics to leach, contaminating the food. In the United States, these ceramic containers cannot be sold without a permanent marking stating “Not for food use.” Similarly, use only plastic wraps labeled as microwave-safe. Avoid using disposable styrofoam or plastic containers such as those used for carryout or margarine.

Similarly, a chemical known as bisphenol A (BPA) can leach from hard plastic bottles and coatings of some food cans into food and beverages. The FDA has some concern about the potential health effects of BPA and is taking steps to reduce exposure in the food supply, including banning its use in baby bottles and sippy cups. Bisphenol S (BPS), a chemically related compound, has been used as a replacement in BPA-free products and has the same toxic effects. Consumers who want to limit their exposure to toxic plastics should know that containers marked with recycle codes 3 or 7 may be made with BPA; those marked 6 contain polystyrene. The safest choices for food use are numbers 1, 2, 4, and 5. In addition, consumers should not use any plastic containers for hot foods or liquids.

To limit contamination and waste from packaging, some manufacturers are creating food wrappers and containers that are edible and soluble. For example, coatings similar to those used to cover pills might encase powdered cocoa; when dropped into hot water, the casing dissolves.

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Chapter 19: Consumer Concerns about Foods and Water 109.

Discuss the two main sources of drinking water and how they differ.

ANSWER: Most major cities obtain their drinking water from surface water—the water in lakes, rivers, and reservoirs. Surface water is readily contaminated because it is directly exposed to acid rain, runoff from highways and urban areas, pesticide runoff from agricultural areas, and industrial wastes that are dumped directly into it. Surface water contamination is reversible, however, because fresh rain constantly replaces the water. It is also cleansed to some degree by aeration, sunlight, plants, and microorganisms that live in it.

Groundwater is the water in underground aquifers—rock formations that are saturated with and yield usable water. People who live in rural areas rely mostly on groundwater pumped up from private wells. Groundwater is contaminated more slowly than surface water, but also more permanently.

Contaminants deposited on the ground migrate slowly through the soil before reaching groundwater.

Once there, the contaminants break down less rapidly than in surface water because of the lack of aeration, sunlight, and aerobic microorganisms. The slow replacement of ground water also helps contaminants remain for a long time. Groundwater is especially susceptible to contamination from hazardous waste sites, dumps and landfills, underground tanks storing gasoline and other chemicals, and improperly discarded household chemicals and solvents.

110. Briefly describe how genetic engineering differs from traditional selective breeding.

ANSWER: For centuries, farmers have been selectively breeding plants and animals to shape the characteristics of their crops and livestock. They have created prettier flowers, hardier vegetables, and leaner animals. Consider the success of selectively breeding corn. Early farmers in Mexico began with a wild, native plant called teosinte that bears only five or six kernels on each small spike. Many years of patient selective breeding have produced large ears filled with hundreds of plump kernels aligned in perfect formation, row after row.

Such genetic improvements, together with the use of irrigation, fertilizers, and pesticides, were responsible for more than half of the increases in US crop yields in the 20th century. Farmers still use selective breeding, but now, in the 21st century, genetic engineering allows scientists to insert or modify the genes in an organism to express a new trait or change the expression of an existing trait.

These advances have brought rapid and dramatic changes to agriculture and food production.

Although selective breeding works, it is slow and imprecise because it involves mixing thousands of genes from two plants and hoping for the best. With genetic engineering, scientists can improve crops (or livestock) by introducing a copy of the specific gene needed to produce the desired trait. Once introduced, the selected gene acts like any other gene—it provides instructions for making a protein.

The protein then determines a characteristic in the genetically modified plant or animal. In short, the process is now faster and more refined. Farmers no longer need to wait patiently for breeding to yield improved crops and animals, nor must they even respect natural lines of reproduction among species. Laboratory scientists can copy genes from one organism and insert them into almost any other organism—plant, animal, or microbe. Their work is changing not only the way farmers plant, fertilize, and harvest their crops, but also the ways the food industry processes food and consumers receive nutrients, phytochemicals, and drugs.

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Chapter 20: Hunger and the Environment 1. Worldwide, more than a. 4 million

people experience persistent hunger.

b. 800 million c. 12 million d. 16 million e. 20 million ANSWER: b 2. Worldwide, one child dies of hunger-related causes every a. 2 seconds

.

b. 10 seconds c. 30 seconds d. 2 minutes e. 10 minutes ANSWER: b 3. Approximately how many people in the United States live in poverty? a. 6 million b. 11 million c. 23 million d. 37 million e. 56 million ANSWER: d 4. Which term is defined as the limited or uncertain access to foods of sufficient quality or quantity to sustain a healthy and active life? a. food insecurity b. food insufficiency c. dietary prevalence d. dietary precariousness e. food poverty ANSWER: a

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Chapter 20: Hunger and the Environment 5. Olivia works two part-time jobs to support her three children. Her financial priorities are to pay the rent and provide healthy food and medical necessities for herself and the children. On the day before payday, when the food is running low, Olivia sometimes eats a small evening meal to leave more food for her children. Olivia is experiencing which of the following? a. high food security b. marginal food security c. low food security d. very low food security e. food poverty ANSWER: b 6. Jakob injured his back and now works odd jobs to support himself and his young son. Because money is so scarce, Jakob must purchase food for himself and his son each day using the money from that day’s odd job.

