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6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-31 CHAPTER 21 Dietetics Dietetics (DY-eh-TET-iks) is the medical specialty that studies nutrients and foods and uses diagnostic tests, medical and surgical procedures, diets, and drugs to maintain wellness and prevent or treat disease. MEASURE YOUR PROGRESS: LEARNING OBJECTIVES After you study this chapter, you should be able to 1. Identify three macronutrients and ten micronutrients and describe their functions in the body. 2. Describe the processes of taste and metabolism. 3. Build dietetic words from combining forms, prefixes, and suffixes. 4. Describe five different types of therapeutic diets. 5. Describe common symptoms, signs, and diseases related to dietetics. 6. Describe common dietetic diagnostic laboratory tests. 7. Describe common dietetic medical and surgical procedures and drug categories. 8. Define common dietetic abbreviations. 9. Correctly spell and pronounce dietetic words. 10. Test your knowledge of dietetics by completing review exercises at the end of the chapter. Medical Language Key To unlock the meaning of a medical word, first define each word part. Then put the word part definitions in order, beginning with the suffix, then the first word part. SUFFIX COMBINING FORM Word Part -ics dietet/o- Word Part Definition knowledge, practice foods, diet Dietetics: The knowledge and practice of foods and diet. dietet/odietet/omeans foods, diet -ics -ics means knowledge, practice 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-32 W-32 | Chapter 21 | Dietetics Anatomy and Physiology Dietetics is related to several different body systems. The limbic system of the brain processes the pleasurable emotions and memories associated with food and eating. The eyes detect the visible presence of food and send this information to the visual cortex of the brain. The nose detects food smells and sends this information to the olfactory cortex of the brain. The tongue detects several different tastes and sends this information to the gustatory cortex of the brain. Food is processed by the gastrointestinal system and transformed into nutrients to meet the needs of the body. Nutrients and Nutrition A nutrient is a substance that provides nourishment to the body. Nutrients include carbohydrates, proteins, lipids, vitamins, and minerals. An essential nutrient is one that the body cannot produce itself and must obtain from food. Macronutrients are nutrients that the body needs in large amounts each day. Carbohydrates, proteins, and lipids are macronutrients. Macronutrients provide different amounts of energy. • Carbohydrates provide 4 calories per gram • Proteins provide 4 calories per gram • Lipids provide 9 calories per gram Micronutrients are nutrients that the body needs in very tiny amounts, sometimes a little as one-millionth of a gram each day. Vitamins and minerals are micronutrients. Nutrition is the process by which the body uses nutrients to meet its needs for nourishment, growth, and reproduction. nutrient (NOO-tree-ent) nutri/o- nourishment -ent pertaining to nutritious (noo-TRISH-us) nutriti/o- nourishment -ous pertaining to macronutrient (MAK-roh-NOO-tree-ent) macr/o- large nutri/o- nourishment -ent pertaining to A macronutrient is not a nutrient that is large in size; it is one that the body needs in large amounts. micronutrient (MY-kroh-NOO-tree-ent) micr/o- small nutri/o- nourishment -ent pertaining to nutrition (noo-TRISH-un) nutri/o- nourishment -tion a process; being or having nutritional (noo-TRISH-un-al) nutri/o- nourishment -tion a process; being or having -al pertaining to 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-33 Dietetics | Chapter 21 | W-33 Carbohydrates The body needs carbohydrates to meet immediate energy needs and to store energy for future needs. The body must obtain all of the carbohydrates it needs from foods in the diet. The enzyme amylase (produced by the salivary glands and the pancreas) breaks down carbohydrates into individual sugar molecules that can be absorbed into the blood. Carbohydrates include monosaccharides, disaccharides, and polysaccharides. Monosaccharides are simple sugars that contain a single sugar molecule. • Glucose (sugar in the blood) • Fructose (sugar in fruits) (see Figure 21-1 ■) carbohydrate (KAR-boh-HY-drayt) carb/o- carbon atoms hydr/o- water; fluid -ate composed of; pertaining to monosaccharide (MAWN-oh-SAK-ah-ride) mon/o- one, single sacchar/o- sugar -ide chemically modified structure glucose (GLOO-kohs) gluc/o- glucose (sugar) -ose full of fructose (FRUHK-tohs) fruct/o- fruit -ose full of Add words to make a correct and complete definition of fructose: full of [the Figure 21-1 ■ Fructose. Fructose is the sugar found naturally in fruits. A survey conducted by the U.S. Department of Agriculture found that, on a daily basis, 50% of the people surveyed did not eat any fruit at all. To meet future demands for a quick source of energy, the body stores glucose molecules as glycogen in the liver and skeletal muscles. Disaccharides are composed of two sugar molecules. • Sucrose (table sugar made from sugar cane) (see Figure 21-2 ■) • Lactose (sugar found in milk from humans and animals) glycogen (GLY-koh-jen) glyc/o- glucose (sugar) -gen that which produces disaccharide (dy-SAK-ah-ride) di- two sacchar/o- sugar -ide chemically modified structure sucrose (SOO-krohs) sucr/o- sugar (cane sugar) -ose full of lactose (LAK-tohs) lact/o- milk -ose full of Add words to make a correct and complete definition of lactose: full of [the sugar found in] milk. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-34 W-34 | Chapter 21 | Dietetics Figure 21-2 ■ Empty calories. Manufactured foods can contain large amounts of sugar (and fat) in which the calories are in a concentrated form and not associated with the vitamins and minerals found in whole foods. Polysaccharides are composed of three or more sugar molecules. • • • Starch (found in vegetables and plants) Cellulose (vegetable fiber found in plants) Pectin (found in fruits) polysaccharide (PAWL-ee-SAK-ah-ride) poly- many, much sacchar/o- sugar -ide chemically modified structure cellulose (SEL-yoo-lohs) cellul/o- cell -ose full of pectin (PEK-tin) pect/o- stiff -in a substance Commercially prepared pectin is added to jellies and jams to thicken them. Did You Know? The first artificial sweetener was named saccharin to emphasize its connection to natural sugar. The combining form sacchar/omeans sugar. Dextrose is a manufactured sugar. It is also known as d-glucose because it is the dextrorotatory or right-handed version of the glucose molecule. It is used in intravenous fluids. For many years, it was felt that simple carbohydrates like table sugar raised the blood sugar quickly while complex carbohydrates like potatoes raised the blood sugar more slowly. Now it has been shown that table sugar raises the blood sugar level at about the same rate as bread or potatoes. Your body cannot break apart cellulose or pectin, and so they function as dietary fiber rather than as carbohydrates. dextrose (DEKS-trohs) dextr/o- right -ose full of Add words to make a correct and complete definition of dextrose: full of a right [-handed molecule of glucose]. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-35 Dietetics | Chapter 21 | W-35 Protein The body needs protein to build, repair, or replace all types of tissues and to synthesize enzymes, hormones, neurotransmitters, antibodies, and hemoglobin. The body obtains the protein it needs from foods in the diet. The enzyme protease (produced by the stomach) breaks down the protein in foods into individual amino acids that can be absorbed into the blood. There are 22 different amino acids. Nine of these are essential amino acids because the body cannot produce them and they must be obtained from foods. If a single food contains all nine essential amino acids, it is a complete protein. Protein that comes from an animal (meat, fish, eggs, dairy products) is a complete protein, but soybeans are a unique example of a complete protein from a plant source. If a single food does not contain all nine essential amino acids, it is an incomplete protein. Vegetables, whole grains, nuts, and seeds are incomplete proteins; however, a variety of incomplete protein foods can be combined to create complete protein. protein (PROH-teen) prote/o- protein -in a substance amino acid (ah-MEE-noh AS-id) Did You Know? The body takes amino acids from the food and uses them to make more than 100,000 different protein molecules for use in the body. Each protein can be a chain of 1,000 or more amino acids. Lipids The body needs lipids to transport and store vitamins A, D, E, and K; to store energy for future needs; and to make hormones. The body must obtain all of the lipids it needs from foods in the diet. Dietary lipids are classified as saturated or polyunsaturated fats. The enzyme lipase (produced by the pancreas) breaks down lipids into fatty acid molecules that can be absorbed into the blood. Saturated fats are lipids in which a hydrogen atom is bonded to every position in the fatty acid chain. Saturated fats are derived from animal products and are solid at room temperature (see Figure 21-3 ■). Polyunsaturated fats are lipids that have fewer hydrogen atoms. Most polyunsaturated fats (oils) are liquids at room temperature. Vegetable oils (with the exception of coconut) contain polyunsaturated fat. lipid (LIP-id) lip/o- lipid (fat) -id resembling; source