Comprehensive Review Course for the Registration Examination for Dietitians

David L. Gee, PhD

Professor of Food Science and Nutrition
Central Washington University


 

Agenda (wishful thinking?)
1:15 - 2:15
    Domain III: Education and Research
    13 questions (30-42)
    Domain I: Food and Nutrition
    Nutrition and Supporting Sciences
    15 questions (51-66)
2:15 - 2:25
    Brain/bladder break
2:25 - 3:25
    Domain I: Food and Nutrition
    Nutrition and Supporting Sciences
    26 questions (67-92)
3:25 - 3:30
    Brain/Bladder Break
3:30 - 3:55
    Domain I: Food and Nutrition
Food Science, Food Safety, Nutrient Composition of Foods
    17 questions (34-50)

Question 30
Prevalence
number of existing cases
Incidence
number of newly diagnosed cases

Question 31
Basic Research
increases fundamental knowledge
Applied Research
supports operational decision making

Question 32
Experimental Research
manipulation of a variable(s)
attempts to relate cause and effect
independent variable
the manipulated variable
dependent variable
variable that may change due to the change in the manipulated variable

Question 33
Basic Research
fundamental knowledge
Applied Research
“directly affects operational decision”
Experimental Research
requires true randomization
Quasi Experimental Research
experimental w/o randomization

Question 34
Double Blind Study
neither subjects or experimenters know the treatment each subject is receiving
avoid biases by subjects
avoid biases by experimenters

Question 35
Validity
does test measure what it is suppose to test?
Reliability
is the test reproducible?

Question 36
Mean
arithmetic average
Median
50% scores above, 50% below
Mode
most frequent score

Question 37
Type I Error
“to falsely reject the null hypothesis”
Null hypothesis
changing independent variable has no effect on dependent variable
Falsely reject
there is an effect when there really isn’t

Question 38
Hypothesis
statement predicting a relationship or outcome

Question 39
Randomization
assignment of subjects in a totally random manner
reduces bias
some factor other than dependent variable caused change in independent variable

Question 40
Independent Variable
variable that experimenter manipulates
Dependent Variable
variable that may change due to manipulation of independent variable

Question 41
Experimental Research
Retrospective Research
looks back in time
case control trial
not randomized
Prospective Research
goes forward in time (follows subjects)
no intervention
not randomized

Question 42
Cross sectional research study (Survey)
non experimental
snapshot in time
does not prove cause and effect
(neither do retrospective or prospective studies)

Question 51
Hydrolysis
breakdown reaction requiring water
Body composition & aging
decline in body water, increase fat
Insensible water loss
sweating, breath
Composition of adipose tissue
20% water

Question 52
Water soluble vitamins
deficiency occurs rapidly
limited storage
absorption & transport
does not require emulisfication or digestion of fat
function as coenzymes
required for enzyme action

Question 53
Pantothenic acid
coenzyme A (CoA)
Vitamin D
calcium homeostasis
Vitamin E
antioxidant
Vitamin A
hormone effects, visual pigment

Question 54
Peptide bonds
links amino acids together
alpha helix
secondary structure of most proteins
hydrogen bonding within backbone
R group
side chain distinguishing amino acids

Question 55
Soluble dietary fiber
dissolves or suspended in water
pectin, gums, mucilages, B-glucans
shown to
    slow gastric emptying
    slows glucose absorption rate
    decreases blood cholesterol (inhibiting cholesterol absortion?)

Question 56
Linoleic acid
essential PUFA, omega - 6, vegetable oil
Lipoic acid
involved in oxidative decarboxylation reactions like pyruvate dehydrogenase
Linolenic acid
essential PUFA, omega-3
Biotin
involved in decarboxylation reactions

Question 57
Folic Acid
food form non-absorbable polyglutamyl-folic acid
requires intestinal folate conjugase
affected by many drugs
affected by alcohol intake
US intake well below DRI
Dietary Reference Intake
Differs from traditional RDA
emphasizes prevention of both deficiency and chronic diseases
Includes:
    RDA
    Adequate Intake (AI)
    Estimated average requirement (EAR)
    Tolerable Upper Intake Level (UL)

Question 58 & 59
Infants have highest % body water
Infant kidney’s have limited ability to concentrate urine
rate of cell division greatest during fetal development
rate of weight change and height change greatest when ?
    absolute
    relative

Question 60
Introduction of solid foods
recommendation at 4-6 months
infant physically able
chew, swallow, digest
nutrient needs change
iron requirements
weight not a factor

Question 61, 62, 63
Role of nutrient supplementation
Need for frequent meals in young children
Collect subjective / objective data and assess before making plan

Question 64
Prevention of osteoporosis & Ca
DRI
    children and teens: 1300 mg/d
    adults: 1000 mg/d
    difference between intake and needs most pronounced teens and young adults
bone density increases into the 20’s

Question 65
RDA Protein (adults) = 0.8g/kgBW
165 lbs / 2.2 lbs/kg = 75 kg
75 kg x 0.8 = 60 g Protein

Question 66
DRI’s for Calcium (AI)
adults = 1000 mg/d
elderly = 1200 mg/d

Question 67
Glucose is major fuel for fetus
Limited ability to oxidize fats and amino acids for energy

Question 68
Relative to cow’s milk, human milk is:
lower in
    protein
    calcium
    phosphorus
    sodium
higher in
    fat
    carbohydrate