Many days Jakob goes without food so that his son can eat. Some days Jakob eats food from the dumpster of a nearby restaurant. Jakob is experiencing which of the following? a. high food security b. marginal food security c. low food security d. very low food security e. food mismanagement ANSWER: d 7. According to the US Department of Agriculture, what percentage of households experience very low food security? a. 4.3% b. 5% c. 6.8% d. 12% e. 21% ANSWER: b 8. What is the primary cause for hunger in developed countries? a. food poverty b. high cost of food c. excessive food waste d. lack of nutrition education ANSWER: a Page 2

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Chapter 20: Hunger and the Environment 9. At what annual income is the poverty line drawn for an individual living in the United States? a. $10,784 b. $12,784 c. $15,784 d. $17,784 e. $21,784 ANSWER: b 10. What percentage of the people in the United States lives in poverty? a. 5% b. 7% c. 12% d. 15% e. 29% ANSWER: c 11. Which of the following is true of the relationship between poverty and hunger? a. Hunger and obesity may exist in the same household. b. The highest rates of obesity occur among the wealthiest. c. The provision of food to the poor increases obesity. d. Even people below the poverty line have enough money for food. e. The elderly population most readily accepts food assistance.

ANSWER: a 12. Approximately what percentage of the Supplemental Nutrition Assistance Program (SNAP) recipients are children? a. 5% b. 10% c. 25% d. 33% e. 50% ANSWER: e

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Chapter 20: Hunger and the Environment 13. What is the largest federal food assistance program in the United States? a. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) b. The Emergency Food Assistance Program (TEFAP) c. School lunch, breakfast, and child-care programs for children d. Supplemental Nutrition Assistance Program (SNAP) e. Senior Meals on Wheels ANSWER: d 14. What is the average monthly benefit for a recipient of the Supplemental Nutrition Assistance Program (SNAP), per person? a. $105 b. $125 c. $155 d. $215 e. $355 ANSWER: b 15. Approximately how many people are served by the US Supplemental Nutrition Assistance Program? a. 18 million b. 28 million c. 38 million d. 48 million e. 58 million ANSWER: c 16. Which of the following can be purchased using a Supplemental Nutrition Assistance Program (SNAP) debit card? a. toothpaste b. seeds to produce food c. cigarettes d. aspirin e. kitchen disinfectant wipes ANSWER: b

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Chapter 20: Hunger and the Environment 17. Which of the following is a food desert? a. drought-induced worldwide crop failures b. absence of fresh fruits and vegetables at certain times of the year c. a neighborhood with limited access to nutritious and affordable foods d. a low-cost energy-dense snack sold primarily in poor neighborhoods e. an area in which poverty has made families unable to purchase necessary food ANSWER: c 18. Which of the following is the largest US national food recovery program? a. Feeding America b. The Hunger Project c. Food and Agriculture Organization d. Food First e. WhyHunger ANSWER: a 19. Approximately what percentage of the world’s food supply is wasted along the way from farm to final consumption? a. 10% b. 25% c. 33% d. 47% e. 50% ANSWER: d 20. Which of the following is the most preferred strategy on the US Environmental Protection Agency (EPA)’s Food Recovery Hierarchy? a. incineration or landfill b. feed animals c. composting d. feed hungry people e. source reduction ANSWER: e

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Chapter 20: Hunger and the Environment 21. Which of the following terms refers to a period of extreme food shortage resulting in widespread starvation and death? a. plague b. famine c. food poverty d. food insecurity e. food desert ANSWER: b 22. Approximately how many people in developing countries do not have enough to eat? a. 85 million b. 585 million c. 800 million d. 980 million e. 8 billion ANSWER: c 23. What percentage of the world’s population has no land and no possessions at all? a. 5% b. 10% c. 15% d. 20% e. 25% ANSWER: b 24. Worldwide, the poorest poor survive on about a. $2 b. $4

per day.

c. $6 d. $8 e. $10 ANSWER: a

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Chapter 20: Hunger and the Environment 25. Researchers estimate that if all adults completed secondary education, global poverty could be cut by a. 10

.

b. 25 c. 50 d. 60 e. 85 ANSWER: c 26.

Where is the highest hunger rate in the world? a. India b. Sub-Saharan Africa c. Southern South America d. China e. Eastern Europe ANSWER: b

27.

Which of the following accurately describes world poverty and hunger? a. Poverty causes hunger in the developing but not the developed world. b. The poorest do not bear children due to poor health. c. Poverty causes hunger, but hunger lessens poverty by stimulating productivity. d. The poorest poor are typically females, because they are under-valued in many societies. e. Recently, natural causes of famine are more critical than political and economic crises.

ANSWER: d

28. Which of the following defines the earth’s carrying capacity? a. The number of tons of edible food that can be produced by all of the earth’s cultivable land. b. The maximum number of living organisms that can be supported without causing environmental degradation. c. The amount of oxygen consumed by all living organisms in relation to the amount of oxygen produced by all living plants. d. The total weight of all living organisms in relation to the weight of all non-living material including the earth’s water mass. e. The maximum number of people who can exist on earth without causing widespread chronic malnutrition.

ANSWER: b

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Chapter 20: Hunger and the Environment 29. According to the US Census Bureau, the world’s population will be an estimated a. 5

billion by 2050.

b. 6.5 c. 7.5 d. 8 e. 10 ANSWER: d 30. On which continent do most of the world’s undernourished people live? a. North America b. South America c. Europe d. Africa e. Asia ANSWER: d 31. Which of the following statements accurately describes the clinical forms of acute malnutrition in children? a. Children with marasmus typically have edema. b. Children with kwashiorkor often have fatty livers. c. Kwashiorkor results mainly from energy inadequacy. d. Marasmus results mainly from protein inadequacy. e. Children with marasmus often have changes in the color of their hair and skin.

