Datasets:

MedRAG
/

textbooks

Dataset card Data Studio Files Files and versions Community

Split (1)

train · 126k rows

Subsets and Splits

No community queries yet

The top public SQL queries from the community will appear here once available.

id stringlengths 14 28	title stringclasses 18 values	content stringlengths 2 999	contents stringlengths 19 1.02k
Biochemistry_Lippincott_1283	Biochemistry_Lippinco	D. Simple sugars and disease There is no direct evidence that the consumption of simple sugars naturally present in food is harmful. Contrary to folklore, diets high in sucrose do not lead to diabetes or hypoglycemia. Also contrary to popular belief, carbohydrates are not inherently fattening. They yield 4 kcal/g (the same as protein and less than one half that of fat; see Fig. 27.5) and result in fat synthesis only when consumed in excess of the body’s energy needs. However, there is an association between sucrose consumption and dental caries, particularly in the absence of fluoride treatment (see p. 405). VII. DIETARY PROTEIN The AMDR for protein is 10%–35%. Dietary protein provides the essential amino acids (see Fig. 20.2, p. 262). Nine of the 20 amino acids needed for the synthesis of body proteins are essential (that is, they cannot be synthesized in humans). A. Protein quality	Biochemistry_Lippinco. D. Simple sugars and disease There is no direct evidence that the consumption of simple sugars naturally present in food is harmful. Contrary to folklore, diets high in sucrose do not lead to diabetes or hypoglycemia. Also contrary to popular belief, carbohydrates are not inherently fattening. They yield 4 kcal/g (the same as protein and less than one half that of fat; see Fig. 27.5) and result in fat synthesis only when consumed in excess of the body’s energy needs. However, there is an association between sucrose consumption and dental caries, particularly in the absence of fluoride treatment (see p. 405). VII. DIETARY PROTEIN The AMDR for protein is 10%–35%. Dietary protein provides the essential amino acids (see Fig. 20.2, p. 262). Nine of the 20 amino acids needed for the synthesis of body proteins are essential (that is, they cannot be synthesized in humans). A. Protein quality
Biochemistry_Lippincott_1284	Biochemistry_Lippinco	A. Protein quality The quality of a dietary protein is a measure of its ability to provide the essential amino acids (EAA) required for tissue maintenance. Most government agencies have adopted the Protein Digestibility–Corrected Amino Acid Score (PDCAAS) as the standard by which to evaluate protein quality. PDCAAS is based on the profile of EAA after correcting for the digestibility of the protein. The highest possible score under these guidelines is 1.00. This amino acid score provides a method to balance intakes of poorer-quality proteins with high-quality dietary proteins. 1.	Biochemistry_Lippinco. A. Protein quality The quality of a dietary protein is a measure of its ability to provide the essential amino acids (EAA) required for tissue maintenance. Most government agencies have adopted the Protein Digestibility–Corrected Amino Acid Score (PDCAAS) as the standard by which to evaluate protein quality. PDCAAS is based on the profile of EAA after correcting for the digestibility of the protein. The highest possible score under these guidelines is 1.00. This amino acid score provides a method to balance intakes of poorer-quality proteins with high-quality dietary proteins. 1.
Biochemistry_Lippincott_1285	Biochemistry_Lippinco	1. Proteins from animal sources: Proteins from animal sources (meat, poultry, milk, and fish) have a high quality because they contain all the EAA in proportions similar to those required for synthesis of human tissue proteins (Fig. 27.19), and they are more readily digested. [Note: Gelatin prepared from animal collagen is an exception. It has a low biologic value as a result of deficiencies in several EAA.] 2. Proteins from plant sources: Plant proteins have a lower quality than do animal proteins. However, proteins from different plant sources may be combined in such a way that the result is equivalent in nutritional value to animal protein. For example, wheat (lysine deficient but methionine rich) may be combined with kidney beans (methionine poor but lysine rich) to produce a higher biologic value than either of the component proteins (Fig. 27.20). [Note: Animal proteins can also complement the biologic value of plant proteins.] B. Nitrogen balance	Biochemistry_Lippinco. 1. Proteins from animal sources: Proteins from animal sources (meat, poultry, milk, and fish) have a high quality because they contain all the EAA in proportions similar to those required for synthesis of human tissue proteins (Fig. 27.19), and they are more readily digested. [Note: Gelatin prepared from animal collagen is an exception. It has a low biologic value as a result of deficiencies in several EAA.] 2. Proteins from plant sources: Plant proteins have a lower quality than do animal proteins. However, proteins from different plant sources may be combined in such a way that the result is equivalent in nutritional value to animal protein. For example, wheat (lysine deficient but methionine rich) may be combined with kidney beans (methionine poor but lysine rich) to produce a higher biologic value than either of the component proteins (Fig. 27.20). [Note: Animal proteins can also complement the biologic value of plant proteins.] B. Nitrogen balance
Biochemistry_Lippincott_1286	Biochemistry_Lippinco	B. Nitrogen balance Nitrogen balance occurs when the amount of nitrogen consumed equals that of the nitrogen excreted in the urine (primarily as urinary urea nitrogen, or UUN), sweat, and feces. Most healthy adults are normally in nitrogen balance. [Note: There is, on average, 1 g nitrogen in 6.25 g protein.] 1. Positive nitrogen balance: This occurs when nitrogen intake exceeds nitrogen excretion. It is observed during situations in which tissue growth occurs, for example, in childhood, pregnancy, or during recovery from an emaciating illness. 2. Negative nitrogen balance: This occurs when nitrogen loss is greater than nitrogen intake. It is associated with inadequate dietary protein; lack of an essential amino acid; or during physiologic stresses, such as trauma, burns, illness, or surgery.	Biochemistry_Lippinco. B. Nitrogen balance Nitrogen balance occurs when the amount of nitrogen consumed equals that of the nitrogen excreted in the urine (primarily as urinary urea nitrogen, or UUN), sweat, and feces. Most healthy adults are normally in nitrogen balance. [Note: There is, on average, 1 g nitrogen in 6.25 g protein.] 1. Positive nitrogen balance: This occurs when nitrogen intake exceeds nitrogen excretion. It is observed during situations in which tissue growth occurs, for example, in childhood, pregnancy, or during recovery from an emaciating illness. 2. Negative nitrogen balance: This occurs when nitrogen loss is greater than nitrogen intake. It is associated with inadequate dietary protein; lack of an essential amino acid; or during physiologic stresses, such as trauma, burns, illness, or surgery.
