NUTRITION (C787) STUDY GUIDE
Unit 2: Nutrition to Support Wellness (Cohort 1)
Reading: Macronutrients
-Identify the differences between macronutrients and micronutrients
* Macronutrients: are carbs, lipids & proteins. Provides energy needed for growth,
thermoregulation, physical activity, pregnancy/lactation. Needed in larger amts than
micronutrients
* Micronutrients: vitamins/minerals in small amts for good health/development. Play various roles
in cell metabolism. Deficiencies cause widespread health probs.
-Differentiate the S/S for the following diseases:
1. Obesity: excess consumption. Increased risk for CAD, some cancers & type 2 diabetes. Puts stress
on knee/ankle joints. Is an energy imbalance, where energy intake exceeds energy expenditure.
Influenced by genetic/environmental factors.
2. Marasmus: general deficiency of macronutrients. Also called protein-calorie malnutrition.
3. Kwashiorkor: primarily attributed to deficiency of dietary protein. s/sx include fatigue, irritability,
lethargy, poor growth, apathy, edema, decreased muscle mass, large belly, diarrhea, dermatitis,
change in hair, infections. Can lead to coma/death.
4. Anorexia nervosa: restricted intake. Body weight @ or < 85% of normal. Intense fear of wt gain,
distorted perception of body wt. 3rd most common condition of adolescents. Common co-morbid
conditions: OCD, depression, anxiety, social phobia. Can lead to decreased micronutrient intake,
which leads to death.
5. Bulimia nervosa: binge eating f/b purging (vomiting or misuse of laxatives/diuretics). Can lead to
obesity.
6. Pellagra: Deficiency of Niacin (Vit B3). Characterized by “4 D’s of Pellagra:” dermatitis, diarrhea,
dementia & death.
Reading: Micronutrients
Identify diseases/illness related to specific vitamin deficiencies (vitamin A, vitamin C, vitamin D, iron,
iodine, etc.).
* Vit C Deficiency (Scurvy): Early signs are bleeding gums/pinpoint hemorrhages under skin, rough
scaly skin, hardening of arteries or massive bleeding can happen & lead to death.
* Vit D Deficiency (Rickets): bone formation impaired. Bow legged appearance
* Vit A Deficiency: leads to blindness. Even mild deficiency causes diarrhea & URIs
* Iron Deficiency (Anemia):
* Iodine Deficiency: leads to physical/mental developmental delays.
Reading: Malnutrition
Identify the differences between kwashiorkor and marasmus
* Kwashiorkor: Adequate calories, not enough protein. Often occurs in areas of famine, low food
supply, low education levels. Often tropical regions w/ diet high in starch/low in protein. Early RX
has + results. Without RX, is fatal
* Marasmus: means to “waste away.” Is acute form of malnutrition. Deficiency of BOTH calories
AND protein. Most severe form of childhood malnutrition. Body fat stores used for energy & then
1
,NUTRITION (C787) STUDY GUIDE
muscle is broken down for body fuel. Person appears as skin/bones w/ lg eyes, bald head,
aged/gaunt appearance. Once severe muscle wasting occurs, death is imminent. Have below
norm body temp.
Reading: Treating Malnutrition
Identify effects and treatments for malnutrition
* Has adverse effects on physical/psychosocial wellbeing by predisposing to disease. Mostly
treatable by optimizing food intake & using oral nutritional supplements. Effects: poor health,
increased infections, increased hosp admits, longer recovery time, increased dependency, more
MD visits, higher medicine costs, higher rate of admits to nsg home, decreased muscle strength,
inactivity, impaired temp regulation, electrolyte/fluid imbalance. Must screen for BMI < 18.5,
recent unintentional wt loss, no intake > 5 days. “Food first” approach, then oral nutritional
supplements (ONS)
Reading: Chapter 1: Applying Nutrition Science to Public Health ((PLEASE ACCESS THE CHAPTER
THROUGH THE UNIT 2 COURSE MATERIAL IF THE LINK DOES NOT WORK FOR YOU)
Briefly define HEI, NHANES, DGA, and the foods/products regulated by the FDA/USDA.