or origin saturated (SATCH-uh-ray-ted) satur/o- filled up -ated pertaining to a condition; composed of polyunsaturated (PAWL-ee-un-SATCH-uh-ray-ted) poly- many, much un- not satur/o- filled up -ated pertaining to a condition; composed of 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-36 W-36 | Chapter 21 | Dietetics Figure 21-3 ■ Saturated fats. Saturated fats in animal products and some plant products like coconut are solid at room temperature. Did You Know? Margarine begins as a polyunsaturated oil (such as corn oil). Hydrogen atoms are then added to the oil in a process known as hydrogenation. This oil is then hydrogenated, which changes its physical properties so that it remains solid at room temperature. In this form, it is known as trans fat. Both trans fat and saturated fat are undesirable in the diet because they raise the level of low-density lipoprotein (LDL), the lipoprotein carrier that deposits cholesterol on the arterial walls. Omega-3 fatty acids, which are found in fish, may help lower serum cholesterol and triglyceride levels. The American diet is very high in fat. Approximately 40 to 50% of the total daily calories come from fat. Ideally, this should be 30 to 35%. Lipid-Containing Compounds Lipid-containing compounds— cholesterol, triglycerides, lipoproteins, and phospholipids—contain fatty acids combined with another molecule. Cholesterol is a combination of fatty acids and an alcohol group. Cholesterol is an important part of bile, the sex hormones estradiol and testosterone, as well as neurotransmitters and cell membranes. Triglyceride is a combination of fatty acids and glycerol molecules. Triglycerides are stored as fat that protects the internal organs, insulates the body from the cold, provides emergency energy reserves, and holds the fat-soluble vitamins A, D, E, and K. Excessive amounts of triglycerides are stored in larger deposits as adipose tissue. Lipoproteins are a combination of fatty acids and protein molecules. They are carrier molecules that transport cholesterol and triglycerides through the blood. Phospholipids are a combination of fatty acids and phosphorus. They are carrier molecules that transport the fat-soluble vitamins A, D, E, and K through the blood. cholesterol (koh-LES-ter-awl) Cholesterol is a combination of the combining form chol/e- (bile, gall) and the suffix -sterol. Cholesterol is the main component of bile. A sterol is a chemical compound with an alcohol group (shown by the suffix -ol). triglyceride (try-GLIS-er-ide) tri- three glycer/o- glycerol (sugar alcohol) -ide chemically modified structure Add words to make a correct and complete definition of triglyceride: a chemically modified [compound of] three [fatty acids and one] glycerol. adipose (AD-ih-pohs) adip/o- fat -ose full of lipoprotein (LIP-oh-PROH-teen) lip/o- lipid (fat) prote/o- protein -in a substance phospholipid (FAWS-foh-LIP-id) phosph/o- phosphorus lip/o- lipid (fat) -id resembling; source or origin 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-37 Dietetics | Chapter 21 | W-37 Vitamins Vitamins are micronutrients that play an important role in many of the chemical reactions of metabolism. There are 13 vitamins—nine watersoluble vitamins and four fat-soluble vitamins. Water-soluble vitamins include vitamin B1 (thiamin), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B5 (pantothenic acid), vitamin B6 (pyridoxine), and vitamin B12 (cyanocobalamin), folate (folic acid), biotin, and vitamin C (ascorbic acid). With the exception of vitamins B12 and C, water-soluble vitamins are not stored in the body (see Table 21-1). Each day, the body needs to replenish its supply of these vitamin (VITE-ah-min) Vitamin is a combination of the Latin word vita (life) and the suffix -amine (chemical compound containing nitrogen and hydrogen), but with the final -e deleted. Table 21-1 Water-Soluble Vitamins Vitamin Name Pronunciation Function Dietary Sources vitamin B1 (thiamin) thiamin (THY-ah-min) Metabolizes carbohydrates Synthesizes neurotransmittors Meat, fish, whole grains, beans, nuts vitamin B2 (riboflavin) riboflavin (RY-boh-FLAY-vin) Helps body to use vitamin B6 Metabolizes amino acids, glucose, and fatty acids Meat, fish, dairy products, whole grains, vegetables, beans, nuts vitamin B3 (niacin) niacin (NY-ah-sin) Metabolizes carbohydrates Meat, fish, eggs, dairy products, whole grains, leafy green vegetables, potatoes, nuts Note: The body also makes this vitamin from the amino acid tryptophan in the diet. vitamin B5 (pantothenic acid) pantothenic acid (PAN-toh-THEN-ik AS-id) Metabolizes carbohydrates Synthesizes fatty acids Meat, fish, eggs, dairy products, whole grains, beans, nuts Note: Bacteria in the intestines produce this vitamin. vitamin B6 (pyridoxine) pyridoxine (PIR-ih-DAWK-seen) Metabolizes proteins and fats Meat, fish, eggs, whole grains, bananas, beans, nuts vitamin B12* (cyanocobalamin) cyanocobalamin (SY-an-oh-kohBAWL-ah-min) Maintains myelin sheath on nerves Helps form red blood cells Meat, fish, eggs, dairy products. There are no plant sources. Note: Bacteria in the intestines also produce a small amount of this vitamin. folate (folic acid) folate (FOH-layt) folic acid (FOH-lik AS-id) Synthesizes DNA and protein Helps form red blood cells Liver, whole grains, beans, green leafy vegetables, fruits biotin biotin (BY-oh-tin) Metabolizes carbohydrates and fats Liver, eggs, beans, vegetables, nuts Note: Bacteria in the intestines also produce this vitamin. vitamin C (ascorbic acid) ascorbic acid (ah-SKOR-bik AS-id) Protects from damage by free radicals in the environment Maintains healthy connective tissue Synthesizes protein Strengthens immune system Citrus fruits (see Figure 21-4 ■), green leafy vegetables *can only be absorbed if the stomach produces intrinsic factor 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-38 W-38 | Chapter 21 | Dietetics Figure 21-4 ■ Vitamin C. Citrus fruits are a rich source of vitamin C. vitamins through food intake or through dietary supplements. Watersoluble vitamins are destroyed by heat and prolonged cooking. The B vitamins are lost during the milling process when the outer covering of a grain like rice or wheat is removed. Manufacturers then replace the B vitamins and label the product as enriched. Megadoses of watersoluble vitamins, extremely large doses taken as dietary supplements, are mostly excreted in the urine. Fat-soluble vitamins include vitamins A, D, E, and K. Fat-soluble vitamins are stored in the fatty tissue of the body (see Table 21-2). The body draws on those stores if the amount of fat-soluble vitamins in the diet is inadequate. During the commercial processing of milk, two fatsoluble vitamins (A and D) are added to make the milk fortified. Megadoses of fat-soluble vitamins remain in the body’s fat stores and can reach toxic levels. A Closer Look Vitamin B1 was the first vitamin to be discovered; hence the designation B1. Because B1 contained a nitrogen group known as an amine, the word vitamine was created in 1912 to describe it. Later, when it was discovered that other vitamins did not have an amine group, the spelling was changed to delete the -e. megadose (MEG-ah-dohs) meg/a- large -dose measured quantity 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-39 Dietetics | Chapter 21 | W-39 Table 21-2 Fat-Soluble Vitamins Vitamin Name Pronunciation Function Dietary Sources vitamin A (retinol, retinoic acid) (betacarotene) retinol (RET-ih-nawl) Builds bones and teeth Maintains healthy retina and macula in the eyes Maintains skin and connective tissues Meat, liver, dairy products, egg yolks, fruits; green, leafy, yellow, and orange vegetables retinoic acid (RET-ih-NOH-ik AS-id) betacarotene (BAY-tah-KAIRoh-teen) Word Alert SOUND-ALIKE WORDS retinol (noun) Vitamin A in food from animal sources Example: Retinol is a form of vitamin A. retinal (adjective) Pertaining to the retina in the eye Example: The retinal artery brings oxygenated blood to the tissues of the retina. Connections Dermatology (Chapter 7). Topical vitamin A–type drugs are used to treat the skin diseases of acne vulgaris, severe cystic acne, and psoriasis. vitamin D (cholecalciferol) (ergocalciferol) cholecalciferol (KOH-lee-kal-SIFer-awl) Builds bones and teeth Helps calcium be absorbed from food Cod liver oil, eggs, dairy products, fortified milk Note: The body also makes this vitamin when sunlight reacts with cholesterol in the skin. ergocalciferol (AIR-goh-kal-SIFer-awl) vitamin E (tocopherol) tocopherol (toh-KAWF-er-awl) Maintains healthy skin and mucous membranes Strengthens the immune system Keeps blood from clotting Maintains healthy reproductive organs Protects body from damage by free radicals Meat, milk, whole grains, green leafy vegetables, nuts, oils vitamin K (phytonadione) phytonadione (FY-toh-nayDY-awn) Important in blood clotting Liver, dairy products, green leafy vegetables, fruits Note: Bacteria in the intestines make this vitamin 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-40 W-40 | Chapter 21 | Dietetics Minerals Minerals are micronutrients that are chemical elements found in the soil and water. Both plant and animal foods contain minerals because plants take up minerals as they grow, and animals ingest minerals when they eat plants (see Table 21-3). Table 21-3 Minerals Mineral Name Pronunciation Function Dietary Sources calcium calcium (KAL-see-um) Builds bones and teeth Contracts muscles Dairy products, salmon, dark green vegetables. Orange juice and milk are often fortified