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Summer 2005 – Final Exam Thursday, July 28, 12:50PM, 201 PE Gee Lecture materials Chapter 11-Achieving and Maintaining a Healthful Body Weight Chapter 9 – Nutrients Involved in Bone Health 20 MC/TF questions See www.cwu.edu/~geed tomorrow for study guide Take Home essay question (turn in with final) What is the role of American Society in Addressing the US Obesity Crisis? 1 page, double space, 12 pt font, 1” margins 10 pts: grammatically perfect, well thought out, clearly states and defends position. Bergman/Bennett – 40 MC/TF questions The Vitamins David L. Gee, PhD Professor of Food Science and Nutrition Central Washington University FCSN 245 - Basic Nutrition Dietary Supplement Use (USA) $ 4,300,000,000 for vit/min in 1995 $ 1,400,000,000 for herbs 35-40% adults regular users females > males 66% multi-vit/min 37% vitamin C 19% vitamin E Calcium supplements Dietary Supplement Use: Pros Supplements dietary deficiencies calcium folic acid Useful for those with limited caloric intake Elderly Dieters children Amounts used in some studies not attainable with dietary sources antioxidants Relatively low cost Dietary Supplement Use: Cons False sense of security folic acid and pregnancy Supplement may a marker chemical and not the actual protective agent Does not contain all potentially useful chemicals in foods Example: compounds found in plants that may be health promoting (phytochemicals) Toxicity almost only due to supplement use Costs significant low income Heavy users of supplements (athletes) Certain supplements are expensive Chondroitin sulfate – bone/cartilage: $30-50/mo SAMe – depression: $40-50/mo The Discovery of Vitamins The Germ Theory of Disease Scurvy: Disease of sailors Beri-Beri: Disease of poor Asians Rickets: Disease of poor Northern European children Pellagra: Disease of poor corn eating cultures The Discovery of Vitamins The Vitamin Theory of Disease Scurvy: Disease of sailors Vitamin C deficiency Beri-Beri: Disease of poor Asians Thiamin deficiency Rickets: Disease of poor Northern European children Vitamin D deficiency Pellagra: Disease of poor corn eating cultures Niacin deficiency Vitamin Nomenclature Fat soluble “A” & Water soluble “B” “Vital amines” = vitamines = vitamins Vitamin B “complex” collection of water soluble vitamins that function as enzyme co-factors Vitamin C Vitamins D and E Mistaken Vitamins Vitamins: Definition Organic compound found in foods Required in small amounts Required in the diet (essential) Proven to be required for health, growth, and reproduction deficiency syndrome identified Fat and Water Soluble Vitamins Fat Soluble Vitamins (A, D, E, K) Soluble in lipids and solvents Excess stored and not excreted Excess may be toxic Deficiency slow to develop Fat and Water Soluble Vitamins Water Soluble Vitamins B vitamins, C Soluble in water excess excreted in urine, little stored generally less toxic deficiency develops quickly General Functions of Vitamins Hormones Vitamin D calcium homeostasis Vitamin A cell division and development General Functions of Vitamins Non-specific chemical reactions Vitamin E antioxidant Vitamin C chemical reducing agent General Functions of Vitamins Coenzymes or Cofactors chemicals that assist enzymes to function as catalysts B vitamins Vitamin C, A, K Vitamin D: Types and Sources Dietary sources: animal foods, fortified milk Human Synthesis of Vitamin D Skin: cholesterol + sunlight “Sunshine Vitamin” – UV-B rays Vitamin D3 5-10 minutes, arms and legs, mid-day sun Liver & Kidney for activation 1,25-di-OH-D3 Vitamin D: Functions Helps regulate blood calcium levels Dietary calcium absorption Urinary calcium excretion Bone calcium metabolism Vitamin D: Deficiency Rickets bone deformities in children Osteomalacia weak bones due to low calcium content Vitamin D deficiency Calcium deficiency multiple pregnancies Vitamin D: Toxicity 5 times the RDA chronically calcification of soft tissue toxicity