* HEI: Healthy Eating Index. Uses a scoring system to evaluate a set of foods. Scores range from 0-
100. An ideal overall HEI score of 100 reflects that the set of foods aligns w/ key dietary
recommendations from the Dietary Guidelines for Americans. Scoring metric is composed of 12
subcomponents, 9 of which receive “adequacy scores” (total fruit, whole fruit, total veggies,
greens & beans, whole grains, dairy, total protein foods, seafood & plant proteins, & fatty acid
ratios) & a higher score indicates higher consumption. 3 remaining subcomponents (refined
grains, sodium & empty calories) & a higher score indicates lower consumption.
* NHANES: National Health & Nutrition Examination Survey. Is a program of studies designed to
assess the health/nutritional status of the US population? Survey combines health interviews &
physical exams w/ dietary info. A goal is to estimate the # & % of persons in the US with selected
diseases & risk factors. They monitor trends of selected diseases. They study the r/s between
diet, nutrition & health. They establish & maintain a national probability sample of baseline info
on health & nutritional status. Collects information on supplement & prescription med intake,
food security, some consumer behaviors & anthropometrics. The integrated dietary component
of the NHANES is titled “What We Eat in America.”
* DGA: Dietary Guidelines for Americans. Published every 5 years by the HHS & USDA. These are
the foundation of federal nutrition policy, nutrition education programs & information activities.
They are evidence-based recommendations for food (& some nutrient intake) designed to
promote health & reduce risk of chronic disease for healthy Americans 2 yrs & older.
* FDA: regulates domestic poultry, red meat (cattle, sheep, goats, horses, mules & other equine),
egg products & products with more than 3% raw meat, 2% cooked meat or other portions of the
carcass or 30% or more fat, tallow or other meat extract, alone or in combination. They regulate
products with 2% or more cooked poultry or more than 10% poultry skins, giblets, fat and poultry
meat in any combination.
* USDA: regulates non-specified poultry (wild turkeys, ducks & geese), non-specified red meats
(bison, rabbits, game animals, zoo animals & members of the deer family including elk & moose),
shells eggs of domestic chickens, turkeys, ducks. They also regulate products with less than 3%
raw meat, 2% cooked meat or other portions of the carcass or less than 30% fat, tallow or other
2
,NUTRITION (C787) STUDY GUIDE
meat extract, alone or in combination. They regulate products with less than 2% cooked poultry
or less than 10% poultry skins, giblets, fat and poultry meat in any combination.
What changes were made when DRIs were established in the late 1990s?
* The DRI extended & replaced the former RDAs (Recommended Daily Allowance) & the Canadian
Recommended Nutrient Intakes.
* They are specified on age, gender & life stage (e.g., pregnancy or lactation).
What are the Physical Activity Guidelines for Americans for different age groups and what benefits
are seen with these levels of physical activity?
* Children/adolescents age 6-17 do 60 mins or more of physical activity/day. For adults, do aerobic
activity. This can significantly reduce disease risk, often in a short period of time. The relationship
between diet & activity contributes to calorie balance/managing body weight.
The USDA recommends limits to added sugars, sodium, alcohol and saturated fats. What are these
limits and why would are these limits recommended?
* Consume less than 10% of calories/day from added sugars
* Consume less than 10% of calories/day from saturated fats
* Consume less than 2300 mg/day of sodium
* If alcohol is consumed, it should be consumed in moderation-up to one drink/day for women
& up to two drinks/day for men- and only by adults of legal drinking age.
These recommended limits help achieve/maintain a healthy body weight, support nutrient adequacy
& reduce risk for chronic disease.
What do the acronyms DRI, UL, EAR, RDA signify? Describe how these numbers are developed and
how they are used to guide nutritional recommendations for people and populations.
* DRI: Dietary Reference Intakes. Replaced RDAs & differ from the original RDAs by incorporating
concepts of disease prevention, upper levels of intake/potential toxicity & nontraditional
nutrients. Are a set of @ least 4 nutrient-based reference values, which are the:
1. UL: Tolerable upper intake level or the highest level of continued daily nutrient intake that is
unlikely to pose an adverse health effect.