ANSWER: b 32.

In which of the following nutrients are children least likely to suffer a deficiency? a. vitamin A b. vitamin C c. iron d. zinc e. iodine ANSWER: b

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Chapter 20: Hunger and the Environment 33. Approximately what percentage of the world’s population has iron-deficiency anemia? a. 10 b. 20 c. 30 d. 40 e. 50 ANSWER: d 34.

Deficiency in a. iron

is associated with irreversible mental impairment in newborns.

b. iodine c. vitamin C d. vitamin A e. zinc ANSWER: b 35. What fraction of the world’s children, younger than age 5, suffer from symptoms of vitamin A deficiency? a. one-tenth b. one-fifth c. one-fourth d. one-third e. one-half ANSWER: d 36. Nearly 1 in a. 20

children in the United States face food shortages.

b. 10 c. 4 d. 3 e. 2 ANSWER: c

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Chapter 20: Hunger and the Environment 37. Worldwide, COVID-19 led to extreme poverty for a. 15 million

people.

b. 25 million c. 50 million d. 100 million e. 250 million ANSWER: c 38. Which of the following characterizes acute malnutrition in children? a. hyperactivity b. fatty liver c. low weight for height d. short height for weight e. stunting ANSWER: c 39. Which of the following characterizes chronic malnutrition in children? a. hyperactivity b. shrunken liver c. short height for age d. low weight for height e. rapid weight loss ANSWER: c 40. Worldwide, an estimated malnutrition. a. 12 b. 25

million children younger than 5 suffer from

severe acute

c. 45 d. 52 e. 100 ANSWER: d

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Chapter 20: Hunger and the Environment 41. Which of the following symptoms are present in a child with kwashiorkor? a. edema b. stunting c. extreme muscle wasting d. baggy-appearing skin e. “match stick” arms and legs ANSWER: a 42. In children with kwashiorkor, edema is a result of a. inadequate concentrations of blood proteins

.

b. lack of fat under the skin c. decreasing supplies of enzymes d. being nursed by a poorly nourished mother e. deteriorating muscle mass ANSWER: a 43. A child who has a severe case of diarrhea can lose essential fluids and minerals that lead to a. a drop in blood pressure

.

b. a stronger heartbeat c. bacterial contamination d. increased edema e. recurring infections ANSWER: a 44. Which of the following is a telling symptom of kwashiorkor? a. The child appears grossly dehydrated. b. The child always feels cold and is mentally impaired. c. The child has been exposed to marasmus. d. The child has hair that is losing its color. e. The child has a “skin and bones” appearance.

ANSWER: d

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Chapter 20: Hunger and the Environment 45. Which of the following is a typical symptom of marasmus? a. patchy, scaly skin b. edema c. sore that don’t heal d. loose skin on the buttocks e. stunting ANSWER: d 46. What does the word “marasmus” mean? a. terribly thin b. without muscle c. dying away d. matchstick e. prior child ANSWER: c 47. Which of the following nutrient deficiencies is a leading cause of maternal deaths and preterm births? a. zinc b. iron c. vitamin A d. iodine e. vitamin D ANSWER: d 48. Which of the following statements accurately describes ready-to-use therapeutic foods (RUTF)? a. It is primarily used to restore fluids. b. It is a powder that must be rehydrated for use. c. It is an intravenous therapy. d. It is a paste made from oil, sugar, and proteins. e. It is a liquid that requires refrigeration.

ANSWER: d

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Chapter 20: Hunger and the Environment 49. What of the following would be best to rehabilitate a child suffering from severe, acute malnutrition? a. ready-to-use therapeutic foods (RUTF) b. supplemental foods from the local diet c. liberal quantities of lactose-free powdered milk until growth rate is restored d. high-protein, low-carbohydrate foods e. bananas, rice, apples, and toast (BRAT) ANSWER: a 50. Which of the following accurately describes a child with marasmus? a. They will be underweight for their height. b. They will be hyperactive and cry for food excessively. c. They brain development will be impaired from ages 2–5. d. They will have severe edema of the abdomen, but insufficient water retention by the brain. e. They will show no outward signs of impairment.

ANSWER: a 51. Which of the following would health care workers use to treat the diarrhea and dehydration common to children suffering from diseases of poverty? a. oral rehydration therapy (ORT) b. bananas, rice, applesauce, and toast (BRAT) c. protein-energy repletion formula d. vitamin-enriched grains e. ready-to-use therapeutic food (RUFT) ANSWER: a 52. Which of the following is a typical ingredient of a simple oral rehydration formula recipe? a. iron b. sugar c. zinc d. powdered eggs e. powdered milk ANSWER: b

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Chapter 20: Hunger and the Environment 53. When factors such as drought and contamination from livestock manure decrease the availability of clean potable water, they create a situation known as . a. biodiversity b. agroecology c. water stress d. forced irrigation e. carrying capacity ANSWER: c 54. Which of the following statements accurately describes sustainable agriculture? a. It reduces a farmer’s profits. b. It uses pesticides to promote pollination. c. It temporarily increases the footprint of animal-derived foods. d. It contributes to soil preservation. e. It minimizes carrying capacity of US agriculture resources.