Question 69

Question 70
Lactating women need more calcium and magnesium due to high losses in breast milk.
Lacating women need more calories due to caloric content of breast milk.
Folate requirements highest in early pregnancy to avoid neural tube defects

Question 71
Salt and sodium restriction not routinely contraindicated
Added salt amounts to only about 15% of salt intake in typical US diets

Question 72
Pre-event meals goals
Top off glycogen stores
Reasonably high CHO meal
Attain normal hydration
Liberal amounts of fluids
Have empty GI tract by event time
Timing
Composition

Question 73
Steatorrhea
Fat in stools
Pancreatic Lipase: digestion of dietary fats
Bile: emulsification of dietary fats

Question 74
Pancreatic Juices contain:
Digestive enzymes
Pancreatic lipase
Pancreatic amylase
Proteolytic enzymes (trypsin, chymotrypsin,…)
Bicarbonate
To neutralize acid stomach contents
Required for pancreatic enzyme activity

Question 75
Digestion
Chemical breakdown of food components into smaller molecues to allow for absorption
Absorption
Occurs mainly in the small intestine
Absorbed nutrients transported to
Portal blood (water soluble)
Lymphatic system (fat soluble)

Question 76
Gastric Protein Hydrolysis
HCL
Pepsin
Small Intestinal Protein Hydrolysis
Pancreatic proteolytic enzymes
Brush border peptidases

Question 77
Sucrase
Brush border enzyme hydrolyzing sucrose into glucose and fructose
Amylase
Pancreatic enzyme hydrolyzing starches into smaller units
Maltase
BB enzyme hydrolyzing maltose into glucose
Ptyalin
Salivary amylase

Question 78
Iron
Hemoglobin & myoglobin
Electron transport
Catalase
Zinc
Common enzyme cofactor (100+ enzymes) including digestive enzymes
Calcium
Bone structure
Regulator of numerous enzymes
Magnesium
Bone structure
Enzymes utilizing ATP

Question 79
Phytates and oxalates
Reduce iron absorption by forming insoluble complexes with iron
Low pH
Enhances Fe absorption, increases solublilty
Low phosphates and presence of gastric intrinsic factor also shown to enhance Fe absorption

Question 80
Lactose
Forms soluble complex with Ca
Vitamin D
Stimulates production of Ca binding protein in absorptive cells
Oxalate
Forms insoluble Ca complex
Hydrochloric acid
Increases Ca solubility

Question 81
“increase iron absorption” (rate)
Vitamin C (OJ) enhances iron absorption
Spinach contains oxalates
Fish and eggs contain iron, but does not affect rate of iron absorption

Question 82
Intrinsic Factor
Glycoprotein produced in stomach
Binds with vitamin B-12 in intestine
Required for B-12 to be absorbed in ileum
B-12 deficiency results in pernicious anemia

Question 83
Absorption of macronutrients is between 90-100%
Iron absorption is a good example of this
(but may not be true of other metals)
These nutrients are small enough to be absorbed
Alcohol does NOT need to be further digested

Question 84
Chylomicrons
Carry dietary fats (mainly TG) from SI to rest of body
HDL
Carry cholesterol via “reverse cholesterol transport”
Highest in density because of high protein to lipid content
LDL
Made from VLDL, transports cholesterol to peripheral cells
Density based on ratio of protein to lipid

Question 85
Anaerobic Glycolysis
AKA Embden Meyerhof Pathway
Glucose to lactic acid
The Cori Cycle
Glycolysis in peripheral cells (Glu to Pyr)
Gluconeogenesis in liver (Pyr to Glu)
Important in starvation and exercise
Alanine Cycle
Like Cori Cycle, but with ALA (transaminated from Pyr)
Important in starvation for gluconeogenesis and transport of AA-N to liver for urea synthesis
Kreb’s Cycle
Complete oxidation of acetylCoA to CO2 producing NADH for ETS-ATP synthesis

Question 87
Acetyl-CoA
Most carbons enter Krebs’ Cycle
All from FA (B-oxidation)
Some AA carbons also enter as Krebs’ Cycle intermediates (OAA, malate, succinate, alpha-keto glutarate)

Question 88
Lactate
Oxidation of glucose in glycolysis produces ATP + NADH
Limited amounts of NAD carrier forces body to “unload” the H: on NADH
Aerobically: through electron transport and ultimately on oxygen to make water
Anaerobically: add on pyruvate to make lactate

Question 89
Catabolic Stress Response
Characterized by:
Negative nitrogen balance
Retention of fluids
Increased potassium excretion
Insulin resistance
Increased blood glucose

Question 90
Potassium
Classic symptoms of K+ deficiency
Sodium
Deficiency rarely causes hyponatremia
Calcium
Deficiency causes tetany (acute, metabolic) or bone disorders (chronic)
Iron
Deficiency results in microcytic hypochromic anemia

Question 91
Actually all are involved in this process
Thiamin (cofactor of pyr dehydrogenase)
Niacin (NAD)
Riboflavin (FAD)
Pantothenic Acid (CoA)
Pyridoxine (mainly amino acid metabolism, but may function with phosphorylase)

Question 92
Insulin
Produced in response to hyperglycemia
Glucagon, epinephrine, glucocorticoids
Produced in response to hypoglycemia
Starvation
Acute hypoglycemia