2. EAR: Estimated avg requirement. This is the median usual intake value estimated to meet the
requirements of half of the healthy individuals. Based on specific criteria of adequacy & on
careful review of scientific evidence. Not all nutrients have an EAR if no acceptable science
base upon which to define one.
3. RDA: RDA = EAR + 2 standard deviation of the requirement, which is the avg daily dietary
intake level sufficient to meet the nutrient requirement of approx. 98% of people. If there is
no EAR for a nutrient, there can be do RDA
4. AI: adequate intake. Provided if no EAR/RDA available.
* Important uses of the DRIs include personal diet planning, dietary guidance, institutional food
planning, military food/planning, planning for food assistance programs, food
labeling/fortification, developing new/modified food products, & guaranteeing food safety.
* In planning menus/diets, important to meet the RDA or AI without exceeding the UL.
Where would you find the %DV and how is it used?
%DV (percent daily value) is found on the Nutrition Facts Label of food. It shows how much of a
nutrient is in one serving of the food. Based on the Daily Values for key nutrients, which are the
3
, NUTRITION (C787) STUDY GUIDE
amounts (in gm, mg, or mcg) of nutrients recommended per day for Americans age 4 and up.
o As a general rule: 5% DV or less of a nutrient per serving is low
o 20% DV or more of a nutrient per serving is high.
Identify the types of dietary fats (including trans-fats) and recommendations regarding their
consumption.
Bad Fats: tend to be more solid @ room temp. Can raise bad cholesterol (LDL) in your blood. Contain
9 cal/gm (same as good fats)
1. Saturated Fats: Dietary Guidelines for Americans recommends less than 10% of cals/day
from saturated fat
2. Trans Fats: “partially hydrogenated oils.” FDA has preliminarily determined that they are no
longer generally recognized as safe in human food. Eating trans fats increases risk of heart
disease/stroke and type 2 diabetes. AHA recommends cutting back on trans-fat in diets. They
raise LDL/lower HDL
Good Fats: Tend to be more liquid @ room temp. Help to lower bad cholesterol. Monounsaturated
Fats: Olive, canola, peanut, safflower & sesame oil as well las avocados, PB, nuts/seeds. Beside
reducing LDL, they also provide nutrients to help develop/maintain body’s cells. Also contribute Vit E.
Still eat in moderation as not required in the diet. No AI or RDA is set, Polyunsaturated Fats: In
addition to benefits provided by monounsaturated fats, they provide essential fats that body needs,
but cannot produce by itself, such as omega-6 and omega-3 fatty acids. Soybean, corn & sunflower
oils. Also, walnuts, sunflower seeds, tofu & soybeans.
What is the DASH diet and what level of sodium has been shown to reduce high blood pressure?
* DASH stands for Dietary Approaches to Stop Hypertension. Is a diet to treat HTN/reduce risk of
CAD. Focuses on fruits, veggies, whole grains, & lean meats while low in red meat, salt, added
sugars & fats. It reduces salt intake.
* Encourages no more than 1 tsp (2300 mg) of sodium/day. The lower salt version recommends no
more than 1500 mg/day.
Reading: MyPlate Method
Understand the MyPlate tips including recommended proportions of grains, fruits and vegetables
and other food groups.
* Creates a plan showing food group targets-what & how much to eat within your calorie
allowance. Is personalized based on age, sex, height, weight & activity level.
* Tips include:
o Find your healthy eating style/maintain it for lifetime. Everything you eat/drink matters.
o Focus on variety, amount, & nutrition
o Choose foods/drinks w/ less saturated fat, sodium & added sugar.
o Start w/ small changes
o Make ½ your plate fruits & veggies. Vary your veggies (include from all 5 veggie
subgroups- dark-green, starchy, red/orange, beans/peas & other veggies) & focus on
whole fruits
o Make ½ your grains whole grains
o Switch to low-fat or fat-free milk/yogurt
o Vary protein routine (protein foods in nutrient-dense forms. Includes meat, poultry,
seafood, beans/peas, eggs, processed soy products, nuts/seeds)
4
Unit 2: Nutrition to Support Wellness (Cohort 1)
Reading: Macronutrients
-Identify the differences between macronutrients and micronutrients
* Macronutrients: are carbs, lipids & proteins. Provides energy needed for growth,
thermoregulation, physical activity, pregnancy/lactation. Needed in larger amts than
micronutrients
* Micronutrients: vitamins/minerals in small amts for good health/development. Play various roles
in cell metabolism. Deficiencies cause widespread health probs.