ANSWER: d 55. Livestock use about protein. a. 10 b. 25 c. 30 d. 45 e. 75

percent of agricultural land but produce less than 40 percent of the world’s

ANSWER: e 56. Which of the following defines aquaculture? Overnutrition results in overweight or obesity in approximately adults worldwide. a. 25 million b. 200 million c. 750 million d. 2 billion e. 25 billion ANSWER: d

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Chapter 20: Hunger and the Environment 57. Which of the following accurately describes severe acute malnutrition? a. The food deprivation associated with it is long-term. b. It is more prevalent in children younger than age 5 than chronic malnutrition is. c. It impedes growth and causes frequent diarrhea. d. Stunting is a common physical feature and is often irreversible. e. It diminishes prospects for escaping from poverty.

ANSWER: b 58. In the United States, consumers waste approximately a. 100,000 b. 150,000 c. 200,000 d. 250,000 e. 300,000

tons of food daily.

ANSWER: b 59. The amount of food wasted by US consumers each day amounts to enough kilocalories to feed which of the following? a. one hungry child b. one hungry adult c. three hungry children d. three hungry teenagers e. five hungry infants ANSWER: a 60. What percentage of the world’s food supply is wasted along the way from farm to final consumption? a. 15% b. 25% c. 33% d. 50% e. 75% ANSWER: c

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Chapter 20: Hunger and the Environment 61.

What term is defined as the ability to produce food indefinitely, with little or no harm to the environment? a. integrated production b. progressive agriculture c. sustainable agriculture d. resource management production e. balanced farming ANSWER: c

62. Which of the following practices helps protect the environment from damage as food is produced? a. applying fertilizers to maximize plant growth b. promoting biodiversity of wild plant species c. using fossil fuels in plants where food is manufactured d. using large-scale irrigation techniques e. eliminating pollinators such as bees ANSWER: b 63. A study calculated the carrying capacity of 10 different eating patterns and concluded that the best option was a . a. vegan diet b. vegetarian diet c. diet containing about 33 percent meat and dairy d. diet containing about 50 percent meat and dairy e. diet containing mostly meat and dairy ANSWER: b 64. Which of the following hunger-relief organizations, which is an international group whose mission is to end hunger and poverty by pioneering sustainable, grassroots, women-centered strategies? a. WhyHunger b. Food First c. Congressional Hunger Center d. Bread for the World e. The Hunger Project ANSWER: e

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Chapter 20: Hunger and the Environment 65. Which method of food transportation accounts for about 5 percent of the food footprint? a. Ship b. Plane c. Train d. Truck e. Car ANSWER: a 66. Of the following, which country has an ecological footprint per person that is almost five times the resources and wastes the planet can handle? a. China b. Brazil c. United States d. Greenland e. India ANSWER: c 67. Protein foods are responsible for most of the agricultural greenhouse emissions, with largest footprint. a. pork b. beef c. chicken d. lamb e. legumes

having the

ANSWER: b 68. Greenhouse gas emissions that result from food being transported by sea accounts for approximately percent of the food footprint. a. 3 b. 5 c. 10 d. 15 e. 30 ANSWER: b

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Chapter 20: Hunger and the Environment 69. A product that claims to be “biodegradable” must break down completely, returning to nature within a. 6 months

.

b. 1 year c. 18 months d. 3 years e. 5 years ANSWER: b 70. Consumers are encouraged to “buy local.” What does “locally grown” mean? a. within 10 miles b. within 25 miles c. within 50 miles d. within 100 miles e. There is no exact definition.

ANSWER: e 71. The painful sensation caused by a lack of food that initiates food-seeking behavior is called a. a.food insufficiency

.

b. satiety c. hunger d. famine e. acute malnutrition ANSWER: c 72. An inadequate amount of food due to a lack of resources is defined as a. a.food recovery

.

b. food insufficiency c. food poverty d. food assistance e. food security ANSWER: b

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Chapter 20: Hunger and the Environment 73. A form of food recovery that involves collecting prepared foods from commercial kitchens is termed a. field gleaning

.

b. salvage c. wholesale rescue d. prepared food rescue e. nonperishable food collection ANSWER: d 74. A form of food recovery that involves collecting processed foods from wholesalers and markets is termed . a. nonperishable food collection b. field gleaning c. perishable food rescue d. resource reclamation e. food recycling ANSWER: a 75. Facilities that collect and distribute food donations to authorized organizations feeding the hungry are called . a. food markets b. food banks c. food pantries d. food deserts e. food wholesalers ANSWER: b 76. The number of people, other living organisms, or crops that a region can support without environmental degradation is called . a. carrying capacity b. food sufficiency c. sustainability d. local sourcing e. ecological footprint ANSWER: a

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Chapter 20: Hunger and the Environment 77. Malnutrition caused by long-term food deprivation; characterized in children by short height for age (stunting) is called malnutrition. a. ready-to-use therapeutic food (RUTF) b. continuous c. acute d. chronic e. oral rehydration therapy (ORT) ANSWER: d 78. A farmer who works with nature to limit environmental harm is engaging in the practice of a. water stress

.

b. agroecology c. farm to fork d. food security e. food diversion ANSWER: b 79. Patterns of eating that promote health and provide food security for the present population while sustaining environmental resources for future generations are called . a. overnutrition b. sustainable diets c. food deprivation d. protein diversity e. plant-based diets ANSWER: b 80. A measure of the resources used to support a nation’s consumption of food, materials, and energy is termed the nation’s . a. carrying capacity b. food sufficiency c. ecological footprint d. food assistance e. hunger relief ANSWER: c