due to excessive vitamin supplementation Calcium Functions Bone Structure (99%) Regulator of Metabolism (1%) nerve impulse transmission muscle contraction blood clotting etc. Calcium Regulation of Blood Calcium 10 mg/dl of blood hypocalcemia & hypercalcemia abnormal muscle cramping nerve irritation Controlled by: vitamin D, parathyroid hormone, calcitonin Calcium RDA 1998 RDA’s 1300 mg/d : children & teens 1000 mg/d : adults 1200 mg/d : older Americans Usual intakes are low Osteoporosis Brittle, weak bones due to loss of total bone mass (minerals and protein) Prevalence 11% of > 65 yrs 22% of > 65 yrs in 20 yrs 24 million fractures/yr 200,000 hip fractures, 1/6 fatal Osteoporotic Bone Normal Bone Changes in the spine with osteoporosis Other osteoporosis fact: National Osteoporosis Foundation - 2003 10 million with osteoporosis 18 million with low bone density 1 in 2 women will develop osteoporosis sometime in their life (1 in 8 men) Osteoporosis Risk Factors Genetics Family History Ethnicity Caucasian > Asian > Blacks Osteoporosis Risk Factors Gender associated with declines in estrogen production post-menopause anorexia, female athletes Undertreatment of Osteoporosis in Men with Hip Fracture. Arch. Int. Med. (Oct. 2002) 10 million Americans with osteoporosis 2 million are men Of 110 men hospitalized with hip fracture 4.5% received treatment for osteoporosis 1 year mortality was 32% Average age 80 yrs Of 253 women hospitalized with hip fracture 27% received treatment for osteoporosis 1 year mortality was 17% Average age 81 yrs Osteoporosis Risk Factors Chronic Calcium Deficiency Lack of Exercise Prevention of Osteoporosis Exercise Dietary Calcium “Rule of 300” 300 mg/d from plant sources 300 mg/d from each serving of dairy Prevention of Osteoporosis Other factors that may increase calcium loss high caffeine intake high protein intake high alcohol intake cigarette smoking Prevention of Osteoporosis Calcium Supplements Calcium carbonate least expensive Tums poor absorption Calcium citrate/malate (CCM) expensive, well absorbed Prevention of Osteoporosis Adequate amounts of vitamin D avoid excesses Hormonal replacement in high risk women If you have a family history of osteoporosis: Get a bone scan Folic Acid DRI (RDA): 1998 400 ug/d (180-200 old RDA) 600 ug/d pregnancy (400) Typical folate intake: 200 ug/d Dietary Sources foliage: fruits & vegetables Folic Acid Functions “single carbon metabolism” DNA synthesis (cell division) other reactions Folic Acid Deficiency Megaloblastic Anemia large abnormal red blood cells Elevated blood homocysteine CHD risk factor Folic Acid Deficiency Neural Tube Defects spina bifida - lower body paralysis required early in pregnancy Grain fortification (1998) will add 100-200 ug/d to diet Iron Functions: Hemoglobin Myoglobin Iron enzymes catalase electron transport system Iron Deficiency Iron deficiency anemia fewer, smaller, paler red blood cells fatigue 5-10% of US premenopausal women up to 40% of population in developing countries Iron Deficiency Causes Blood loss menstrual blood loss parasites and bleeding ulcerations Inadequate dietary intake RDA men = 10 mg/d RDA women = 15 mg/d US usual intake 6 mg/1000 Cal Dietary Sources of Iron Heme Iron meats (Hb & Mb) 20-30% absorbed Non-heme Iron plants inorganic iron 1-10% absorbed vitamin C increases absorption iron cookware Iron Overload Toxicity Children (accidental poisoning) Men and post-menopausal women Genetic “defect” improved iron absorption Excess iron is a pro-oxidant. oxidized LDL-C tissue injury Iron Overload Toxicity May occur in 10% of men Treatment avoid iron containing supplements avoid excess vitamin C supplements bleeding or blood donation Final Advice from Your Nutrition Professor: Eat your vegetables! And fruits and whole grains too! Watch your weight! Easier to maintain your weight than to lose weight you’ve gained Everything in moderation! You can have your cake and eat it too! Enjoy your food and your good health!