Biochemistry_Lippincott_1287	Biochemistry_Lippinco	Nitrogen (N) balance (g Nin – g Nout) in a 24-hour period can be determined by the formula, N balance = protein intake in g/6.25 – (UUN + 4 g), where 4 g accounts for urinary loss in forms other than UUN plus loss in skin and feces. C. Protein requirements	Biochemistry_Lippinco. Nitrogen (N) balance (g Nin – g Nout) in a 24-hour period can be determined by the formula, N balance = protein intake in g/6.25 – (UUN + 4 g), where 4 g accounts for urinary loss in forms other than UUN plus loss in skin and feces. C. Protein requirements
Biochemistry_Lippincott_1288	Biochemistry_Lippinco	C. Protein requirements The amount of dietary protein required in the diet varies with its biologic value. The greater the proportion of animal protein in the diet, the less protein is required. The RDA for protein is computed for proteins of mixed biologic value at 0.8 g/kg of body weight for adults, or ~56 g of protein for a 70-kg individual. People who exercise strenuously on a regular basis may benefit from extra protein to maintain muscle mass, and a daily intake of ~1 g/kg has been recommended for athletes. Women who are pregnant or lactating require up to 30 g/day in addition to their basal requirements. To support growth, infants should consume 2 g/kg/day. [Note: Disease states influence protein needs. Protein restriction may be needed in kidney disease, whereas burns require increased protein intake.] 1.	Biochemistry_Lippinco. C. Protein requirements The amount of dietary protein required in the diet varies with its biologic value. The greater the proportion of animal protein in the diet, the less protein is required. The RDA for protein is computed for proteins of mixed biologic value at 0.8 g/kg of body weight for adults, or ~56 g of protein for a 70-kg individual. People who exercise strenuously on a regular basis may benefit from extra protein to maintain muscle mass, and a daily intake of ~1 g/kg has been recommended for athletes. Women who are pregnant or lactating require up to 30 g/day in addition to their basal requirements. To support growth, infants should consume 2 g/kg/day. [Note: Disease states influence protein needs. Protein restriction may be needed in kidney disease, whereas burns require increased protein intake.] 1.
Biochemistry_Lippincott_1289	Biochemistry_Lippinco	Consumption of excess protein: There is no physiologic advantage to the consumption of more protein than the RDA. Protein consumed in excess of the body’s needs is deaminated, and the resulting carbon skeletons are metabolized to provide energy or acetyl coenzyme A for fatty acid synthesis. When excess protein is eliminated from the body as urinary nitrogen, it is often accompanied by increased urinary calcium, thereby increasing the risk of nephrolithiasis (kidney stones) and osteoporosis. 2.	Biochemistry_Lippinco. Consumption of excess protein: There is no physiologic advantage to the consumption of more protein than the RDA. Protein consumed in excess of the body’s needs is deaminated, and the resulting carbon skeletons are metabolized to provide energy or acetyl coenzyme A for fatty acid synthesis. When excess protein is eliminated from the body as urinary nitrogen, it is often accompanied by increased urinary calcium, thereby increasing the risk of nephrolithiasis (kidney stones) and osteoporosis. 2.
Biochemistry_Lippincott_1290	Biochemistry_Lippinco	2. The protein-sparing effect of carbohydrates: The dietary protein requirement is influenced by the carbohydrate content of the diet. When the intake of carbohydrates is low, amino acids are deaminated to provide carbon skeletons for the synthesis of glucose that is needed as a fuel by the central nervous system. If carbohydrate intake is <130 g/day, substantial amounts of protein are metabolized to provide precursors for gluconeogenesis. Therefore, carbohydrate is considered to be “protein-sparing,” because it allows amino acids to be used for repair and maintenance of tissue protein rather than for gluconeogenesis. D. Protein-energy (calorie) malnutrition	Biochemistry_Lippinco. 2. The protein-sparing effect of carbohydrates: The dietary protein requirement is influenced by the carbohydrate content of the diet. When the intake of carbohydrates is low, amino acids are deaminated to provide carbon skeletons for the synthesis of glucose that is needed as a fuel by the central nervous system. If carbohydrate intake is <130 g/day, substantial amounts of protein are metabolized to provide precursors for gluconeogenesis. Therefore, carbohydrate is considered to be “protein-sparing,” because it allows amino acids to be used for repair and maintenance of tissue protein rather than for gluconeogenesis. D. Protein-energy (calorie) malnutrition
Biochemistry_Lippincott_1291	Biochemistry_Lippinco	D. Protein-energy (calorie) malnutrition In developed countries, protein-energy malnutrition (PEM), also known as protein-energy undernutrition (PEU), is most commonly seen in patients with medical conditions that decrease appetite or alter how nutrients are digested or absorbed or in hospitalized patients with major trauma or infections. [Note: Such highly catabolic patients frequently require intravenous (IV, or parenteral) or tube-based (enteral) administration of nutrients.] PEM may also be seen in children or the elderly who are malnourished. In developing countries, an inadequate intake of protein and/or calories is the primary cause of PEM. Affected individuals show a variety of symptoms, including a depressed immune system with a reduced ability to resist infection. Death from secondary infection is common. PEM is a spectrum of degrees of malnutrition, and two extreme forms are kwashiorkor and marasmus (Fig. 27.21). [Note: Marasmic kwashiorkor has features of both forms.] 1.	Biochemistry_Lippinco. D. Protein-energy (calorie) malnutrition In developed countries, protein-energy malnutrition (PEM), also known as protein-energy undernutrition (PEU), is most commonly seen in patients with medical conditions that decrease appetite or alter how nutrients are digested or absorbed or in hospitalized patients with major trauma or infections. [Note: Such highly catabolic patients frequently require intravenous (IV, or parenteral) or tube-based (enteral) administration of nutrients.] PEM may also be seen in children or the elderly who are malnourished. In developing countries, an inadequate intake of protein and/or calories is the primary cause of PEM. Affected individuals show a variety of symptoms, including a depressed immune system with a reduced ability to resist infection. Death from secondary infection is common. PEM is a spectrum of degrees of malnutrition, and two extreme forms are kwashiorkor and marasmus (Fig. 27.21). [Note: Marasmic kwashiorkor has features of both forms.] 1.
Biochemistry_Lippincott_1292	Biochemistry_Lippinco	Kwashiorkor: Kwashiorkor occurs when protein deprivation is relatively greater than the reduction in total calories. Protein deprivation is associated with severely decreased synthesis of visceral protein. Kwashiorkor is commonly seen in developing countries in children after weaning at about age 1 year, when their diet consists predominantly of carbohydrates. Typical symptoms include stunted growth, skin lesions, depigmented hair, anorexia, fatty liver, bilateral pitting edema, and decreased serum albumin concentration. Edema results from the lack of adequate blood proteins, primarily albumin, to maintain the distribution of water between blood and tissues. It may mask muscle and fat loss. Therefore, chronic malnutrition is reflected in the level of serum albumin. [Note: Because caloric intake from carbohydrates may be adequate, insulin levels suppress lipolysis and proteolysis. Kwashiorkor is, therefore, nonadapted malnutrition.] 2.	Biochemistry_Lippinco. Kwashiorkor: Kwashiorkor occurs when protein deprivation is relatively greater than the reduction in total calories. Protein deprivation is associated with severely decreased synthesis of visceral protein. Kwashiorkor is commonly seen in developing countries in children after weaning at about age 1 year, when their diet consists predominantly of carbohydrates. Typical symptoms include stunted growth, skin lesions, depigmented hair, anorexia, fatty liver, bilateral pitting edema, and decreased serum albumin concentration. Edema results from the lack of adequate blood proteins, primarily albumin, to maintain the distribution of water between blood and tissues. It may mask muscle and fat loss. Therefore, chronic malnutrition is reflected in the level of serum albumin. [Note: Because caloric intake from carbohydrates may be adequate, insulin levels suppress lipolysis and proteolysis. Kwashiorkor is, therefore, nonadapted malnutrition.] 2.