with calcium. iodine iodine (EYE-oh-dine) Component of thyroid hormones Seafood, iodized salt iron iron (EYE-ern) Forms red blood cells Meat, eggs, whole grains magnesium magnesium (mag-NEE-zee-um) Component of enzymes Whole grains, beans, bananas, fruits, nuts, raisins, prunes phosphorus phosphorus (FAWS-for-us) Builds bones and teeth Maintains cell membrane Meat, fish, eggs, milk, whole grains, beans, nuts potassium potassium (poh-TAS-ee-um) Contracts muscles Bananas, brewer’s yeast, dried fruits, beans, nuts, molasses sodium sodium (SOH-dee-um) Maintains fluid balance and blood pressure Conducts nerve impulses Contracts muscles Most foods and public drinking water, salt tablets zinc zinc (ZINGK) Metabolizes carbohydrates and proteins Produces testosterone and sperm Meat, shellfish, eggs, dairy products, legumes, peanut butter Connections Public Health. The Recommended Dietary Allowance (RDA) is a guideline prepared by the Food and Nutrition Board of the National Academy of Sciences. It establishes the amount of an essential nutrient that is needed to meet the nutritional needs of most healthy people. There are 18 different categories of RDAs, based on age and sex. There are also special categories for pregnant women and nursing mothers. Most water-soluble vitamins and all of the fat-soluble vitamins have a recommended dietary allowance (RDA). There is an RDA for some minerals (calcium, phosphorus, magnesium, iron, zinc, and iodine), and a recommended daily range of intake for other minerals. Carbohydrates, lipids, proteins, and fiber do not have an RDA. Sodium plays a role in the development of hypertension. The first step in treating hypertension is to put the patient on a no-added-salt or a lowsodium diet. The American Heart Association recommends a maximum daily sodium intake of 3,000 mg. However, the average American eats 4,000 to 5,000 mg of sodium each day. In November 2002, the American Public Health Association called for a 50% reduction in the sodium content of processed foods and restaurant foods. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-41 Dietetics | Chapter 21 | W-41 Physiology of Taste and Metabolism As food enters the oral cavity, food particles touch taste buds on the tongue. The taste buds contain hundreds of different taste receptors that sense the taste and relay that information to the gustatory cortex in the brain. Traditionally, the sense of taste has been thought of as having four parts: sweet, salty, sour, or bitter. A fifth taste receptor has been identified that detects umami, the savory taste found in meats, monosodium glutamate (MSG), mushrooms, aged cheese, and soy sauce. Foods are broken down into their component nutrients in the gastrointestinal system. Nutrients are absorbed from the small intestine into the blood and then distributed throughout the body. When nutrients enter a cell, intracellular enzymes break down their molecules into individual atoms. Breaking the chemical bonds between atoms releases heat and energy. The heat, which is measured in calories, is used to warm the body. The energy is stored in the intracellular molecule ATP (adenosine triphosphate) and released according to the needs of the cell. These processes go on continuously in every cell as part of the process of metabolism. Metabolism includes catabolism (breaking down molecules) and anabolism (assembling molecules). How people’s bodies use nutrients to build muscle and deposit fat is reflected in their body build or somatotype. There are three somatotypes: ectomorph, mesomorph, and endomorph. An ectomorphic body type is long and thin. A mesomorphic body type has a balanced appearance of the trunk and limbs. An endomorphic body type has a round trunk with thin extremities. gustatory (GUS-tah-toh-ree) gustat/o- the sense of taste -ory having the function of umami (yoo-MAH-mee) Umami is a Japanese word meaning good taste. calorie (KAL-oh-ree) calor/o- heat -ie a thing caloric (kah-LOR-ik) calor/o- heat -ic pertaining to metabolism (meh-TAB-oh-lizm) metabol/o- change, transformation -ism process; disease from a specific cause Some word parts have more than one definition. The best definition of metabolism is process of change or transformation. metabolic (MET-ah-BAWL-ik) metabol/o- change, transformation -ic pertaining to catabolism (kah-TAB-oh-lizm) catabol/o- breaking down -ism process; disease from a specific cause anabolism (ah-NAB-oh-lizm) anabol/o- building up -ism process; disease from a specific cause somatotype (SOH-mah-toh-type) somat/o- body -type particular kind of; a model of ectomorph (EK-toh-morf) ecto- outermost, outside morph/o- shape -ic pertaining to Add words to make a correct and complete definition of ectomorph: Pertaining to the outermost [limbs of the body and their] shape. mesomorph (MEZ-oh-morf) meso- middle morph/o- shape -ic pertaining to endomorph (EN-doh-morf) endo- innermost, within morph/o- shape -ic pertaining to Add words to make a correct and complete definition of endomorph: Pertaining to the innermost [central trunk of the body and its] shape. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-42 W-42 | Chapter 21 | Dietetics Vocabulary Review Anatomy and Physiology Now that you have studied the anatomy and physiology of dietetics and types of nutrients, take time to review those new words and descriptions. Memorize the combining forms and their definitions before going on the next section. Word or Phrase adipose tissue Combining Form and Definition adip/ofat amino acids Description Large deposits of triglycerides; body fat Building blocks of protein molecules anabolism anabol/obuilding up Assembling new molecules in the body calorie calor/oheat Measurement of the amount of heat produced when food is metabolized carbohydrates carb/ocarbon atoms hydr/owater; fluid Category of macronutrient that includes monosaccharides, disaccharides, and polysaccharides catabolism catabol/obreaking down Breaking down of molecules in the body cellulose cellul/ocell Polysaccharide type of carbohydrate. Example: Fiber found in plants. cholesterol Lipid-containing compound that is a component of bile (from the gallbladder), sex hormones, neurotransmitters and cell membranes complete protein prote/oprotein A food that contains all nine essential amino acids. Foods from animal sources are complete proteins. dextrose dextr/oright Manufactured sugar that is the right-handed version of naturally occurring glucose. Used in intravenous fluids. Also known as D-glucose. disaccharides sacchar/osugar Carbohydrates composed of two sugar molecules. Examples: Sucrose, lactose. enriched Grain products that contain added B vitamins to replace what was lost during the milling process essential amino acid Amino acid that the body must obtain from foods in the diet. There are nine of these. essential nutrient Nutrient that the body cannot produce itself and must obtain from foods in the diet fortified Milk that contains added vitamins A and D fructose fruct/ofruit Monosaccharide type of carbohydrate. Fructose is the simple sugar that is in fruit. gustatory cortex gustat/othe sense of taste Area of the brain that identifies the different tastes of food: sweet, salty, sour, bitter, and umami glycogen glyc/oglucose (sugar) Glucose in its stored form in the liver and skeletal muscles 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-43 Dietetics | Chapter 21 | W-43 Combining Form and Definition Description glucose gluc/oglucose (sugar) Monosaccharide type of carbohydrate. Glucose is the simple sugar that is in the blood. incomplete protein prote/oprotein A food that does not contain all nine essential amino acids. Foods from vegetable sources are incomplete proteins (with the exception of soy beans). lactose lact/omilk Disaccharide type of carbohydrate. Lactose is the sugar in milk that comes from humans and animals. lipid lip/olipid (fat) Category of macronutrient that includes saturated and polyunsaturated fats lipoprotein lip/olipid (fat) prote/oprotein Lipid-containing compound that carries cholesterol and triglycerides through the blood macronutrient nutri/onourishment Nutrient that the body needs in large amounts each day. Examples: Carbohydrates, proteins, and lipids. megadose meg/alarge Extremely large dose of a vitamin metabolism metabol/ochange, transformation The ongoing cycle of anabolism and catabolism Word or Phrase minerals Micronutrients in the soil and water that are taken up by plants and by animals that eat plants. Minerals include calcium, iodine, iron, potassium, sodium, and so forth. micronutrient nutri/onourishment Nutrient that the body needs in very small amounts. Examples: Vitamins, minerals. monosaccharides sacchar/osugar Carbohydrates composed of a single sugar molecule. Examples: Glucose, fructose. nutrient nutri/onourishment Substance that provides nourishment to the body nutrition nutri/onourishment Process by which the body uses food to meet its needs for nourishment, growth, and reproduction pectin pect/ostiff Polysaccharide type of carbohydrate from fruits. Example: Used to thicken jams and jellies. phospholipid phosph/ophosphorus lip/olipid (fat) Lipid-containing compound that carries vitamins A, D, E, and K through the blood polysaccharides sacchar/osugar Carbohydrates composed of three or more sugar molecules. Examples: Starch, cellulose, and pectin. polyunsaturated fats satur/ofilled up Category of lipids that are liquid (oils) at room temperature and come from vegetable sources protein prote/oprotein Category of macronutrient that is composed of amino acids. Proteins are used to build tissues, enzymes, hormones, neurotransmitters, antibodies, and so forth. saturated fats satur/ofilled up Category of lipids in which a hydrogen atom is bonded to every position on the fatty acid chain. Animal products contain saturated fat. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-44 W-44 | Chapter 21 | Dietetics Word or Phrase somatotype Combining Form and Definition somat/obody morph/oshape Description Body build. The three somatotypes are ectomorphic (long and thin), mesomorphic (balanced body type), and endomorphic (round trunk with thin extremities). starch Polysaccharide type of carbohydrate. Examples: Corn starch (used for cooking) and dusting powder. sucrose sucr/osugar (cane sugar) trans fat triglyceride Disaccharide type of carbohydrate. Sucrose from sugar cane is made into table sugar. Saturated fat that is made by adding hydrogen atoms (hydrogenation) to polyunsaturated fat glycer/oglycerol (sugar alcohol) Lipid-containing compound that is a reservoir for vitamins A, D, E, and K. Stored triglycerides are energy reserves. Larger deposits are adipose tissue. umami Savory taste found in meats, soy sauce, and other foods. There is a taste receptor for it on the tongue (along with the sweet, salty, sour, and bitter taste receptors). vitamins Micronutrients that participate in the chemical reactions of metabolism. Fat-soluble vitamins include vitamins A, D, E, and K. Water-soluble vitamins include vitamins B1, B2, B3, B5, B6, B12, biotin, folate, and vitamin C. Building Medical Words Combining Forms Here are the combining forms you have learned so far. Next to each combining form, write its meaning. Use the Answer Key to check your answers. The first one has been done for you. Combining Form Medical Meaning Combining Form Medical Meaning 1. hydr/o- water; fluid _______________________________ 17. macr/o- _______________________________ 2. adip/o- _______________________________ 18. meg/a- _______________________________ 3. anabol/o- _______________________________ 19. metabol/o- _______________________________ 4. calor/o- _______________________________ 20. micr/o- _______________________________ 5. carb/o- _______________________________ 21. mon/o- _______________________________ 6. catabol/o- _______________________________ 22. morph/o- _______________________________ 7. cellul/o- _______________________________ 23. nutri/o- _______________________________ 8. dextr/o- _______________________________ 24. nutriti/o- _______________________________ 9. dietet/o- _______________________________ 25. pect/o- _______________________________ 10. fruct/o- _______________________________ 26. phosph/o- _______________________________ 11. gluc/o- _______________________________ 27. prote/o- _______________________________ 12. glycer/o- _______________________________ 28. sacchar/o- _______________________________ 13. glyc/o- _______________________________ 29. satur/o- _______________________________ 14. gustat/o- _______________________________ 30. somat/o- _______________________________ 15. lact/o- _______________________________ 31. sucr/o- _______________________________ 16. lip/o- _______________________________ 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-45 Dietetics | Chapter 21 | W-45 Combining Forms and Suffixes Read the definition hint for the medical word you are to build. Look at the combining form that is given. Write the correct suffix on the blank line. Then write the medical word. (Remember: You may need to remove the combining vowel. Always remove the hyphens and slash.) Use the Answer Key to check your answers. The first one has been done for you. SUFFIX LIST -ated (pertaining to a condition) -ent (pertaining to) -gen (that which produces) -ic (pertaining to) -ics (knowledge, practice) -id (resembling; source or origin) -ism (process; disease from a specific cause) Definition Hint Combining Form Suffix calor/o- -ic -ory (having the function of) -ose (full of) -tion (a process; being or having) Write the Medical Word caloric ____________________________ 1. Pertaining to heat 2. Knowledge or practice of foods and diet dietet/o- __________ ____________________________ 3. Process of change and transformation metabol/o- __________ ____________________________ 4. Having the function of taste gustat/o- __________ ____________________________ 5. Full of fat adip/o- __________ ____________________________ 6. Process of nourishment nutri/o- __________ ____________________________ 7. Resembling fat lip/o- __________ ____________________________ 8. That which produces glucose glyc/o- __________ ____________________________ 9. Pertaining to a condition of being filled up satur/o- __________ ____________________________ 10. Full of sugar gluc/o- __________ ____________________________ 11. Pertaining to nourishment nutri/o- __________ ____________________________ 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-46 W-46 | Chapter 21 | Dietetics Diets Word or Phrase ADA diet Word Part and Definition diabetic (DY-ah-BET-ik) diabet/o- diabetes -ic pertaining to diet (DY-et) Description Follows the guidelines of the American Diabetes Association (ADA). The physician specifies the upper limit for the total daily number of calories. Example: 1500-calorie ADA diet. The diet is balanced, but the amount of carbohydrates and fats is limited. Also known as a diabetic diet. Word Alert SOUND ALIKE WORDS diabetic (adjective) a descriptive word for a patient with diabetes mellitus or a diet for that patient Example: Patients with type 2 diabetes mellitus are often treated with a diabetic diet and an oral antidiabetic medicine. dietetic balanced diet (adjective) a descriptive word pertaining to foods and diets Example: The dietetic department is planning a large banquet for all staff members. Contains all of the essential nutrients in the proper amounts to ensure good nutrition and health. As a guide to a balanced diet and daily food choices, the first food groups were created in 1940. In 1992, the U.S. Department of Agriculture and the U.S. Department of Health and Human Services created the food pyramid. It was revised and updated in 2005 (see Figure 21-5 ■). GRAINS 6 oz. VEGETABLES 2.5 cups FRUITS 2 cups SWEETS AND OIL sparingly DAIRY 3 cups MEATS AND BEANS 5.5 oz. Figure 21-5 ■ New Food Pyramid. The new food pyramid was introduced in 2005. The concept of a serving size was also updated: one serving of fruits or vegetables equals the size of a baseball, one serving of potato equals the size of a computer mouse, and one serving of meat or fish equals the size of a bar of soap. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-47 Dietetics | Chapter 21 | W-47 Word or Phrase Word Part and Definition bland diet challenge diet Description Not stimulating, free from spices, “hot” foods, caffeine, and so forth elimination (ee-LIM-ih-NAY-shun) elimin/o- expel, remove -ation a process; being or having Test diet for patients suspected of having allergies. After the patient fasts, one food at a time is added until an allergic response is detected. Also known as an elimination diet because all foods are eliminated and then only one is introduced at a time. clear liquid diet Used before surgery (so that the patient will have no stomach contents to aspirate during surgery) or after surgery (to allow the digestive system time to recover function). It consists of clear juice, tea, carbonated soda, gelatin, clear broth, and popsicles. fad diet Contradicts accepted nutritional information and stresses eating only one food or food combination to the exclusion of others, or claims it will produce a quick weight loss that is not realistic. full liquid diet Used after surgery as the patient progresses from a clear liquid diet to a regular diet. It consists of milk, ice cream, pudding, and cream soup, as well as foods included in a clear liquid diet. gluten-free diet gluten (GLOO-ten) Gluten is a Latin word meaning glue. Gluten is the protein in wheat flour that gives bread dough its sticky, elastic quality. high-fiber diet kosher diet Diet for patients who are allergic to gluten. It is free of wheat and wheat products. Used to promote regular elimination; prevent constipation, diverticulosis, and hemorrhoids; and decrease the incidence of colon cancer. Dietary fiber is not digested. It passes through the large intestine, absorbing water and making the stool softer and bulkier. kosher (KOH-sher) Excludes foods from unclean animals (pork, shellfish, and so forth) and also follows the dietary laws of Judaism for food preparation. low-cholesterol diet Limits the intake of dietary cholesterol. It is prescribed as the first step in trying to control elevated levels of cholesterol in the blood. low-sodium diet Limits the amount of sodium in the diet. The physician specifies the upper limit for total daily intake of sodium. Example: 2-gram sodium diet. It is prescribed for patients with hypertension and heart disease. A no-added-salt diet restricts the use of table salt sprinkled on foods or added during cooking. mechanical soft diet Excludes raw fruits, raw vegetables, and whole nuts and modifies the texture of other foods (meat is ground up). It is prescribed for patients who have difficulty chewing or swallowing regular foods, including patients who have had a stroke; had surgery on the mouth, teeth, or throat; or are edentulous. Also known as a dental soft diet. n.p.o. The Latin abbreviation n.p.o. stands for nil per os (nothing through the mouth). Absence of a diet and food intake. Patients who are n.p.o. are not given any food or water, usually for a specified period of time prior to surgery. Postoperatively, they can resume p.o. intake. puree diet puree (pyoo-RAY) (pyoo-REE) Puree is a French word meaning purified. Uses foods pureed in a blender and thickened to a specific consistency. Foods such as mashed potatoes, applesauce, or hot oatmeal are served as is. Pureed foods are prescribed for patients who have a significant difficulty with chewing or swallowing and are unable to tolerate a mechanical soft diet. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-48 W-48 | Chapter 21 | Dietetics Word or Phrase Word Part and Definition regular diet Description Provides a balanced variety of foods suitable for a hospitalized patient who has no special dietary restrictions (see Figure 21-6 ■). Figure 21-6 ■ Regular diet. A regular diet includes all foods with no restrictions as to calories, foods, or food texture. In the hospital, this is also known as the house diet. subsistence diet Provides barely enough nutrients for the body to subsist on, with no extra nutrients available for growth, reproduction, etc. tea-and-toast diet Eaten by some elderly people. This diet is limited in variety (tea and toast are the main components), low in nutrients, but is quick to fix, easy to chew, and comforting to eat. thickened liquids Includes regular solid food, but liquids are thickened with cornstarch or a commercial thickener to a consistency specified by the dietitian. Used for patients who have a tendency to aspirate thin liquids. vegetarian diet vegetarian (VEJ-eh-TAIR-ee-an) veget/o- vegetable -arian pertaining to a person vegan (VEE-gan) lactoovovegetarian (LAK-toh-OH-voh-VEJ-ehTAIR-ee-an) lact/o- milk ov/o- egg veget/o- vegetable -arian pertaining to a person Consists entirely of fruits, vegetables, grains, nuts, and seeds. It specifically excludes all animal foods and foods produced by animals like milk and eggs. Vegetarians are also known as vegans while lactoovovegetarians eat a vegetarian diet as well as milk and eggs. Did You Know? The Greek philosopher Pythagoras is considered the father of vegetarianism. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-49 Dietetics | Chapter 21 | W-49 Symptoms, Signs, and Diseases Word or Phrase cachexia Word Part and Definition cachexia (kah-KEK-see-ah) cac/o- bad, poor hex/o- habitual condition of the body -ia condition, state, thing Description Generalized weight loss, muscle wasting, and malnutrition. Often present in the elderly who have both malnutrition and several chronic diseases. Treatment: Correct the underlying cause. cachectic (kah-KEK-tik) cac/o- bad, poor hec/o- habitual condition of the body -tic pertaining to emaciation emaciation (ee-MAY-see-AA-shun) emaci/o- to make thin -ation a process; being or having Excessive weight loss, muscle wasting, and malnutrition often associated with several different chronic diseases. Treatment: Correct the underlying cause. emaciated (ee-MAY-see-aa-ted) emaci/o- to make thin -ated pertaining to a condition; composed of failure to thrive Failure of a child to develop physically according to age-specific height and weight charts. Can be due to diseases of the endocrine or gastrointestinal systems or poor nutrition. Treatment: Correct the underlying cause. food allergies Allergic reaction that commonly occurs to eggs, wheat, citrus fruits, milk, and chocolate, but many other foods cause allergies as well. Food allergies in infants can manifest themselves as eczema or colic. Treatment: Avoidance of those foods, allergy shots. food poisoning Caused by eating food that has been improperly prepared, refrigerated, canned, or stored. Treatment: Correct the underlying cause. Connections botulism (BAWT-yoo-lizm) botul/o- sausage -ism process; disease from a specific cause Add words to make a correct and complete definition of botulism: a disease from a specific cause [of a bacterium that is shaped like a] sausage. Microbiology. Large numbers of bacteria in spoiling food cause gastrointestinal symptoms in anyone who eats the food. Campylobacter is found in undercooked poultry, unpasteurized milk, and raw eggs. Salmonella is found in undercooked meat and raw eggs. Escherichia coli is found in undercooked beef that was contaminated with feces during the slaughtering process. Staphylococcus aureus, found in the nose and throat of food handlers, is transferred to food by the hands. Both the bacteria and the toxin it produces can cause food poisoning. Clostridium botulinum occurs when low-acid foods have been improperly canned (usually home canning) or when cans are damaged. The bacteria grow without oxygen and multiply until the ends of the can bulge from the pressure. The toxin from this bacterium affects the muscles and nervous system and can cause death. This condition is called botulism. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-50 W-50 | Chapter 21 | Dietetics Word or Phrase Word Part and Definition gluten enteropathy gluten (GLOO-ten) enteropathy (EN-ter-AWP-ah-thee) enter/o- intestine -pathy disease, suffering Description Weight loss and tissue damage in the small intestine caused by the immune response’s reaction to the gluten in wheat products. Gluten is the protein in wheat that gives dough its elastic quality. This disease is also known as celiac disease. Treatment: Avoidance of wheat products. celiac (SEE-lee-ak) celi/o- abdomen -ac pertaining to lactose intolerance malnutrition Decreased amount of the enzyme lactase that is needed to digest the sugar in milk (lactose). Lactose intolerance is common in persons from Asia, Africa, or South America. It also occurs as part of the aging process in people over age 50. It causes bloating and diarrhea as bacteria in the intestine eat undigested lactose and form gas. Treatment: Avoid dairy products. Take the dietary supplements LactAid or Dairy Ease, which contain lactase. malnutrition (MAL-noo-TRISH-un) mal- bad; inadequate nutri/o- nourishment -tion a process; being or having General state of inadequate nutrition caused by too little food, poor food selection, or malabsorption (inadequate absorption of nutrients). Treatment: Correct the underlying cause. malabsorption (MAL-ab-SORP-shun) mal- bad; inadequate absorpt/o- absorb or take in -ion action; condition micronutrient deficiency diseases deficiency (de-FISH-en-see) defici/o- lacking, inadequate -ency condition of being Decreased levels of a specific micronutrient can be associated with a disease (see Table 21-4). Treatment: Dietary supplement of the micronutrient. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-51 Dietetics | Chapter 21 | W-51 Table 21-4 Micronutrient Deficiency Diseases Micronutrient Symptoms, Signs, and Diseases vitamin B1 beriberi* vitamin B2 changes in the skin and eye tissues vitamin B3 pellegra* vitamin B12 pernicious anemia, damage to the peripheral nerves folate neural tube defect in the fetus, folic acid deficiency anemia vitamin C poor wound healing, bleeding gums, scurvy,* weakened immune response vitamin A nightblindness, softening of the cornea, dry eyes vitamin D osteomalacia, osteoporosis, rickets* vitamin K prolonged clotting time, hemorrhagic disease of the newborn calcium osteoporosis iodine goiter iron iron deficiency anemia potassium muscle weakness, cardiac arrhythmias sodium low blood pressure zinc poor wound healing, decreased sense of smell and taste *Seldom seen in the United States Micronutrients not included in this table have no obvious diseases associated with their deficiency. A vitamin B6 deficiency is rare because vitamin B6 is found in most foods. Deficiencies of vitamin E and biotin are rare. Word or Phrase obesity Word Part and Definition obesity (oh-BEE-sih-tee) obes/o- fat -ity state; condition obese (oh-BEES) Obese is derived from a Latin word meaning to devour. exogenous (eks-AWJ-eh-nus) (ek-SAWJ-eh-nus) ex/o- away from, external, outward gen/o- arising from; produced by -ous pertaining to endogenous (en-DAWJ-eh-nus) endo- innermost, within gen/o- arising from; produced by -ous pertaining to Description Overweight condition with large deposits of adipose tissue. Categories include exogenous (originating from an external source, i.e., overeating) or endogenous (originating from an internal source, i.e., due to endocrine gland disorders). An obese person has a body mass index (BMI) of 30 or higher. On standard height/weight tables, mild obesity is greater than 20% over the normal weight for the person’s height. Morbid obesity is the condition of weighing at least 2 times more than the ideal body weight. Large amounts of adipose tissue in the abdominal area form an abdominal panniculus. Obesity increases the likelihood of developing diabetes mellitus and osteoarthritis. Treatment: Weight loss. (continued) 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-52 W-52 | Chapter 21 | Dietetics Word or Phrase obesity (continued) Word Part and Definition morbid (MOR-bid) morb/o- disease -id resembling; source or origin panniculus (pah-NIK-yoo-lus) Panniculus is a Latin word meaning sheet of cloth. A panniculus lies across the abdomen like a sheet or an apron. Description Across the Life Span One in four children in America is overweight. This is due to a decrease in physical activity (more time spent watching TV and playing computer games, less time playing outside, fewer hours in gym class at school) and eating an extra 200 calories