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Chapter 20: Hunger and the Environment 81. Food deserts are common in high-income neighborhoods because of a lack of convenience stores. a. True b. False ANSWER: False 82. In the United States, approximately three-fourths of individuals who are food insecure are eligible for food assistance programs. a. True b. False ANSWER: True 83. SNAP cards can be used to purchase nonfood items such as paper plates. a. True b. False ANSWER: False 84. In the United States, about 100 million people are facing food shortages. a. True b. False ANSWER: False 85. In developing countries, poverty is the primary cause of hunger. a. True b. False ANSWER: True 86. Education is essential to ending world hunger and poverty. a. True b. False ANSWER: True 87. International food relief programs are prohibited from offering food assistance to countries that have chronic food shortages. a. True b. False ANSWER: False

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Chapter 20: Hunger and the Environment 88. Severe acute malnutrition affects more children throughout the world than chronic malnutrition. a. True b. False ANSWER: False 89. Blindness is a symptom of vitamin A deficiency in children. a. True b. False ANSWER: True 90. Severe acute malnutrition is a life-threatening condition. a. True b. False ANSWER: True 91. Wasting is a common sign of chronic malnutrition in children. a. True b. False ANSWER: False 92. Severe malnutrition that impairs brain development in a child’s early years can be reversed using medical nutrition therapy during the teenage years. a. True b. False ANSWER: False 93. The world’s food systems produce less than 15 percent of global greenhouse emissions. a. True b. False ANSWER: False 94. Composting is one of the U.S. Environmental Protection Agency (EPA)’s most-preferred methods of diverting wasted food. a. True b. False ANSWER: False

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Chapter 20: Hunger and the Environment 95. A sustainable diet consists of more plant-based foods and fewer animal-derived foods. a. True b. False ANSWER: True 96. A decision by one person to reduce food waste can have a positive impact on global efforts to end hunger. a. True b. False ANSWER: True 97. Diet composition has little impact on the environmental footprint. a. True b. False ANSWER: False 98. n individual who wants a sustainable diet that fulfills dietary requirements and lowers greenhouse gas emissions must eliminate meat. a. True b. False ANSWER: False 99. A diet in which all food products are locally sourced can increase greenhouse gas emissions. a. True b. False ANSWER: True 100.

Pork and chicken are foods that have a larger environmental footprint than beef. a. True b. False ANSWER: False

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Chapter 20: Hunger and the Environment 101.

Discuss ways consumers can conserve resources when making food-related choices.

ANSWER: Hunger has many causes, but in developed countries, the primary cause is food poverty. People are hungry not because there is no food nearby to purchase, but because they lack money. The rate and severity of US poverty Increased over the past decade. An estimated 12 percent of the people in the United States lives in poverty. Even those above the poverty line ($12,784 per year for an individual) may not have food security. Physical and mental illnesses and disabilities, unemployment, low-paying jobs, unexpected or ongoing medical expenses, and high living expenses threaten financial stability.

Other problems further contribute to food poverty, such as abuse of alcohol and other drugs; lack of awareness of available food assistance programs; and the reluctance of people, particularly older adults, to accept what they perceive as “government handouts” or charity. In the United States, poverty and hunger reach across various segments of society, touching some more than others— notably, single-parent families, people living with disabilities, and those who are black, Hispanic, or Native American. Low-income families spend about a third of their incomes on food. They are simply unable to buy sufficient amounts of nourishing foods, even if they are wise shoppers. For many of the children in these families, school lunch (and breakfast, where available) may provide the only nourishment for the day. In some areas, food assistance programs work to improve food security for low-income school-aged children during the summer months. Otherwise children go hungry, waiting for an adult to find money for food. Not surprisingly, these children are more likely to have chronic health problems than those who eat regularly. They also tend to perform poorly in school and in social situations. For adults, the risks of developing chronic diseases increase.

102.

Describe the Supplemental Nutrition Assistance Program and the controversy that surrounds it.

ANSWER: The Supplemental Nutrition Assistance Program (SNAP) administered by the US Department of Agriculture (USDA) is the largest federal food assistance program, both in amount of money spent and in number of people served, providing assistance to more than 38 million people at a cost of $68 billion per year. About half of the recipients are children. The USDA issues debit cards through state agencies to households—people who buy and prepare food together. The amount a household receives depends on its size, resources, and income. The average monthly benefit for an individual is about $125. Recipients may use SNAP cards to purchase food and food-bearing plants and seeds, but not to buy tobacco, cleaning items, alcohol, or other nonfood items.

Controversy surrounds the question of whether SNAP participants should be given incentives for purchasing fruits and vegetables and restrictions on purchasing soft drinks and other nonnutritious foods and beverages. Some argue that government programs should not support poor-quality foods that promote obesity and other diseases; others argue that government programs should not tell consumers what they cannot eat and drink. Such a lack of quality control on food purchases may not only promote obesity and disease, but it may also exacerbate hunger; consider that, given the same number of kcalories, a child will become hungrier sooner after drinking a 20-ounce soft drink than after eating a large apple with a heaping spoonful of peanut butter. In general, SNAP participants have low-quality diets and poor health. The SNAP benefits are simply insufficient to fully support a healthy diet as recommended by theDietary Guidelines for Americans.

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Chapter 20: Hunger and the Environment 103.

Explain how hunger and obesity often exist side by side in the same household (aka the poverty-obesity paradox).