-Differentiate the S/S for the following diseases:
1. Obesity: excess consumption. Increased risk for CAD, some cancers & type 2 diabetes. Puts stress
on knee/ankle joints. Is an energy imbalance, where energy intake exceeds energy expenditure.
Influenced by genetic/environmental factors.
2. Marasmus: general deficiency of macronutrients. Also called protein-calorie malnutrition.
3. Kwashiorkor: primarily attributed to deficiency of dietary protein. s/sx include fatigue, irritability,
lethargy, poor growth, apathy, edema, decreased muscle mass, large belly, diarrhea, dermatitis,
change in hair, infections. Can lead to coma/death.
4. Anorexia nervosa: restricted intake. Body weight @ or < 85% of normal. Intense fear of wt gain,
distorted perception of body wt. 3rd most common condition of adolescents. Common co-morbid
conditions: OCD, depression, anxiety, social phobia. Can lead to decreased micronutrient intake,
which leads to death.
5. Bulimia nervosa: binge eating f/b purging (vomiting or misuse of laxatives/diuretics). Can lead to
obesity.
6. Pellagra: Deficiency of Niacin (Vit B3). Characterized by “4 D’s of Pellagra:” dermatitis, diarrhea,
dementia & death.
Reading: Micronutrients
Identify diseases/illness related to specific vitamin deficiencies (vitamin A, vitamin C, vitamin D, iron,
iodine, etc.).
* Vit C Deficiency (Scurvy): Early signs are bleeding gums/pinpoint hemorrhages under skin, rough
scaly skin, hardening of arteries or massive bleeding can happen & lead to death.
* Vit D Deficiency (Rickets): bone formation impaired. Bow legged appearance
* Vit A Deficiency: leads to blindness. Even mild deficiency causes diarrhea & URIs
* Iron Deficiency (Anemia):
* Iodine Deficiency: leads to physical/mental developmental delays.
Reading: Malnutrition
Identify the differences between kwashiorkor and marasmus
* Kwashiorkor: Adequate calories, not enough protein. Often occurs in areas of famine, low food
supply, low education levels. Often tropical regions w/ diet high in starch/low in protein. Early RX
has + results. Without RX, is fatal
* Marasmus: means to “waste away.” Is acute form of malnutrition. Deficiency of BOTH calories
AND protein. Most severe form of childhood malnutrition. Body fat stores used for energy & then
1
,NUTRITION (C787) STUDY GUIDE
muscle is broken down for body fuel. Person appears as skin/bones w/ lg eyes, bald head,
aged/gaunt appearance. Once severe muscle wasting occurs, death is imminent. Have below
norm body temp.
Reading: Treating Malnutrition
Identify effects and treatments for malnutrition
* Has adverse effects on physical/psychosocial wellbeing by predisposing to disease. Mostly
treatable by optimizing food intake & using oral nutritional supplements. Effects: poor health,
increased infections, increased hosp admits, longer recovery time, increased dependency, more
MD visits, higher medicine costs, higher rate of admits to nsg home, decreased muscle strength,
inactivity, impaired temp regulation, electrolyte/fluid imbalance. Must screen for BMI < 18.5,
recent unintentional wt loss, no intake > 5 days. “Food first” approach, then oral nutritional
supplements (ONS)
Reading: Chapter 1: Applying Nutrition Science to Public Health ((PLEASE ACCESS THE CHAPTER
THROUGH THE UNIT 2 COURSE MATERIAL IF THE LINK DOES NOT WORK FOR YOU)
Briefly define HEI, NHANES, DGA, and the foods/products regulated by the FDA/USDA.