per day. For nursing home residents, a weight loss of 5% or more in a month or greater than 10% in the last 6 months must be reported by law to the state government by dietitians or nurses who work with the resident. phenylketonuria (PKU) phenylketonuria (FEN-il-KEE-toh-NYOO-ree-ah) Phenylketonuria is a combination of phenyl- (short for the amino acid phenylalanine), keton/o(ketones), and the suffix -uria (substance in the urine). Inherited metabolic disorder. There is a deficiency of an enzyme that changes the essential amino acid phenylalanine into another amino acid that is needed to build nearly every protein in the body. Phenylalanine is in human milk and infant formula. Without the enzyme, phenylalanine accumulates in the blood and causes mental retardation. Excess levels spill into the urine and are detected by the PKU test. To be accurate, this test is not done until the newborn has taken milk feedings regularly for three days. Treatment: Protein-restricted diet, sometimes for life. pica pica (PY-kah) (PEE-kah) Pica is a Latin word meaning magpie. Magpies are birds that collect unusual materials like metal or plastic to put in their nests. Unnatural craving for and compulsive eating of substances with no nutritional value, such as clay, chalk, dirt, starch, paint, ice, plaster, or hair. Seen in pregnant women or persons with an iron or zinc deficiency. Treatment: Correct underlying mineral deficiency. polyphagia polyphagia (PAWL-ee-FAY-jee-ah) poly- many, much phag/o- eating, swallowing -ia condition, state, thing Excessive overeating. Caused by an overactive thyroid gland, diabetes mellitus, or a psychiatric illness. Treatment: Correct the underlying cause. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-53 Dietetics | Chapter 21 | W-53 Diagnostic Procedures Word or Phrase albumin Word Part and Definition albumin (al-BYOO-min) Description Blood test that measures the level of albumin (the most abundant protein in the blood). Decreased levels affect the body’s ability to build new tissue and heal wounds. This test is used to monitor patients who have malnutrition, burns, nonhealing wounds, or decubitus ulcers. Word Alert SOUND-ALIKE WORDS albumen (noun) egg white Example: Albumen is the protein found in egg whites. albumin (noun) major protein in the plasma of the blood Example: The physician ordered a serum albumin level because the patient’s wound was not healing well. blood smear Blood test that examines the size, shape, and color of red blood cells under the microscope to detect anemia caused by dietary deficiencies of iron, folate, or vitamin B12. fasting blood sugar (FBS) Blood test that measures the level of glucose in the blood after the patient has fasted. Elevated levels may indicate diabetes mellitus. lipid profile Blood test that measures the levels of cholesterol and triglycerides, as well as the lipoproteins (HDL, LDL, and VLDL) that carry them through the blood. Schilling test Schilling (SHIL-ing) The Schilling test was named by Victor Schilling (1883–1960), a German hematologist. This is an example of an eponym: a person from whom something takes its name. Urine test that measures the amount of radioactive vitamin B12 excreted in the urine. Radioactive vitamin B12 is given orally, with and without intrinsic factor. Patients with pernicious anemia will only be able to absorb the vitamin B12 (and excrete it in the urine) if it is given with intrinsic factor. Medical and Surgical Procedures Word or Phrase body mass index (BMI) Word Part and Definition Description Most accurate way to relate the weight to the height of a patient. It is calculated as the weight in kilograms divided by the height in meters squared. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-54 W-54 | Chapter 21 | Dietetics Word or Phrase Word Part and Definition skin fold measurement Description The width of a skin fold can be used to estimate the percentage of body fat (see Figure 21-7 ■). Figure 21-7 ■ Skin fold measurement. The skin of the biceps, triceps, upper back, abdomen, or thigh is pinched and then measured with skin calipers to estimate the percentage of body fat. feeding tube nasogastric (NAY-zoh-GAS-trik) nas/o- nose gastr/o- stomach -ic pertaining to gastrostomy (gas-TRAWS-toh-mee) gastr/o- stomach -stomy surgically created opening jejunostomy (JEH-jyoo-NAWS-toh-mee) jejun/o- jejunum -stomy surgically created opening intravenous (IV) fluids intravenous (IN-trah-VEE-nus) intra- within ven/o- vein -ous pertaining to Tube used to provide temporary or extended access to the gastrointestinal tract for the purposes of feeding. A nasogastric (NG) tube is a long, flexible tube inserted through the nose and passed into the stomach. A gastrostomy is a surgically created stoma (opening) in the abdominal wall with a short tube inserted into the stomach. A jejunostomy is a stoma in the abdominal wall with a short tube into the jejunum. Did You Know? The first nasogastric tube was developed in the late 1700s and consisted of eel skin. It was used for five weeks to feed a patient. Provide hydration and calories to patients who temporarily cannot eat, usually due to surgery. The most commonly used intravenous fluids contain dextrose, saline, electrolytes, or a combination of these. intravenous lipids Specially formulated solution of soybean or safflower oil, water, and egg yolk. It provides essential fatty acids and extra calories to patients who cannot eat and do not have a feeding tube. intravenous vitamins Specially formulated combination of 12 vitamins: nine water-soluble vitamins and three fat-soluble vitamins (A, D, and E). It is prescribed for patients who cannot eat and do not have a feeding tube. obesity surgery Used to help severely obese patients lose weight. The stomach is stapled (gastric stapling) to form a small pouch to which the intestine is attached. The patient is only able to eat small amounts of food at a time. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-55 Dietetics | Chapter 21 | W-55 Word or Phrase total parenteral nutrition (TPN) Word Part and Definition parenteral (pah-REN-ter-al) par- beside enter/o- intestine -al pertaining to The parenteral route of administration is beside (different from) the oral route that involves the intestines. Description Intravenous fluid that provides essential amino acids, electrolytes, vitamins, and minerals—all the nutrients that are lacking in standard intravenous fluids and intravenous lipids. TPN is also known as hyperalimentation. hyperalimentation (HY-per-AL-ih-men-TAY-shun) hyper- above; more than normal aliment/o- food, nourishment -ation a process; being or having Drug Categories Several different categories of drugs are used to treat the symptoms, signs, and diseases associated with dietetics. The most common drugs in each category are listed. Category Word Analysis Description Examples liquid nutritional supplements Liquid formulas given through feeding tubes Compleat, Ensure, Resource MCT oil Easy-to-digest oil dietary supplement given to very young and very old patients. It contains medium-chain triglycerides (MCT). vitamin B12 Given by intramuscular injection or intraNascobal nasally as a gel to treat vitamin B12 deficiency and pernicious anemia vitamin D Used with calcium supplements and other drugs to promote bone growth in patients with osteoporosis vitamin K Given by intramuscular injection to newborns to prevent hemorrhagic disease of the newborn AquaMEPHYTON weight-loss drugs Used to treat obesity, in conjunction with a reduced-calorie diet. Some are central nervous system stimulants that decrease the appetite. Others prevent fats from being absorbed in the intestines Meridia, Xenical 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-56 W-56 | Chapter 21 | Dietetics Abbreviations ADA American Diabetes Association, American Dietetic Association HFCS high fructose corn syrup NG nasogastric BMI body mass index RD registered dietitian CDE certified diabetes educator RDA recommended dietary allowance CNS certified nutrition specialist TPN total parenteral nutrition DTR dietetic technician, registered WDWN well-developed, well-nourished (person) FBS fasting blood sugar Word Alert ABBREVIATIONS Abbreviations are commonly used in all types of medical documentation; however, they can mean different things to different people and their meaning can be misinterpreted. Always verify that the meaning of the abbreviation makes sense in the context of the report. ADA stands for the American Diabetes Association, the American Dietetic Association, and the American Dental Association. CNS stands for certified nutrition specialist, but it also stands for central nervous system. It also sounds nearly identical to C&S, which stands for culture and sensitivity. DTR stands for dietetic technician, registered, but it also stands for deep tendon reflexes. Career Focus Dietitians are allied health professionals with expertise in foods, diets, and menu planning. They motivate and assist patients in choosing healthy, balanced diets to prevent disease or help them select foods that fit a specific diet recommended or prescribed by their physician. Dietitians work in hospitals, clinics, and physician offices. Family pratice physicians, internal medicine physicians, and specialists in endocrinology or bariatrics treat patients with obesity. Gastroenterologists perform obesity surgery and gastrostomy and jejunostomy surgery. dietitian (DY-eh-TISH-un) diet/o- foods, diet -itian a skilled professional or expert bariatrics (BAR-ee-AT-riks) bar/o- weight iatr/o- physician; medical treatment -ics knowledge, practice Meet Karyn, a dietitian. I decided to become a dietician when I was working in food service as a food service worker. I was looking around for a career and thought about becoming a nurse but decided that I already had a lot of experience in food service. In my first job as a dietician, I worked at a small community hospital. The exciting thing about being a dietician is that there’s always a challenge every day. Every patient is very different. All the types of clinical cases that we see can range from diabetes to pancreatitis to tube feedings to parenteral feedings, and you have to learn to adjust everything that you do according to each patient that you see. Each week, on different units, we have multidisciplinary care plan rounds that involve nurses, care managers, physical therapy, pharmacy, and dieticians. Dieticians treat people who weigh too much, people who have cardiac conditions and diabetes, the very elderly who have lost a lot of weight, patients who have cancer, premature infants who are growing, as well as pediatric cases and adults with different types of gastrointestinal disorders. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-57 Dietetics | Chapter 21 | W-57 CHAPTER REVIEW EXERCISES Review all the material in this chapter by completing the review exercises in this section. Use the Answer Key to check your answers. Anatomy and Physiology Matching Exercise Match each numbered word or phrase to its description. 1. visual cortex _____ Pertaining to the sense of taste 2. metabolism _____ Sugar found in milk 3. lipase _____ Enzyme that breaks down fats into fatty acids 4. lactose _____ All chemical reactions in the body 5. umami _____ Memories of food 6. olfactory _____ Pertaining to the sense of smell 7. limbic system _____ A type of taste receptor 8. gustatory _____ Where the sight of food is processed True or False Indicate whether each statement is true or false by writing T or F on the line. 1. ____ Nutrition is the process by which the body uses nutrients for nourishment, growth, and reproduction. 2. ____ Proteins and carbohydrates are examples of micronutrients. 3. ____ The body stores extra glucose in the liver and skeletal muscles in the form of sucrose. 4. ____ The sugar found in fruits is known as fructose. 5. ____ Saccharin was the first artificial sweetener. 6. ____ Protein molecules are the building blocks of amino acids. 7. ____ Most saturated fats come from animals. 8. ____ Adipose tissue is composed of deposits of cholesterol. 9. ____ Trans fat is oil that has been hydrogenated so that it is solid. 10. ____ Vitamins A, B, C, and D are the fat-soluble vitamins. 11. ____ Grains that are milled and then have the B vitamins replaced are said to be enriched. 12. ____ A body build that is long and thin is known as an endomorph. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-58 W-58 | Chapter 21 | Dietetics Matching Exercise Match each numbered word or phrase to its description. 1. calcium _____ Also known as niacin 2. iodine _____ Also known as retinoic acid 3. iron _____ Vitamin that forms red blood cells 4. vitamin A _____ Mineral found in bones and teeth 5. vitamin B3 _____ Body makes this when sunlight hits the skin 6. vitamin B12 _____ Important in blood clotting 7. vitamin D _____ Mineral found in thyroid hormones 8. vitamin E _____ Mineral that forms red blood cells 9. vitamin K _____ Protects body from free radicals Multiple Choice Circle the best answer to the question from the answers provided. 1. What is a nutrient? a. b. c. d. 2. Vitamin B12 can only be absorbed if the stomach produces sufficient amounts of ______________________________. a. b. c. d. 3. amylase free radicals intrinsic factor pepsin Milk with added vitamins A and D is said to be ______________________________. a. b. c. d. 4. a substance contained in food or manufactured by the body a recommended daily allowance glucose stored in the liver a complete protein fortified a megadose a dietary supplement enriched ______________________________ are micronutrients found in the soil and water. a. b. c. d. Lipids Sugars Minerals Vitamins 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-59 Dietetics | Chapter 21 | W-59 Medical Language Word Parts Name That Word Part Identify each of the word parts given here by writing the correct letter (P, C, or S) on the line beside it. Then write the definition of the word part on the blank line. The first one has been done for you. Prefix = P Combining Form = C Word Part Definition Suffix = S Word Part Definition 1. -al S _______ pertaining to ___________________ 34. fruct/o- _______ ___________________ 2. absorpt/o- _______ ___________________ 35. gastr/o- _______ ___________________ 3. -ac _______ ___________________ 36. -gen _______ ___________________ 4. adip/o- _______ ___________________ 37. gen/o- _______ ___________________ 5. aliment/o- _______ ___________________ 38. gluc/o- _______ ___________________ 6. anabol/o- _______ ___________________ 39. glycer/o- _______ ___________________ 7. -arian _______ ___________________ 40. glyc/o- _______ ___________________ 8. -ate _______ ___________________ 41. gustat/o- _______ ___________________ 9. -ated _______ ___________________ 42. hec/o- _______ ___________________ 10. -ation _______ ___________________ 43. hex/o- _______ ___________________ 11. bar/o- _______ ___________________ 44. hydr/o- _______ ___________________ 12. botul/o- _______ ___________________ 45. hyper- _______ ___________________ 13. cac/o- _______ ___________________ 46. -ia _______ ___________________ 14. calor/o- _______ ___________________ 47. iatr/o- _______ ___________________ 15. carb/o- _______ ___________________ 48. -ic _______ ___________________ 16. catabol/o- _______ ___________________ 49. -ics _______ ___________________ 17. celi/o- _______ ___________________ 50. -id _______ ___________________ 18. cellul/o- _______ ___________________ 51. -ide _______ ___________________ 19. defici/o- _______ ___________________ 52. -ie _______ ___________________ 20. dextr/o- _______ ___________________ 53. -in _______ ___________________ 21. di- _______ ___________________ 54. intra- _______ ___________________ 22. diabet/o- _______ ___________________ 55. -ion _______ ___________________ 23. dietet/o- _______ ___________________ 56. -ism _______ ___________________ 24. diet/o- _______ ___________________ 57. -itian _______ ___________________ 25. -dose _______ ___________________ 58. -ity _______ ___________________ 26. ecto- _______ ___________________ 59. jejun/o- _______ ___________________ 27. elimin/o- _______ ___________________ 60. lact/o- _______ ___________________ 28. emaci/o- _______ ___________________ 61. lip/o- _______ ___________________ 29. -ency _______ ___________________ 62. macr/o- _______ ___________________ 30. endo- _______ ___________________ 63. mal- _______ ___________________ 31. -ent _______ ___________________ 64. meg/a- _______ ___________________ 32. enter/o- _______ ___________________ 65. meso- _______ ___________________ 33. ex/o- _______ ___________________ 66. metabol/o- _______ ___________________ 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-60 W-60 | Chapter 21 | Dietetics Word Part Definition Word Part Definition 67. micr/o- _______ ___________________ 83. phosph/o- _______ ___________________ 68. mon/o- _______ ___________________ 84. poly- _______ ___________________ 69. morb/o- _______ ___________________ 85. prote/o- _______ ___________________ 70. morph/o- _______ ___________________ 86. sacchar/o- _______ ___________________ 71. nas/o- _______ ___________________ 87. satur/o- _______ ___________________ 72. nutri/o- _______ ___________________ 88. somat/o- _______ ___________________ 73. nutriti/o- _______ ___________________ 89. -stomy _______ ___________________ 74. obes/o- _______ ___________________ 90. sucr/o- _______ ___________________ 75. -ory _______ ___________________ 91. -tic _______ ___________________ 76. -ose _______ ___________________ 92. -tion _______ ___________________ 77. -ous _______ ___________________ 93. tri- _______ ___________________ 78. ov/o- _______ ___________________ 94. -type _______ ___________________ 79. par- _______ ___________________ 95. un- _______ ___________________ 80. -pathy _______ ___________________ 96. veget/o- _______ ___________________ 81. pect/o- _______ ___________________ 97. ven/o- _______ ___________________ 82. phag/o- _______ ____________________ Word-Building Exercise Use the combining forms, prefixes, and suffixes given here to build words that match the definitions given. Write the word you build on the blank line. Some word parts may be used more than once. The first one has been done for you. Word Parts adip/o- (fat) calor/o- (heat) -dose (measured quantity) -ent (pertaining to) gastr/o- (stomach) gluc/o- (sugar, glucose) gustat/o- (the sense of taste) -ie (a thing) -ity (state; condition) meg/a- (large) nutri/o- (nourishment) obes/o- (fat) -ory (having the function of) -ose (full of) -stomy (surgically created opening) somat/o- (body) -tion (a process; being or having) -type (particular kind of; a model of) (You think nutri/o- + -ent). You write nutrient ____________________________________________________ 1. Pertaining to nourishment 2. Having the function of the sense of taste ____________________________________________________________________________ 3. A surgically created opening in the