Biochemistry_Lippincott_1293	Biochemistry_Lippinco	Marasmus: Marasmus occurs when calorie deprivation is relatively greater than the reduction in protein. It usually occurs in developing countries in children younger than age 1 year when breast milk is supplemented or replaced with watery gruels of native cereals that are usually deficient in both protein and calories. Typical symptoms include arrested growth, extreme muscle wasting and depletion of subcutaneous fat (emaciation), weakness, and anemia (Fig. 27.22). Individuals with marasmus do not show the edema observed in kwashiorkor. [Note: Refeeding severely malnourished individuals can result in hypophosphatemia (see p. 400), because any available phosphate is used to phosphorylate carbohydrate intermediates. Milk is frequently given because it is rich in phosphate.]	Biochemistry_Lippinco. Marasmus: Marasmus occurs when calorie deprivation is relatively greater than the reduction in protein. It usually occurs in developing countries in children younger than age 1 year when breast milk is supplemented or replaced with watery gruels of native cereals that are usually deficient in both protein and calories. Typical symptoms include arrested growth, extreme muscle wasting and depletion of subcutaneous fat (emaciation), weakness, and anemia (Fig. 27.22). Individuals with marasmus do not show the edema observed in kwashiorkor. [Note: Refeeding severely malnourished individuals can result in hypophosphatemia (see p. 400), because any available phosphate is used to phosphorylate carbohydrate intermediates. Milk is frequently given because it is rich in phosphate.]
Biochemistry_Lippincott_1294	Biochemistry_Lippinco	Cachexia, a wasting disorder characterized by loss of appetite and muscle atrophy (with or without increased lipolysis) that cannot be reversed by conventional nutritional support, is seen with a number of chronic diseases, such as cancer and chronic pulmonary and renal disease. It is associated with decreased treatment tolerance and response and decreased survival time. VIII. NUTRITION TOOLS A set of tools has been developed that gives consumers information about what (and how much) they should eat as well as the nutritional content of the foods they do eat. Additional tools allow medical professionals to assess whether or not the nutritional needs of an individual are being met. A. MyPlate	Biochemistry_Lippinco. Cachexia, a wasting disorder characterized by loss of appetite and muscle atrophy (with or without increased lipolysis) that cannot be reversed by conventional nutritional support, is seen with a number of chronic diseases, such as cancer and chronic pulmonary and renal disease. It is associated with decreased treatment tolerance and response and decreased survival time. VIII. NUTRITION TOOLS A set of tools has been developed that gives consumers information about what (and how much) they should eat as well as the nutritional content of the foods they do eat. Additional tools allow medical professionals to assess whether or not the nutritional needs of an individual are being met. A. MyPlate
Biochemistry_Lippincott_1295	Biochemistry_Lippinco	A. MyPlate MyPlate was designed by the U.S. Department of Agriculture (USDA) to graphically illustrate its recommendations as to what food groups and how much of each should be consumed daily. In MyPlate, the relative amounts of each of five food groups (vegetables, grains, protein, fruit, and dairy) are represented by the relative size of their section on the plate (Fig. 27.23). The number of servings depends on variables that include age and sex. [Note: MyPlate replaced MyPyramid in 2011.] B. Nutrition facts label Most types of packaged goods are required to have a Nutrition Facts label, or “food label” (Fig. 27.24), that includes the size of a single serving, the Cal it provides, and the number of servings per container. In addition, a percent daily value (%DV) is shown for most nutrients listed. [Note: The %DV is based on a 2,000-Cal diet for healthy adults.] 1.	Biochemistry_Lippinco. A. MyPlate MyPlate was designed by the U.S. Department of Agriculture (USDA) to graphically illustrate its recommendations as to what food groups and how much of each should be consumed daily. In MyPlate, the relative amounts of each of five food groups (vegetables, grains, protein, fruit, and dairy) are represented by the relative size of their section on the plate (Fig. 27.23). The number of servings depends on variables that include age and sex. [Note: MyPlate replaced MyPyramid in 2011.] B. Nutrition facts label Most types of packaged goods are required to have a Nutrition Facts label, or “food label” (Fig. 27.24), that includes the size of a single serving, the Cal it provides, and the number of servings per container. In addition, a percent daily value (%DV) is shown for most nutrients listed. [Note: The %DV is based on a 2,000-Cal diet for healthy adults.] 1.
Biochemistry_Lippincott_1296	Biochemistry_Lippinco	Percent daily value: The %DV compares the amount of a given nutrient in a single serving of a product to the recommended daily intake for that nutrient. For example, the %DV for the micronutrients listed, as well as for total carbohydrates and fiber, are based on their recommended minimum daily intake. Thus, if the label lists 20% for calcium, one serving provides 20% of the minimum recommended amount of calcium needed each day. In contrast, the %DV for saturated fat, cholesterol, and sodium are based on their recommended maximum daily intake, and the %DV reflects what percentage of this maximum a serving provides. There is no %DV for protein because the recommended intake depends on body weight (see p. 367). [Note: “Sugars” represents mono-and disaccharides. The remainder of the carbohydrate (total carbohydrate – [fiber + sugars]) is the oligo-and polysaccharides.] 2.	Biochemistry_Lippinco. Percent daily value: The %DV compares the amount of a given nutrient in a single serving of a product to the recommended daily intake for that nutrient. For example, the %DV for the micronutrients listed, as well as for total carbohydrates and fiber, are based on their recommended minimum daily intake. Thus, if the label lists 20% for calcium, one serving provides 20% of the minimum recommended amount of calcium needed each day. In contrast, the %DV for saturated fat, cholesterol, and sodium are based on their recommended maximum daily intake, and the %DV reflects what percentage of this maximum a serving provides. There is no %DV for protein because the recommended intake depends on body weight (see p. 367). [Note: “Sugars” represents mono-and disaccharides. The remainder of the carbohydrate (total carbohydrate – [fiber + sugars]) is the oligo-and polysaccharides.] 2.