* HEI: Healthy Eating Index. Uses a scoring system to evaluate a set of foods. Scores range from 0-
100. An ideal overall HEI score of 100 reflects that the set of foods aligns w/ key dietary
recommendations from the Dietary Guidelines for Americans. Scoring metric is composed of 12
subcomponents, 9 of which receive “adequacy scores” (total fruit, whole fruit, total veggies,
greens & beans, whole grains, dairy, total protein foods, seafood & plant proteins, & fatty acid
ratios) & a higher score indicates higher consumption. 3 remaining subcomponents (refined
grains, sodium & empty calories) & a higher score indicates lower consumption.
* NHANES: National Health & Nutrition Examination Survey. Is a program of studies designed to
assess the health/nutritional status of the US population? Survey combines health interviews &
physical exams w/ dietary info. A goal is to estimate the # & % of persons in the US with selected
diseases & risk factors. They monitor trends of selected diseases. They study the r/s between
diet, nutrition & health. They establish & maintain a national probability sample of baseline info
on health & nutritional status. Collects information on supplement & prescription med intake,
food security, some consumer behaviors & anthropometrics. The integrated dietary component
of the NHANES is titled “What We Eat in America.”
* DGA: Dietary Guidelines for Americans. Published every 5 years by the HHS & USDA. These are
the foundation of federal nutrition policy, nutrition education programs & information activities.
They are evidence-based recommendations for food (& some nutrient intake) designed to
promote health & reduce risk of chronic disease for healthy Americans 2 yrs & older.
* FDA: regulates domestic poultry, red meat (cattle, sheep, goats, horses, mules & other equine),
egg products & products with more than 3% raw meat, 2% cooked meat or other portions of the
carcass or 30% or more fat, tallow or other meat extract, alone or in combination. They regulate
products with 2% or more cooked poultry or more than 10% poultry skins, giblets, fat and poultry
meat in any combination.
* USDA: regulates non-specified poultry (wild turkeys, ducks & geese), non-specified red meats
(bison, rabbits, game animals, zoo animals & members of the deer family including elk & moose),
shells eggs of domestic chickens, turkeys, ducks. They also regulate products with less than 3%
raw meat, 2% cooked meat or other portions of the carcass or less than 30% fat, tallow or other
2
,NUTRITION (C787) STUDY GUIDE
meat extract, alone or in combination. They regulate products with less than 2% cooked poultry
or less than 10% poultry skins, giblets, fat and poultry meat in any combination.
What changes were made when DRIs were established in the late 1990s?
* The DRI extended & replaced the former RDAs (Recommended Daily Allowance) & the Canadian
Recommended Nutrient Intakes.
* They are specified on age, gender & life stage (e.g., pregnancy or lactation).
What are the Physical Activity Guidelines for Americans for different age groups and what benefits
are seen with these levels of physical activity?
* Children/adolescents age 6-17 do 60 mins or more of physical activity/day. For adults, do aerobic
activity. This can significantly reduce disease risk, often in a short period of time. The relationship
between diet & activity contributes to calorie balance/managing body weight.
The USDA recommends limits to added sugars, sodium, alcohol and saturated fats. What are these
limits and why would are these limits recommended?
* Consume less than 10% of calories/day from added sugars
* Consume less than 10% of calories/day from saturated fats
* Consume less than 2300 mg/day of sodium
* If alcohol is consumed, it should be consumed in moderation-up to one drink/day for women
& up to two drinks/day for men- and only by adults of legal drinking age.
These recommended limits help achieve/maintain a healthy body weight, support nutrient adequacy
& reduce risk for chronic disease.
What do the acronyms DRI, UL, EAR, RDA signify? Describe how these numbers are developed and
how they are used to guide nutritional recommendations for people and populations.
* DRI: Dietary Reference Intakes. Replaced RDAs & differ from the original RDAs by incorporating
concepts of disease prevention, upper levels of intake/potential toxicity & nontraditional
nutrients. Are a set of @ least 4 nutrient-based reference values, which are the:
1. UL: Tolerable upper intake level or the highest level of continued daily nutrient intake that is
unlikely to pose an adverse health effect.