ANSWER: Ironically, hunger and obesity often exist side by side—sometimes within the same household or even the same person. That hunger reflects an inadequate food intake and obesity implies an excessive intake seems paradoxical, but the highest rates of obesity occur among those living in the greatest poverty—the same people who live with food insecurity. This paradox between hunger and obesity is most notable among older women.

Unfortunately, many healthful food choices, such as fruits and vegetables, are not readily available in low-income or rural neighborhoods. Instead of supermarkets, these neighborhoods typically have convenience stores that stock canned foods, sodas, and chips, but not fresh produce.

Neighborhoods and communities characterized by limited access to nutritious and affordable foods are known as food deserts. Food deserts are especially prevalent in low-income communities. With limited access to grocery stores carrying varieties of fruits and vegetables, residents in these neighborhoods have fewer healthy options and fall short of meeting their nutrient needs. Furthermore, fruits and vegetables tend to cost more than the energy-dense foods that foster weight gain. Foods such as doughnuts, pizzas, and hamburgers provide the most energy and satiety for the least cost.

Quite simply, poor-quality diets deliver more kcalories, but fewer nutrients, for less money; highquality diets deliver fewer kcalories, but more nutrients, for more money. The challenge, of course, is finding the foods that deliver the most nutrients for the lowest cost.

Economic uncertainty and stress greatly influence the prevalence of obesity. People who are unsure about their next meal may overeat when food or money are available. Interestingly, food insecure people who do not participate in food assistance programs have a greater risk of obesity than those who do participate—illustrating that providing food actually helps support a healthy body weight.

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Chapter 20: Hunger and the Environment 104.

Identify three reasons why hunger is present in developing countries ANSWER: Although hunger in developing countries has diverse causes, the primary cause is poverty, and the poverty is far more extreme than in the United States. Of the almost 8 billion people in the world, 10 percent have no land and no possessions at all. They are the “poorest poor.” They survive on less than $2 a day each, and they lack safe housing, clean water, and health care. The “poorest poor” are usually female.

Many societies around the world under-value females, providing girls with poorer diets, less education, and fewer opportunities than boys. Malnourished girls become malnourished mothers who give birth to low-birthweight infants—and the cycle of hunger, malnutrition, and poverty continues.

The consequences of stunted growth in early childhood are evident throughout life. Not only does poverty cause hunger, but tragically, hunger worsens poverty by robbing a person of the good health and the physical and mental energy needed to become active and productive. Hungry people simply cannot work hard enough to overcome poverty. An essential key to ending world hunger and poverty is education. Researchers estimate that if all adults completed secondary education, global poverty could be cut by more than half within a generation.

World hunger statistics reflect data from all countries, but some developing nations are affected more than others. Famine is a severe food shortage that causes widespread starvation and death. Such food shortages may be caused by natural disasters such as droughts, floods, fires, and storms. Other countries may be chronically short of food because of ongoing drought and poverty. Even as the natural causes of famine have been growing ever more widespread and severe, the political crises created by people have become equally devastating and intensified the widespread misery inflicted by hunger. In addition, the economic crises, such as those associated with the COVID-19 pandemic, can further hamper people’s ability to get enough food, especially in countries already struggling with poverty and hunger.

The world’s population continues to increase even though more slowly than before. Ever-increasing numbers threaten earth’s carrying capacity—that is, its ability to provide safe water and adequate food for all its inhabitants. As the world’s population continues to grow, much of the increase is occurring in developing countries where hunger and malnutrition are already widespread. With more mouths to feed, hunger and poverty worsen.

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Chapter 20: Hunger and the Environment 105.

Briefly discuss nutrient deficiencies in the developing world. Then discuss how these nutrient deficiencies affect not only individuals but entire nations.

ANSWER: Without adequate nourishment, body functions begin to fail and deficiency symptoms begin to develop. Because symptoms are not always apparent, nutrient deficiencies represent hidden hunger.

An estimated 2 billion people lack key nutrients, most likely iron, iodine, vitamin A, and zinc. An estimated 40 percent of the world’s pregnant women and young children have iron-deficiency anemia, a leading cause of maternal deaths, preterm births, low birthweights, infections, and premature deaths.22 Iodine deficiency affects almost 25 percent of the world's population, resulting in stillbirths and irreversible mental impairment (cretinism) in newborns.23 One-third of the world’s children (younger than age 5) suffer from symptoms of vitamin A deficiency—blindness, growth restriction, and poor resistance to common childhood infections such as measles. An estimated 20 percent of the world’s population have zinc deficiencies, which contribute to growth failure, diarrhea, and pneumonia.

The consequences of nutrient deficiencies are felt not only by individuals but also by entire nations.

When people suffer from intellectual disability, blindness, infections, and other consequences of malnutrition, the economies of their countries decline as productivity decreases and health-care costs increase. The dramatic signs of malnutrition are most evident at end of the life span in a nation’s high infant mortality rate and short life expectancy.

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Chapter 20: Hunger and the Environment 106.

Discuss the growth failure characteristics of severe acute malnutrition and chronic malnutrition.

ANSWER: Without adequate nourishment, children fail to grow. When food suddenly becomes unavailable, as in drought or war, children rapidly lose weight. Underweight for height (described as wasting) is a common sign of severe acute malnutrition (SAM), a life-threatening condition. Not as immediately deadly, but still damaging to health, is chronic malnutrition, which occurs when food shortages are ongoing or recurring. These children tend to be short for their age (described as stunting). This classification is useful to health care workers, but it may be an oversimplification of how the body adapts to poor nutrition during times of growth. Some evidence suggests that stunting may be the body’s response to continual wasting; in other words, stunted children are survivors of acute malnutrition. All of these children bear exceptionally high risks of mortality.