Biochemistry_Lippincott_1297	Biochemistry_Lippinco	Proposed revisions: In 2014, the USDA proposed the following changes to the Nutrition Facts label for implementation by 2018: Added sugars, vitamin D, and potassium are to be included; vitamins A and C, total fat, and Cal from fat are to be removed; and serving size is to be adjusted to reflect the amounts people are now consuming. Additionally, design changes to highlight key parts of the label were proposed (Fig. 27.25). [Note: The proposed addition/removal of certain micronutrients is based on newer data on the risk for underingestion.] C. Nutrition assessment	Biochemistry_Lippinco. Proposed revisions: In 2014, the USDA proposed the following changes to the Nutrition Facts label for implementation by 2018: Added sugars, vitamin D, and potassium are to be included; vitamins A and C, total fat, and Cal from fat are to be removed; and serving size is to be adjusted to reflect the amounts people are now consuming. Additionally, design changes to highlight key parts of the label were proposed (Fig. 27.25). [Note: The proposed addition/removal of certain micronutrients is based on newer data on the risk for underingestion.] C. Nutrition assessment
Biochemistry_Lippincott_1298	Biochemistry_Lippinco	C. Nutrition assessment Nutrition assessment evaluates nutritional status based on clinical information. It includes (but is not limited to) dietary history, anthropometric measures, and laboratory data. [Note: Assessment findings may result in medical nutrition therapy, which is the treatment of medical conditions through changes in diet (for example, replacement of long-chain TAG with medium-chain TAG in malabsorption disorders) and/or the method of intake (for example, enteral [tube] or parenteral [IV] feeding).] 1.	Biochemistry_Lippinco. C. Nutrition assessment Nutrition assessment evaluates nutritional status based on clinical information. It includes (but is not limited to) dietary history, anthropometric measures, and laboratory data. [Note: Assessment findings may result in medical nutrition therapy, which is the treatment of medical conditions through changes in diet (for example, replacement of long-chain TAG with medium-chain TAG in malabsorption disorders) and/or the method of intake (for example, enteral [tube] or parenteral [IV] feeding).] 1.
Biochemistry_Lippincott_1299	Biochemistry_Lippinco	Dietary history: This is a record of food intake over a period of time. For a food diary, the specific types and exact amounts of food eaten are recorded in “real time” (as soon as possible after eating) for a period of 3–7 days. Retrospective approaches include a food frequency questionnaire (for example, what fruits were eaten and how often they were eaten in a typical day, week, or month) and a 24-hour recall of the specific foods and the amounts eaten in the last 24 hours. 2.	Biochemistry_Lippinco. Dietary history: This is a record of food intake over a period of time. For a food diary, the specific types and exact amounts of food eaten are recorded in “real time” (as soon as possible after eating) for a period of 3–7 days. Retrospective approaches include a food frequency questionnaire (for example, what fruits were eaten and how often they were eaten in a typical day, week, or month) and a 24-hour recall of the specific foods and the amounts eaten in the last 24 hours. 2.
Biochemistry_Lippincott_1300	Biochemistry_Lippinco	2. Anthropometric measures: These are physical measures of the body. They include (but are not limited to) weight, height, body mass index (an indicator of obesity, see p. 349), skin-fold thickness (an indicator of subcutaneous fat), and waist circumference (an indicator of abdominal fat, see p. 349). [Note: Ideal body weight can be calculated using the Hamwi method: 106 lb (for males) or 100 lb (for females) for the first 5 ft of height + 5 lb for every inch over 5 ft, with an adjustment of −10% for a small frame and + 10% for a large one.] 3.	Biochemistry_Lippinco. 2. Anthropometric measures: These are physical measures of the body. They include (but are not limited to) weight, height, body mass index (an indicator of obesity, see p. 349), skin-fold thickness (an indicator of subcutaneous fat), and waist circumference (an indicator of abdominal fat, see p. 349). [Note: Ideal body weight can be calculated using the Hamwi method: 106 lb (for males) or 100 lb (for females) for the first 5 ft of height + 5 lb for every inch over 5 ft, with an adjustment of −10% for a small frame and + 10% for a large one.] 3.
Biochemistry_Lippincott_1301	Biochemistry_Lippinco	Laboratory data: These are obtained by tests performed on body fluids, tissues, and waste. They can include plasma LDL-C (for cardiovascular risk), fecal fat (for malabsorption), red cell indices (for vitamin deficiencies), and N balance and serum proteins (such as albumin and transthyretin [prealbumin]) for protein–energy status. [Note: These proteins are made in the liver and transport molecules such as fatty acids and thyroxine (see p. 406) through blood. Low albumin levels correlate with increased morbidity and mortality in hospitalized patients. The short half-life (2–3 days) of transthyretin as compared to that of albumin (20 days) has led to its use in monitoring the progress of hospitalized patients.] Nutritional insufficiency can be the result of inadequate nutrient intake (caused, for example, by an inability to eat, loss of appetite, or decreased availability), inadequate absorption, decreased utilization, increased excretion, or increased requirements.	Biochemistry_Lippinco. Laboratory data: These are obtained by tests performed on body fluids, tissues, and waste. They can include plasma LDL-C (for cardiovascular risk), fecal fat (for malabsorption), red cell indices (for vitamin deficiencies), and N balance and serum proteins (such as albumin and transthyretin [prealbumin]) for protein–energy status. [Note: These proteins are made in the liver and transport molecules such as fatty acids and thyroxine (see p. 406) through blood. Low albumin levels correlate with increased morbidity and mortality in hospitalized patients. The short half-life (2–3 days) of transthyretin as compared to that of albumin (20 days) has led to its use in monitoring the progress of hospitalized patients.] Nutritional insufficiency can be the result of inadequate nutrient intake (caused, for example, by an inability to eat, loss of appetite, or decreased availability), inadequate absorption, decreased utilization, increased excretion, or increased requirements.
Biochemistry_Lippincott_1302	Biochemistry_Lippinco	IX. NUTRITION AND THE LIFE STAGES Macronutrient energy sources, micronutrients, EFA, and EAA are required at every life stage. Additionally, each stage has specific nutrition needs. A. Infancy, childhood, and adolescence	Biochemistry_Lippinco. IX. NUTRITION AND THE LIFE STAGES Macronutrient energy sources, micronutrients, EFA, and EAA are required at every life stage. Additionally, each stage has specific nutrition needs. A. Infancy, childhood, and adolescence
Biochemistry_Lippincott_1303	Biochemistry_Lippinco	The rapid growth and development in infancy (birth to age 1 year) and childhood (age 1 year to adolescence) necessitate higher energy and protein needs relative to body size than are required in subsequent life stages. In adolescence, the marked increases in height and weight that occur increase nutritional needs. Growth charts (Fig. 27.26) are used to compare an individual’s stature (height) and/or weight to the expected values for others of the same age (≤20 years) and sex. They are based on data from large numbers of normal individuals over time. [Note: Deviations from the expected growth curve, as reflected in the crossing of two or more percentile lines, raise concern.] 1. Infants: Ideal infant nutrition is based on human breast milk because it provides calories and most micronutrients in amounts appropriate for the human infant. Carbohydrates, protein, and fat are present in a 7:3:1 ratio. [Note: In addition to the disaccharide lactose, human milk contains nearly 200 unique	Biochemistry_Lippinco. The rapid growth and development in infancy (birth to age 1 year) and childhood (age 1 year to adolescence) necessitate higher energy and protein needs relative to body size than are required in subsequent life stages. In adolescence, the marked increases in height and weight that occur increase nutritional needs. Growth charts (Fig. 27.26) are used to compare an individual’s stature (height) and/or weight to the expected values for others of the same age (≤20 years) and sex. They are based on data from large numbers of normal individuals over time. [Note: Deviations from the expected growth curve, as reflected in the crossing of two or more percentile lines, raise concern.] 1. Infants: Ideal infant nutrition is based on human breast milk because it provides calories and most micronutrients in amounts appropriate for the human infant. Carbohydrates, protein, and fat are present in a 7:3:1 ratio. [Note: In addition to the disaccharide lactose, human milk contains nearly 200 unique
Biochemistry_Lippincott_1304	Biochemistry_Lippinco	in amounts appropriate for the human infant. Carbohydrates, protein, and fat are present in a 7:3:1 ratio. [Note: In addition to the disaccharide lactose, human milk contains nearly 200 unique oligosaccharides. About 90% of the microbiota (the population of microbes) in the breast-fed infant’s intestine is represented by one type, Bifidobacterium infantis, which expresses all the enzymes needed to degrade these complex sugars. The sugars, in turn, act as prebiotics that support the growth of B. infantis, a probiotic (helpful bacteria).] Breast milk is low in vitamin D, however, and exclusively breast-fed babies require vitamin D supplementation. [Note: Human milk provides antibodies and other proteins that reduce the risk of infection.]	Biochemistry_Lippinco. in amounts appropriate for the human infant. Carbohydrates, protein, and fat are present in a 7:3:1 ratio. [Note: In addition to the disaccharide lactose, human milk contains nearly 200 unique oligosaccharides. About 90% of the microbiota (the population of microbes) in the breast-fed infant’s intestine is represented by one type, Bifidobacterium infantis, which expresses all the enzymes needed to degrade these complex sugars. The sugars, in turn, act as prebiotics that support the growth of B. infantis, a probiotic (helpful bacteria).] Breast milk is low in vitamin D, however, and exclusively breast-fed babies require vitamin D supplementation. [Note: Human milk provides antibodies and other proteins that reduce the risk of infection.]