stomach __________________________________________________________________________ 4. A process of nourishment __________________________________________________________________________________________ 5. Full of sugar ______________________________________________________________________________________________________ 6. Full of fat _________________________________________________________________________________________________________ 7. Large measured quantity ___________________________________________________________________________________________ 8. A thing that is a measurement of heat _______________________________________________________________________________ 9. Particular kind of a body ___________________________________________________________________________________________ 10. A state of being fat ________________________________________________________________________________________________ 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-61 Dietetics | Chapter 21 | W-61 Nutrients and Diet Unscramble and Match Unscramble the word and write the correct spelling in the blank provided. Then match the word with its definition or description in the right-hand column. The first one has been done for you. 1. tied diet _____________________ _____ Sugar in the bloodstream 2. scroues _____________________ _____ Wheat protein that makes bread rise 3. rupee _____________________ _____ Diet that excludes animal foods 4. gleunt _____________________ 1 Combinations of nutrients and foods _____ 5. spplioeiornt _____________________ _____ Diet where foods are processed in a blender 6. laetof _____________________ _____ Component of thyroid hormones 7. lugsoec _____________________ _____ Table sugar 8. vgneeatria _____________________ _____ Active in many chemical reactions 9. iieond _____________________ _____ Molecules that carry lipids in the blood stamvnii _____________________ _____ Prevents neural tube defects in babies 10. Multiple Choice Circle the correct answer from the choices given. 1. The ______________________________ diet includes gelatin and clear juice. a. b. c. d. 2. In the new food pyramid introduced in 2005, a serving size of one potato equals the size of a ____________________________. a. b. c. d. 3. vitamin content color flavor consistency A ______________________________ diet is comforting to eat and favored by older persons. a. b. c. d. 6. mechanical soft diet high-fiber diet gluten-free diet no-added-salt diet For a puree diet, foods must have a specific ______________________________. a. b. c. d. 5. spoonful carton of milk computer mouse business envelope No raw fruits and vegetables or whole nuts are included in a ______________________________. a. b. c. d. 4. fad clear liquid ADA bland tea-and-toast subsistence vegetarian balanced Another name for a challenge diet is a/an ______________________________. a. b. c. d. diabetic diet fad diet tea-and-toast diet elimination diet 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-62 W-62 | Chapter 21 | Dietetics Symptoms, Signs, and Diseases True or False Indicate whether each statement is true or false by writing T or F on the line. 1. ____ Pernicious anemia is due to a deficiency of iron. 2. ____ Botulism can be caused by eating low-acid foods that were improperly canned. 3. ____ Endogenous obesity is caused by a thyroid or pituitary disorder. 4. ____ Generalized weight loss with muscle wasting and malnutrition is known as cachexia. 5. ____ Colic and eczema in infants are related to food allergies. 6. ____ Someone who has a gluten intolerance should not eat meat. 7. ____ Pica is a craving during pregnancy for nonfood items. Circle Exercise Circle the correct answer from the choices given. 1. Obesity is characterized by (adipose tissue, bulimia, steatorrhea). 2. Gluten enteropathy is also known as (celiac disease, osteomalacia, polyphagia). 3. Patients who are lactose intolerant do not have the (enzyme, micronutrient, vitamin) to digest milk sugar. 4. A lack of vitamin D can cause (abdominal panniculus, nightblindness, osteomalacia). 5. Patients with diabetes mellitus are ordered a/an (ADA, high-fiber, vegetarian) diet. 6. All of these disorders are caused by a vitamin deficiency. Which one is still commonly seen in the United States? (beriberi, pellagra, pernicious anemia, scurvy) Laboratory, Surgery, Drugs, and Abbreviations True or False Indicate whether each statement is true or false by writing T or F on the line. 1. ____ A lipid profile is used to diagnose pernicious anemia. 2. ____ A patient with a nonhealing wound would have a Schilling test done. 3. ____ Hyperalimentation is also known as total parenteral nutrition. 4. ____ MCT oil contains cholesterol. 5. ____ Vitamin D is given by intramuscular injection to newborns. 6. ____ The American Diabetes Association and the American Dietetic Association share the same abbreviation. 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-63 Dietetics | Chapter 21 | W-63 Matching Exercise Match each word or phrase to its description. 1. vitamin D _____ Given with calcium to treat osteoporosis 2. intravenous fluids _____ Hyperalimentation 3. jejunostomy _____ Prescription drug for weight loss 4. TPN _____ Recommended amounts of micronutrients 5. RDA _____ Measures blood glucose levels before the patient eats 6. FBS _____ Provide fluids and calories to patients who cannot eat 7. Meridia _____ Feeding tube 8. bariatrics _____ The study and treatment of obesity Applied Skills Plural Noun and Adjective Spelling Fill in the blanks with the correct word form. Be sure to check your spelling. The first one has been done for you. Singular Noun Plural Noun Adjective emaciated _________________________ 1. emaciation 2. nutrient _________________________ _________________________ 3. calorie _________________________ _________________________ 4. metabolism _________________________ 5. obesity _________________________ 6. cachexia _________________________ 6262MC21.qxd_lbI 12/12/06 9:17 AM Page W-64 W-64 | Chapter 21 | Dietetics Pronunciation Checklist Read each word and its pronunciation. Practice pronouncing each word. Check the box next to the word after you master its pronunciation. ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ adipose tissue (AD-ih-pohs TISH-yoo) albumin (al-BYOO-min) amino acid (ah-MEE-noh AS-id) anabolism (ah-NAB-oh-lizm) ascorbic acid (ah-SKOR-bik AS-id) bariatrics (BAR-ee-AT-riks) betacarotene (BAY-tah-KAIR-oh-teen) biotin (BY-oh-tin) botulism (BAWT-yoo-lizm) cachectic (kah-KEK-tik) cachexia (kah-KEK-see-ah) calcium (KAL-see-um) calorie (KAL-oh-ree) caloric (kah-LOR-ik) carbohydrate (KAR-boh-HY-drayt) catabolism (kah-TAB-oh-lizm) celiac disease (SEE-lee-ak DIS-eez) cellulose (SEL-yoo-lohs) cholecalciferol (KOH-lee-kal-SIF-er-awl) cholesterol (koh-LES-ter-awl) cyanocobalamin (SY-an-oh-koh-BAWL-ah-min) dextrose (DEKS-trohs) diabetic diet (DY-ah-BET-ik DY-et) dietetics (DY-eh-TET-iks) dietitian (DY-eh-TISH-un) disaccharide (dy-SAK-ah-ride) ectomorph (EK-toh-morf) elimination diet (ee-LIM-ih-NAY-shun DY-et) endomorph (EN-doh-morf) emaciated (ee-MAY-see-aa-ted) emaciation (ee-MAY-see-AA-shun) endogenous obesity (en-DAWJ-eh-nus oh-BEE-sih-tee) ergocalciferol (AIR-goh-kal-SIF-er-awl) exogenous obesity (eks-AWJ-eh-nus oh-BEE-sih-tee) (ek-SAWJ-eh-nus) folate (FOH-layt) folic acid (FOH-lik AS-id) fructose (FRUHK-tohs) ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ gastrostomy (gas-TRAWS-toh-mee) glucose (GLOO-kohs) gluten (GLOO-ten) gluten enteropathy (GLOO-ten EN-ter-AWP-ah-thee) glycogen (GLY-koh-jen) gustatory cortex (GUS-tah-tor-ee KOR-teks) hyperalimentation (HY-per-AL-ih-men-TAY-shun) intravenous (IN-trah-VEE-nus) iodine (EYE-oh-dine) iron (EYE-ern) jejunostomy (JEH-jyoo-NAWS-toh-mee) kosher (KOH-sher) lactoovovegetarian (LAK-toh-OH-voh-VEJ-eh-TAIR-ee-an) lactose (LAK-tohs) lipid (LIP-id) lipoprotein (LIP-oh-PROH-teen) macronutrient (MAK-roh-NOO-tree-ent) magnesium (mag-NEE-zee-um) malabsorption (MAL-ab-SORP-shun) malnutrition (MAL-noo-TRISH-un) megadose (MEG-ah-dohs) mesomorph (MEZ-oh-morf) metabolic (MET-ah-BAWL-ik) metabolism (meh-TAB-oh-lizm) micronutrient (MY-kroh-NOO-tree-ent) monosaccharide (MAWN-oh-SAK-ah-ride) morbid obesity (MOR-bid oh-BEE-sih-tee) nasogastric tube (NAY-zoh-GAS-trik TOOB) niacin (NY-ah-sin) nutrient (NOO-tree-ent) nutrition (noo-TRISH-un) nutritional deficiency (noo-TRISH-un-al de-FISH-en-see) ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ ❏ nutritious (noo-TRISH-us) obese (oh-BEES) obesity (oh-BEE-sih-tee) panniculus (pah-NIK-yoo-lus) pantothenic acid (PAN-toh-THEN-ik AS-id) parenteral nutrition (pah-REN-ter-al noo-TRISH-un) pectin (PEK-tin) phenylketonuria (FEN-il-KEE-toh-NYOO-ree-ah) phospholipid (FAWS-foh-LIP-id) phosphorus (FAWS-for-us) phytonadione (FY-toh-nay-DY-awn) pica (PY-kah) (PEE-kah) polyphagia (PAWL-ee-FAY-jee-ah) polysaccharide (PAWL-ee-SAK-ah-ride) polyunsaturated (PAWL-ee-un-SATCH-uh-ray-ted) potassium (poh-TAS-ee-um) protein (PROH-teen) puree (pyoo-RAY) (pyoo-REE) pyridoxine (PIR-ih-DAWK-seen) retinol (RET-ih-nawl) retinoic acid (RET-ih-NOH-ik AS-id) riboflavin (RY-boh-FLAY-vin) saturated (SATCH-uh-ray-ted) Schilling test (SHIL-ing test) sodium (SOH-dee-um) somatotype (SOH-mah-toh-type) sucrose (SOO-krohs) thiamin (THY-ah-min) tocopherol (toh-KAWF-er-awl) triglyceride (try-GLIS-er-ide) umami (uh-MAH-mee) vegan (VEE-gan) vegetarian (VEJ-eh-TAIR-ee-an) vitamin (VITE-ah-min) zinc (ZINGK) (Getty Images—Photodisc) (Getty Images—Photodisc) (© Elena Dorfman/Pearson Education)