Children with SAM are sometimes differentiated by physical and developmental characteristics, with marasmus referring to children who are very thin for their height and kwashiorkor referring to children who have edema. In marasmus, the body’s tissues have wasted away, having been used to provide the energy needed to stay alive. These children are underweight for their height and their upper arm circumference measures are smaller than normal. The loose skin on the buttocks and thighs often sags down, so that the children look as if they are wearing baggy pants. Sadly, these children are often described as just “skin and bones.” Some starving children face this threat to life by engaging in as little activity as possible—not even crying for food. Others cry inconsolably. All their muscles, including the heart, are weak and deteriorating. Enzymes are in short supply, and the GI tract lining deteriorates. Consequently, what little food is eaten upsets digestion and absorption. In kwashiorkor, some wasting may occur, but the distinguishing feature is edema. Fluid shifts in response to inadequate concentrations of blood proteins. A fatty liver develops in response to inadequate protein carriers to transport lipids out of the liver. Hair loses its color and the skin becomes patchy and scaly, with sores that often fail to heal.

Many more children worldwide live with chronic malnutrition. They subsist on diluted cereals that supply little energy and scant protein; such food allows them to survive but not to thrive. Without adequate nourishment, growth is stunted and often irreversible. These children may be no larger at age 4 than at age 2 and they often suffer the miseries of malnutrition: frequent infections and diarrhea, and the symptoms of multiple vitamin and mineral deficiencies. Severe malnutrition during these early years of childhood irreversibly impairs brain development and learning ability, and greatly diminishes prospects for escaping from poverty.

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Chapter 20: Hunger and the Environment 107.

Describe at least four environmental consequences of the current methods of food production.

ANSWER: To feed all of the world’s people enough nutritious foods to live active, healthy lives without destroying the natural resources needed to continue producing food poses multiple challenges. The current methods of food production damages the environment through land use, water use and pollution, energy use, greenhouse gases, biodiversity, and food waste.

Agriculture uses about half of the world’s habitable land. Livestock use more than 75 percent of that agricultural land but produce less than 20 percent of the world’s kcalories and less than 40 percent of the world’s protein.

Agriculture is responsible for 70 percent of the world’s freshwater use and much of the pollution.

With rain or irrigation, fertilizer from croplands and manure from feed lots runoff into waterways causing algae overgrowth. The algae die and decompose, creating dead zones where oxygen depletion kills marine life. As human populations grow, so does the demand for clean potable water.

In areas experiencing high water stress, natural and manmade influences converge to limit access to safe drinking water.

The entire food industry—whether based on growing crops, raising livestock, or fishing—requires energy. Worldwide, food systems account for about 30 percent of all the energy used. Because food systems run primarily on fossil fuels, they contribute significantly to greenhouse gas emissions.

The world’s food systems produce more than 25 percent of global greenhouse gas emissions. These emissions derive primarily from livestock methane production and fuel consumption; crop production use of fertilizers and machinery; and food processing, transport, packaging, and retail. Importantly, different foods are responsible for emitting dramatically different quantities of greenhouse gases, with beef production releasing 60 times more than legumes, for example.

Agricultural practices and the increasing uniformity of global food habits have threatened species and contributed to the loss of biodiversity. As people everywhere eat the same limited array of foods, demand for a local region’s native, genetically diverse plants is no longer financially justifiable. Yet, in the future, as the climate and environment change, those very plants may be the ones needed for food. A wild species of corn that grows in a dry climate, for example, might contain the genetic information necessary to help make domestic corn resistant to drought.

Each year, an estimated one-third of the world’s food supply is wasted along the way from farm to final consumption. Global studies find that food waste increases as consumer wealth increases.

Reducing food waste and alleviating food insecurity is a national and international goal, and every step from farm to fork has a role to play. Consumers in the United States waste an estimated 150,000 tons of food every day. To produce that wasted food requires 30 million acres of cropland, 4.2 trillion gallons of irrigation water, 1.8 billion pounds of fertilizer, and 780 million pounds of pesticides. The wasted foods represent more than 1200 kcalories per person per day—enough to feed a hungry child. Among the many services provided by Feeding America is a food rescue program that diverts 1 billion pounds of food from landfills to families in need by offering food companies a convenient, free, and safe way to donate their surpluses. The EPA’s Food Recovery Hierarchy prioritizes actions to prevent and divert wasted food. The hierarchy aims to reduce, reuse, and recycle food waste.

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Chapter 20: Hunger and the Environment 108.

Describe ready-to-use therapeutic food (RUTF) and oral rehydration therapy (ORT) and how they can be used to help children suffering from severe malnutrition.

ANSWER: Severe malnutrition may require hospitalization, which demands intensive nursing care, gradual reintroduction of nutritious foods, and medication. Two forms of medical nutrition therapy include ready-to-use therapeutic food (RUTF) and oral rehydration therapy (ORT).

To ensure weight gain and correct nutrient deficiencies, children suffering from malnutrition may be given RUTF—specially formulated pastes of oil and sugars with ground peanuts, powdered milk, or other protein sources sealed in single-serving, sterilized pouches. Because it does not need to be mixed with water, the risk of bacterial contamination is minimized. Another benefit is that it can be stored for 3 to 4 months without refrigeration.