Biochemistry_Lippincott_1305	Biochemistry_Lippinco	The microbiota in and on the human body plus their genomes are referred to as the microbiome. It is acquired at birth from the environment and changes with the life stages. The gut microbiome influences host nutrition by facilitating processing of food consumed and is itself influenced by that food. Its relationship with undernutrition, obesity, and diabetes is under investigation. 2. Children: As with infants, children have increased need for calories and nutrients. The primary concerns in this stage, however, are deficiencies of iron and calcium. 3. Adolescents: In the teen years, the increases in height and weight increase the need for calories, protein, calcium, iron, and phosphorus. Eating patterns in this stage can result in overconsumption of fat, sodium, and sugar and underconsumption of vitamin A, thiamine, and folic acid. [Note: Eating disorders and obesity are concerns in this age group.] B. Adulthood	Biochemistry_Lippinco. The microbiota in and on the human body plus their genomes are referred to as the microbiome. It is acquired at birth from the environment and changes with the life stages. The gut microbiome influences host nutrition by facilitating processing of food consumed and is itself influenced by that food. Its relationship with undernutrition, obesity, and diabetes is under investigation. 2. Children: As with infants, children have increased need for calories and nutrients. The primary concerns in this stage, however, are deficiencies of iron and calcium. 3. Adolescents: In the teen years, the increases in height and weight increase the need for calories, protein, calcium, iron, and phosphorus. Eating patterns in this stage can result in overconsumption of fat, sodium, and sugar and underconsumption of vitamin A, thiamine, and folic acid. [Note: Eating disorders and obesity are concerns in this age group.] B. Adulthood
Biochemistry_Lippincott_1306	Biochemistry_Lippinco	B. Adulthood Overnutrition is a concern in young adults, whereas malnutrition is a concern in older adults. 1. Young adults: Nutrition in young adults focuses on the maintenance of good health and the prevention of disease. The goal is a diet rich in plant-based foods (with a focus on fiber and whole grains), limited intake of saturated fat and trans fatty acids, and balanced intake of ω-3 and ω-6 PUFA. 2. Pregnant or lactating women: The requirements for calories, protein, and virtually all micronutrients increase in pregnancy and lactation. Supplementation with folic acid (to prevent neural tube defects [see p. 379]), vitamin D, calcium, iron, iodine, and DHA is typically recommended. 3.	Biochemistry_Lippinco. B. Adulthood Overnutrition is a concern in young adults, whereas malnutrition is a concern in older adults. 1. Young adults: Nutrition in young adults focuses on the maintenance of good health and the prevention of disease. The goal is a diet rich in plant-based foods (with a focus on fiber and whole grains), limited intake of saturated fat and trans fatty acids, and balanced intake of ω-3 and ω-6 PUFA. 2. Pregnant or lactating women: The requirements for calories, protein, and virtually all micronutrients increase in pregnancy and lactation. Supplementation with folic acid (to prevent neural tube defects [see p. 379]), vitamin D, calcium, iron, iodine, and DHA is typically recommended. 3.
Biochemistry_Lippincott_1307	Biochemistry_Lippinco	3. Older adults: Aging increases the risk of malnutrition. Decreased appetite resulting from a reduced sense of taste (dysgeusia) and smell (hyposmia) decreases nutrient intake. [Note: Physical limitations, including problems with dentition, and psychosocial factors, such as isolation, may also play a role in reduced intake.] Inadequate intake of protein, calcium, and vitamins D and B12 is common. B12 deficiency can result from decreased absorption caused by achlorhydria (reduced stomach acid, see p. 381). In aging, lean muscle mass decreases and fat increases, resulting in decreased RMR. [Note: Drug–nutrient interactions can occur at any life stage but are more common as the number of medications increases as in aging.] Monoamine oxidase inhibitors (MAOI), used to treat depression (see p.	Biochemistry_Lippinco. 3. Older adults: Aging increases the risk of malnutrition. Decreased appetite resulting from a reduced sense of taste (dysgeusia) and smell (hyposmia) decreases nutrient intake. [Note: Physical limitations, including problems with dentition, and psychosocial factors, such as isolation, may also play a role in reduced intake.] Inadequate intake of protein, calcium, and vitamins D and B12 is common. B12 deficiency can result from decreased absorption caused by achlorhydria (reduced stomach acid, see p. 381). In aging, lean muscle mass decreases and fat increases, resulting in decreased RMR. [Note: Drug–nutrient interactions can occur at any life stage but are more common as the number of medications increases as in aging.] Monoamine oxidase inhibitors (MAOI), used to treat depression (see p.