2. EAR: Estimated avg requirement. This is the median usual intake value estimated to meet the
requirements of half of the healthy individuals. Based on specific criteria of adequacy & on
careful review of scientific evidence. Not all nutrients have an EAR if no acceptable science
base upon which to define one.
3. RDA: RDA = EAR + 2 standard deviation of the requirement, which is the avg daily dietary
intake level sufficient to meet the nutrient requirement of approx. 98% of people. If there is
no EAR for a nutrient, there can be do RDA
4. AI: adequate intake. Provided if no EAR/RDA available.
* Important uses of the DRIs include personal diet planning, dietary guidance, institutional food
planning, military food/planning, planning for food assistance programs, food
labeling/fortification, developing new/modified food products, & guaranteeing food safety.
* In planning menus/diets, important to meet the RDA or AI without exceeding the UL.
Where would you find the %DV and how is it used?
%DV (percent daily value) is found on the Nutrition Facts Label of food. It shows how much of a
nutrient is in one serving of the food. Based on the Daily Values for key nutrients, which are the
3
, NUTRITION (C787) STUDY GUIDE
amounts (in gm, mg, or mcg) of nutrients recommended per day for Americans age 4 and up.
o As a general rule: 5% DV or less of a nutrient per serving is low
o 20% DV or more of a nutrient per serving is high.
Identify the types of dietary fats (including trans-fats) and recommendations regarding their
consumption.
Bad Fats: tend to be more solid @ room temp. Can raise bad cholesterol (LDL) in your blood. Contain
9 cal/gm (same as good fats)
1. Saturated Fats: Dietary Guidelines for Americans recommends less than 10% of cals/day
from saturated fat
2. Trans Fats: “partially hydrogenated oils.” FDA has preliminarily determined that they are no
longer generally recognized as safe in human food. Eating trans fats increases risk of heart
disease/stroke and type 2 diabetes. AHA recommends cutting back on trans-fat in diets. They
raise LDL/lower HDL
Good Fats: Tend to be more liquid @ room temp. Help to lower bad cholesterol. Monounsaturated
Fats: Olive, canola, peanut, safflower & sesame oil as well las avocados, PB, nuts/seeds. Beside
reducing LDL, they also provide nutrients to help develop/maintain body’s cells. Also contribute Vit E.
Still eat in moderation as not required in the diet. No AI or RDA is set, Polyunsaturated Fats: In
addition to benefits provided by monounsaturated fats, they provide essential fats that body needs,
but cannot produce by itself, such as omega-6 and omega-3 fatty acids. Soybean, corn & sunflower
oils. Also, walnuts, sunflower seeds, tofu & soybeans.
What is the DASH diet and what level of sodium has been shown to reduce high blood pressure?
* DASH stands for Dietary Approaches to Stop Hypertension. Is a diet to treat HTN/reduce risk of
CAD. Focuses on fruits, veggies, whole grains, & lean meats while low in red meat, salt, added
sugars & fats. It reduces salt intake.
* Encourages no more than 1 tsp (2300 mg) of sodium/day. The lower salt version recommends no
more than 1500 mg/day.
Reading: MyPlate Method
Understand the MyPlate tips including recommended proportions of grains, fruits and vegetables
and other food groups.
* Creates a plan showing food group targets-what & how much to eat within your calorie
allowance. Is personalized based on age, sex, height, weight & activity level.
* Tips include:
o Find your healthy eating style/maintain it for lifetime. Everything you eat/drink matters.
o Focus on variety, amount, & nutrition
o Choose foods/drinks w/ less saturated fat, sodium & added sugar.
o Start w/ small changes
o Make ½ your plate fruits & veggies. Vary your veggies (include from all 5 veggie
subgroups- dark-green, starchy, red/orange, beans/peas & other veggies) & focus on
whole fruits
o Make ½ your grains whole grains
o Switch to low-fat or fat-free milk/yogurt
o Vary protein routine (protein foods in nutrient-dense forms. Includes meat, poultry,
seafood, beans/peas, eggs, processed soy products, nuts/seeds)
4