In addition to nutrition intervention, children suffering from diarrhea commonly need rehydration. In severe cases, diarrhea will have incurred dramatic fluid and mineral losses that need to be corrected immediately to help raise the blood pressure and strengthen the heartbeat. Health care workers around the world save millions of lives each year by effectively correcting dehydration and diarrhea with oral rehydration therapy (ORT). ORT is a simple, inexpensive, and effective treatment that consists of giving a sugar and salt solution orally. In addition to ORT, adequate sanitation and clean water are needed to prevent infectious disease.

109.

List three methods of creating sustainable food systems that support the health of the planet and its people.

ANSWER: Sustainable food systems can be created through sustainable agriculture, sustainable diets, and sustainable actions.

Many farmers are moving toward sustainable practices that use state of- the-art, science-based methods to maximize productivity and minimize environmental damage. Ideally, sustainable agriculture meets all the following needs: economic—supports a profitable business that delivers affordable products; social—deals fairly with workers and interacts positively with the nearby community; and environmental—tends to natural systems and preserves resources, including maintaining healthy soil, managing water use, minimizing pollution, and promoting biodiversity. Sustainable agriculture practices depend on agroecology, the science of managing farms as ecosystems. When farmers understand and work with nature, they can limit environmental damage without losing productivity or profits.

In addition to meeting economic, social, and environmental needs, sustainability must also provide enough nutritious foods for all people everywhere to sustain healthy and active lives. Sustainable diets protect the health of both people and the environment. Consumers can adopt sustainable diets by minimizing the consumption of energy-dense, highly processed, and packaged foods that tend to provide excessive amounts of added sugars and saturated fats; including a diversity of plant-based foods and fewer animal-derived foods, especially beef; and meeting daily energy needs without excess. These shifts in eating patterns reduce overconsumption of foods, especially resource-intensive foods, and contribute to a sustainable future.

The benefits are threefold—improving food security, minimizing environmental impacts, and promoting good health. Diet composition dramatically influences the environmental footprint. Shifting eating patterns toward plant-based diets reduces the environmental costs and increases the carrying capacity of US agricultural resources. Research findings confirm that even slight shifts in the diet can Page 30

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Chapter 20: Hunger and the Environment support both nutritional and environmental health.

Dietitians and foodservice managers have special roles to play, and their efforts can make impressive differences. Their professional organization, the Academy of Nutrition and Dietetics, urges members to conserve resources and minimize waste in both their professional and their personal lives. In addition, members can educate themselves and others on hunger, its consequences, and programs to fight it; conduct research on the effectiveness and benefits of programs; and serve as advocates on the local, state, and national levels to help end hunger in the United States. Globally, these professionals support programs that combat malnutrition, provide food security, promote sustainable diets, respect local cultures, protect the environment, and sustain the economy.

One person’s choice to reduce food waste or to recycle bottles or to volunteer at food recovery programs can make a difference. Such choices produce several benefits. For one, one person’s action may influence many other people over time. For another, repeated actions become habits, with compounded benefits. For still another, making choices with an awareness of the consequences improves behaviors and gives a person a sense of personal control, hope, and effectiveness. The daily actions of many concerned people can help solve the problems of hunger both in their own communities and on the other side of the world. Individuals can assist the global community in solving its poverty and hunger problems by joining and working for hunger-relief organizations. They can also support the changes in economic policies that are needed to influence food availability and price volatility both at home and in developing countries. Most importantly, all individuals can tr y to make lifestyle choices that honor the environmental consequences. Many small decisions each day produce major environmental effects.

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Chapter 20: Hunger and the Environment 110. Describe three ways consumers can conserve resources when making food-related choices.

ANSWER: Consumers can conserve resources when making food-related choices, such as switching from animal-derived foods to plant-based foods. For the most part, animal-based foods have a much larger footprint than plant-based foods, with beef having the most environmentally damaging influence by far. This conclusion holds true whether comparing the footprint of foods based on their weight, protein, or kcalories. Protein foods account for most of the agricultural greenhouse emissions, with beef and lamb producing more than 10 kilograms of carbon dioxide equivalents per 100 grams of protein. Completely eliminating all animal-derived foods from the diet is not necessary to design a sustainable diet that meets dietary requirements and lowers greenhouse gas emissions. For example, one study concluded that plant-based diets that include only small amounts of meat and dairy products are better than vegan diets with respect to the earth’s carrying capacity. Some consumers are opting for fish instead of meat. This choice may be a practical alternative if seafood is selected with an awareness of the environmental consequences.

Some consumers believe that an environmentally responsible diet must be based on locally grown products. Buying local products does offer some advantages, but as for the environment, what you eat seems to matter much more than its location. In general, transportation has a relatively insignificant impact on the environmental costs of foods. Local beef still has a larger footprint than plant foods grown and shipped from across the world. One study showed that using chicken, fish, eggs, or a plant-based alternative instead of beef and dairy products even one day a week reduces greenhouse gas emissions more than buying all groceries from local sources. In some cases, eating local foods may actually increase emissions—for example, when growing vegetables during the winter inside hot greenhouses instead of importing from regions where they are in season.

Some consumers are attracted to products and packaging that claim to be “eco-friendly,” expecting far-reaching environmental benefits, even though such claims may be unsubstantiated. The Federal Trade Commission, which is responsible for enforcing truth-in-advertising laws, has created “green guides.”

Consumers make dozens of decisions every day that can help conserve resources and protect the environment. Examples include reducing food waste and eating closer to nutrient requirements.

Overeating contributes to food losses as much as any other food waste does.

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