Biochemistry_Lippincott_1308	Biochemistry_Lippinco	Monoamine oxidase inhibitors (MAOI), used to treat depression (see p. 287) and early Parkinson disease, can interact with tyramine-containing foods. Tyramine is a monoamine derived from the decarboxylation of tyrosine during the curing, aging, or fermentation of food (Fig. 27.27). It causes the release of norepinephrine, increasing blood pressure and heart rate. Patients who take an MAOI and consume such foods are at risk for a hypertensive crisis. X. CHAPTER SUMMARY	Biochemistry_Lippinco. Monoamine oxidase inhibitors (MAOI), used to treat depression (see p. 287) and early Parkinson disease, can interact with tyramine-containing foods. Tyramine is a monoamine derived from the decarboxylation of tyrosine during the curing, aging, or fermentation of food (Fig. 27.27). It causes the release of norepinephrine, increasing blood pressure and heart rate. Patients who take an MAOI and consume such foods are at risk for a hypertensive crisis. X. CHAPTER SUMMARY
Biochemistry_Lippincott_1309	Biochemistry_Lippinco	The Dietary Reference Intakes (DRI) provide estimates of the amounts of nutrients required to prevent deficiencies and maintain optimal health and growth. They consist of the Estimated Average Requirement (EAR), the average daily nutrient intake level estimated to meet the requirement of 50% of the healthy individuals in a particular life stage (age) and gender group; the Recommended Dietary Allowance (RDA), the average daily dietary intake level that is sufficient to meet the nutrient requirements of nearly all (97%–98%) individuals in a life stage and gender group; the Adequate Intake (AI), which is set instead of an RDA if sufficient scientific evidence is not available to calculate the RDA; and the Tolerable Upper Intake Level (UL), the highest average daily nutrient intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population. The energy generated by the metabolism of the macronutrients (9 kcal/g of fat and 4 kcal/g of	Biochemistry_Lippinco. The Dietary Reference Intakes (DRI) provide estimates of the amounts of nutrients required to prevent deficiencies and maintain optimal health and growth. They consist of the Estimated Average Requirement (EAR), the average daily nutrient intake level estimated to meet the requirement of 50% of the healthy individuals in a particular life stage (age) and gender group; the Recommended Dietary Allowance (RDA), the average daily dietary intake level that is sufficient to meet the nutrient requirements of nearly all (97%–98%) individuals in a life stage and gender group; the Adequate Intake (AI), which is set instead of an RDA if sufficient scientific evidence is not available to calculate the RDA; and the Tolerable Upper Intake Level (UL), the highest average daily nutrient intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population. The energy generated by the metabolism of the macronutrients (9 kcal/g of fat and 4 kcal/g of
Biochemistry_Lippincott_1310	Biochemistry_Lippinco	is likely to pose no risk of adverse health effects to almost all individuals in the general population. The energy generated by the metabolism of the macronutrients (9 kcal/g of fat and 4 kcal/g of protein or carbohydrate) is used for three energy-requiring processes that occur in the body: resting metabolic rate, physical activity, and the thermic effect of food. Acceptable Macronutrient Distribution Ranges (AMDR) are defined as the ranges of intake for a particular macronutrient that are associated with reduced risk of chronic disease while providing adequate amounts of essential nutrients. Adults should consume 45%–65% of their total calories from carbohydrates, 20%–35% from fat, and 10%–35% from protein (Fig. 27.28). Elevated levels of cholesterol in low-density lipoproteins (LDL-C) result in increased risk for coronary heart disease (CHD). In contrast, elevated levels of cholesterol in high-density lipoproteins (HDL-C) have been associated with a decreased risk for CHD. Dietary	Biochemistry_Lippinco. is likely to pose no risk of adverse health effects to almost all individuals in the general population. The energy generated by the metabolism of the macronutrients (9 kcal/g of fat and 4 kcal/g of protein or carbohydrate) is used for three energy-requiring processes that occur in the body: resting metabolic rate, physical activity, and the thermic effect of food. Acceptable Macronutrient Distribution Ranges (AMDR) are defined as the ranges of intake for a particular macronutrient that are associated with reduced risk of chronic disease while providing adequate amounts of essential nutrients. Adults should consume 45%–65% of their total calories from carbohydrates, 20%–35% from fat, and 10%–35% from protein (Fig. 27.28). Elevated levels of cholesterol in low-density lipoproteins (LDL-C) result in increased risk for coronary heart disease (CHD). In contrast, elevated levels of cholesterol in high-density lipoproteins (HDL-C) have been associated with a decreased risk for CHD. Dietary
Biochemistry_Lippincott_1311	Biochemistry_Lippinco	result in increased risk for coronary heart disease (CHD). In contrast, elevated levels of cholesterol in high-density lipoproteins (HDL-C) have been associated with a decreased risk for CHD. Dietary or drug treatment of hypercholesterolemia is effective in decreasing LDL-C, increasing HDLC, and reducing the risk for CHD. Consumption of saturated fats is strongly associated with high levels of total plasma and LDL-C. When substituted for saturated fatty acids in the diet, monounsaturated fats lower both total plasma cholesterol and LDL-C but maintain or increase HDL-C. Consumption of fats containing ω-6 polyunsaturated fatty acids lowers plasma LDL-C, but HDL-C, which protects against CHD, is also lowered. Dietary ω-3 polyunsaturated fats suppress cardiac arrhythmias and reduce plasma triacylglycerols, decrease the tendency for thrombosis, and substantially reduce the risk of cardiovascular mortality. Carbohydrates provide energy and fiber to the diet. When they are consumed as part	Biochemistry_Lippinco. result in increased risk for coronary heart disease (CHD). In contrast, elevated levels of cholesterol in high-density lipoproteins (HDL-C) have been associated with a decreased risk for CHD. Dietary or drug treatment of hypercholesterolemia is effective in decreasing LDL-C, increasing HDLC, and reducing the risk for CHD. Consumption of saturated fats is strongly associated with high levels of total plasma and LDL-C. When substituted for saturated fatty acids in the diet, monounsaturated fats lower both total plasma cholesterol and LDL-C but maintain or increase HDL-C. Consumption of fats containing ω-6 polyunsaturated fatty acids lowers plasma LDL-C, but HDL-C, which protects against CHD, is also lowered. Dietary ω-3 polyunsaturated fats suppress cardiac arrhythmias and reduce plasma triacylglycerols, decrease the tendency for thrombosis, and substantially reduce the risk of cardiovascular mortality. Carbohydrates provide energy and fiber to the diet. When they are consumed as part
Biochemistry_Lippincott_1312	Biochemistry_Lippinco	decrease the tendency for thrombosis, and substantially reduce the risk of cardiovascular mortality. Carbohydrates provide energy and fiber to the diet. When they are consumed as part of a diet in which caloric intake is equal to energy expenditure, they do not promote obesity. Dietary protein provides essential amino acids. Protein quality is a measure of its ability to provide the essential amino acids required for tissue maintenance. Proteins from animal sources, in general, have a higher-quality protein than that derived from plants. However, proteins from different plant sources may be combined in such a way that the result is equivalent in nutritional value to animal protein. Positive nitrogen (N) balance occurs when N intake exceeds N excretion. It is observed in situations in which tissue growth occurs, for example, in childhood, pregnancy, or during recovery from an emaciating illness. Negative N balance occurs when N losses are greater than N intake. It is associated with	Biochemistry_Lippinco. decrease the tendency for thrombosis, and substantially reduce the risk of cardiovascular mortality. Carbohydrates provide energy and fiber to the diet. When they are consumed as part of a diet in which caloric intake is equal to energy expenditure, they do not promote obesity. Dietary protein provides essential amino acids. Protein quality is a measure of its ability to provide the essential amino acids required for tissue maintenance. Proteins from animal sources, in general, have a higher-quality protein than that derived from plants. However, proteins from different plant sources may be combined in such a way that the result is equivalent in nutritional value to animal protein. Positive nitrogen (N) balance occurs when N intake exceeds N excretion. It is observed in situations in which tissue growth occurs, for example, in childhood, pregnancy, or during recovery from an emaciating illness. Negative N balance occurs when N losses are greater than N intake. It is associated with
Biochemistry_Lippincott_1313	Biochemistry_Lippinco	tissue growth occurs, for example, in childhood, pregnancy, or during recovery from an emaciating illness. Negative N balance occurs when N losses are greater than N intake. It is associated with inadequate dietary protein; lack of an essential amino acid; or during physiologic stresses such as trauma, burns, illness, or surgery. Kwashiorkor occurs when protein deprivation is relatively greater than the reduction in total calories. It is characterized by edema. Marasmus occurs when calorie deprivation is relatively greater than the reduction in protein. No edema is seen. Both are extreme forms of protein-energy malnutrition (PEM). Nutrition Facts labels give consumers information about the nutritional content of packaged foods. Medical assessment of nutritional status includes dietary history, anthropometric measures, and laboratory data. Each life stage has specific nutrition needs. Growth charts are used to monitor the growth pattern of an individual from birth through adolescence.	Biochemistry_Lippinco. tissue growth occurs, for example, in childhood, pregnancy, or during recovery from an emaciating illness. Negative N balance occurs when N losses are greater than N intake. It is associated with inadequate dietary protein; lack of an essential amino acid; or during physiologic stresses such as trauma, burns, illness, or surgery. Kwashiorkor occurs when protein deprivation is relatively greater than the reduction in total calories. It is characterized by edema. Marasmus occurs when calorie deprivation is relatively greater than the reduction in protein. No edema is seen. Both are extreme forms of protein-energy malnutrition (PEM). Nutrition Facts labels give consumers information about the nutritional content of packaged foods. Medical assessment of nutritional status includes dietary history, anthropometric measures, and laboratory data. Each life stage has specific nutrition needs. Growth charts are used to monitor the growth pattern of an individual from birth through adolescence.
Biochemistry_Lippincott_1314	Biochemistry_Lippinco	anthropometric measures, and laboratory data. Each life stage has specific nutrition needs. Growth charts are used to monitor the growth pattern of an individual from birth through adolescence. Drug–nutrient interactions are of concern, especially in older adults.	Biochemistry_Lippinco. anthropometric measures, and laboratory data. Each life stage has specific nutrition needs. Growth charts are used to monitor the growth pattern of an individual from birth through adolescence. Drug–nutrient interactions are of concern, especially in older adults.
Biochemistry_Lippincott_1315	Biochemistry_Lippinco	Choose the ONE best answer. 7.1. For the child shown at right, which of the statements would support a diagnosis of kwashiorkor? The child: A. appears plump due to increased deposition of fat in adipose tissue. B. displays abdominal and peripheral edema. C. has a serum albumin level above normal. D. has markedly decreased weight for height. The correct answer = B. Kwashiorkor is caused by inadequate protein intake in the presence of fair to good energy (calorie) intake. Typical findings in a patient with kwashiorkor include abdominal and peripheral edema (note the swollen belly and legs) caused largely by a decreased serum albumin concentration. Body fat stores are depleted, but weight for height can be normal because of edema. Treatment includes a diet adequate in calories and protein. 7.2. Which one of the following statements concerning dietary fat is correct? A. Coconut oil is rich in monounsaturated fats, and olive oil is rich in saturated fats.	Biochemistry_Lippinco. Choose the ONE best answer. 7.1. For the child shown at right, which of the statements would support a diagnosis of kwashiorkor? The child: A. appears plump due to increased deposition of fat in adipose tissue. B. displays abdominal and peripheral edema. C. has a serum albumin level above normal. D. has markedly decreased weight for height. The correct answer = B. Kwashiorkor is caused by inadequate protein intake in the presence of fair to good energy (calorie) intake. Typical findings in a patient with kwashiorkor include abdominal and peripheral edema (note the swollen belly and legs) caused largely by a decreased serum albumin concentration. Body fat stores are depleted, but weight for height can be normal because of edema. Treatment includes a diet adequate in calories and protein. 7.2. Which one of the following statements concerning dietary fat is correct? A. Coconut oil is rich in monounsaturated fats, and olive oil is rich in saturated fats.
Biochemistry_Lippincott_1316	Biochemistry_Lippinco	7.2. Which one of the following statements concerning dietary fat is correct? A. Coconut oil is rich in monounsaturated fats, and olive oil is rich in saturated fats. B. Fatty acids containing trans double bonds, unlike the naturally occurring cis isomers, raise high-density lipoprotein cholesterol levels. C. The polyunsaturated fatty acids linoleic and linolenic acids are required components. D. Triacylglycerols obtained from plants generally contain less unsaturated fatty acids than do those from animals. Correct answer = C. Humans are unable to make linoleic and linolenic fatty acids. Consequently, these fatty acids are essential in the diet. Coconut oil is rich in saturated fats, and olive oil is rich in monounsaturated fats. Trans fatty acids raise plasma levels of low-density lipoprotein cholesterol, not high-density lipoprotein cholesterol. Triacylglycerols obtained from plants generally contain more unsaturated fatty acids than do those from animals.	Biochemistry_Lippinco. 7.2. Which one of the following statements concerning dietary fat is correct? A. Coconut oil is rich in monounsaturated fats, and olive oil is rich in saturated fats. B. Fatty acids containing trans double bonds, unlike the naturally occurring cis isomers, raise high-density lipoprotein cholesterol levels. C. The polyunsaturated fatty acids linoleic and linolenic acids are required components. D. Triacylglycerols obtained from plants generally contain less unsaturated fatty acids than do those from animals. Correct answer = C. Humans are unable to make linoleic and linolenic fatty acids. Consequently, these fatty acids are essential in the diet. Coconut oil is rich in saturated fats, and olive oil is rich in monounsaturated fats. Trans fatty acids raise plasma levels of low-density lipoprotein cholesterol, not high-density lipoprotein cholesterol. Triacylglycerols obtained from plants generally contain more unsaturated fatty acids than do those from animals.
Biochemistry_Lippincott_1317	Biochemistry_Lippinco	7.3. Given the information that a 70-kg man is consuming a daily average of 275 g of carbohydrate, 75 g of protein, and 65 g of fat, which one of the following conclusions can reasonably be drawn? A. About 20% of calories are derived from fats. B. The diet contains a sufficient amount of fiber. C. The individual is in nitrogen balance. D. The proportions of carbohydrate, protein, and fat in the diet conform to current recommendations. E. The total energy intake per day is about 3,000 kcal.	Biochemistry_Lippinco. 7.3. Given the information that a 70-kg man is consuming a daily average of 275 g of carbohydrate, 75 g of protein, and 65 g of fat, which one of the following conclusions can reasonably be drawn? A. About 20% of calories are derived from fats. B. The diet contains a sufficient amount of fiber. C. The individual is in nitrogen balance. D. The proportions of carbohydrate, protein, and fat in the diet conform to current recommendations. E. The total energy intake per day is about 3,000 kcal.
Biochemistry_Lippincott_1318	Biochemistry_Lippinco	D. The proportions of carbohydrate, protein, and fat in the diet conform to current recommendations. E. The total energy intake per day is about 3,000 kcal. Correct answer = D. The total energy intake is (275 g carbohydrate × 4 kcal/g) + (75 g protein × 4 kcal/g) + (65 g fat × 9 kcal/g) = 1,100 + 300 + 585 = 1,985 total kcal/day. The percentage of calories derived from carbohydrate is 1,100/1,985 = 55, from protein is 300/1,985 = 15, and from fat is 585/1,985 = 30. These are very close to current recommendations. The amount of fiber or nitrogen balance cannot be deduced from the data presented. If the protein is of low biologic value, a negative nitrogen balance is possible.	Biochemistry_Lippinco. D. The proportions of carbohydrate, protein, and fat in the diet conform to current recommendations. E. The total energy intake per day is about 3,000 kcal. Correct answer = D. The total energy intake is (275 g carbohydrate × 4 kcal/g) + (75 g protein × 4 kcal/g) + (65 g fat × 9 kcal/g) = 1,100 + 300 + 585 = 1,985 total kcal/day. The percentage of calories derived from carbohydrate is 1,100/1,985 = 55, from protein is 300/1,985 = 15, and from fat is 585/1,985 = 30. These are very close to current recommendations. The amount of fiber or nitrogen balance cannot be deduced from the data presented. If the protein is of low biologic value, a negative nitrogen balance is possible.
Biochemistry_Lippincott_1319	Biochemistry_Lippinco	7.6. In chronic bronchitis, excessive mucus production causes airway obstruction that results in hypoxemia (low blood oxygen level), impaired expiration, and hypercapnia (carbon dioxide retention). Why might a high-fat, low-carbohydrate diet be recommended for a patient with chronic obstructive pulmonary disease caused by chronic bronchitis? A. Fat contains more oxygen atoms relative to carbon or hydrogen atoms than do carbohydrates. B. Fat is calorically less dense than carbohydrates. C. Fat metabolism generates less carbon dioxide. D. The respiratory quotient (RQ) for fat is higher than the RQ for carbohydrates.	Biochemistry_Lippinco. 7.6. In chronic bronchitis, excessive mucus production causes airway obstruction that results in hypoxemia (low blood oxygen level), impaired expiration, and hypercapnia (carbon dioxide retention). Why might a high-fat, low-carbohydrate diet be recommended for a patient with chronic obstructive pulmonary disease caused by chronic bronchitis? A. Fat contains more oxygen atoms relative to carbon or hydrogen atoms than do carbohydrates. B. Fat is calorically less dense than carbohydrates. C. Fat metabolism generates less carbon dioxide. D. The respiratory quotient (RQ) for fat is higher than the RQ for carbohydrates.
Biochemistry_Lippincott_1320	Biochemistry_Lippinco	C. Fat metabolism generates less carbon dioxide. D. The respiratory quotient (RQ) for fat is higher than the RQ for carbohydrates. Correct answer = C. A treatment goal for the chronic obstructive pulmonary disease (COPD) caused by acute bronchitis is to insure appropriate nutrition without increasing the respiratory quotient (RQ), which is the ratio of carbon dioxide (CO2) produced to oxygen consumed, thereby minimizing the production of CO2. Less CO2 is produced from the metabolism of fat (RQ = 0.7) than from the catabolism of carbohydrate (RQ =1.0). Fat contains fewer oxygen atoms. Fat is calorically denser than is carbohydrate. [Note: RQ is determined by indirect calorimetry.] 7.7. A 32-year-old man who was rescued from a house fire was admitted to the hospital with burns over 45% of his body (severe burns). The man weighs 154 lb (70 kg) and is 72 in (183 cm) tall. Which one of the following is the best rapid estimate of the immediate daily caloric needs of this patient?	Biochemistry_Lippinco. C. Fat metabolism generates less carbon dioxide. D. The respiratory quotient (RQ) for fat is higher than the RQ for carbohydrates. Correct answer = C. A treatment goal for the chronic obstructive pulmonary disease (COPD) caused by acute bronchitis is to insure appropriate nutrition without increasing the respiratory quotient (RQ), which is the ratio of carbon dioxide (CO2) produced to oxygen consumed, thereby minimizing the production of CO2. Less CO2 is produced from the metabolism of fat (RQ = 0.7) than from the catabolism of carbohydrate (RQ =1.0). Fat contains fewer oxygen atoms. Fat is calorically denser than is carbohydrate. [Note: RQ is determined by indirect calorimetry.] 7.7. A 32-year-old man who was rescued from a house fire was admitted to the hospital with burns over 45% of his body (severe burns). The man weighs 154 lb (70 kg) and is 72 in (183 cm) tall. Which one of the following is the best rapid estimate of the immediate daily caloric needs of this patient?
Biochemistry_Lippincott_1321	Biochemistry_Lippinco	A. 1,345 kcal B. 1,680 kcal C. 2,690 kcal D. 3,360 kcal Correct answer = D. A commonly used rough estimate of the total energy expenditure (TEE) for men is 1 kcal/1 kg body weight/24 hours. [Note: It is 0.8 kcal for women.] For this patient, that value is 1,680 kcal (1 kcal/kg/hour × 24 hours × 70 kg). In addition, an injury factor of 2 for severe burns must be included in the calculation: 1,680 kcal × 2 = 3,360 kcal. 7.8. Which one of the following is the best advice to give a patient who asks about the notation “%DV” (percent daily value) on the Nutrition Facts label? A. Achieve 100% daily value for each nutrient each day. B. Select foods that have the highest percent daily value for all nutrients. C. Select foods with a low percent daily value for the micronutrients. D. Select foods with a low percent daily value for saturated fat.	Biochemistry_Lippinco. A. 1,345 kcal B. 1,680 kcal C. 2,690 kcal D. 3,360 kcal Correct answer = D. A commonly used rough estimate of the total energy expenditure (TEE) for men is 1 kcal/1 kg body weight/24 hours. [Note: It is 0.8 kcal for women.] For this patient, that value is 1,680 kcal (1 kcal/kg/hour × 24 hours × 70 kg). In addition, an injury factor of 2 for severe burns must be included in the calculation: 1,680 kcal × 2 = 3,360 kcal. 7.8. Which one of the following is the best advice to give a patient who asks about the notation “%DV” (percent daily value) on the Nutrition Facts label? A. Achieve 100% daily value for each nutrient each day. B. Select foods that have the highest percent daily value for all nutrients. C. Select foods with a low percent daily value for the micronutrients. D. Select foods with a low percent daily value for saturated fat.
Biochemistry_Lippincott_1322	Biochemistry_Lippinco	C. Select foods with a low percent daily value for the micronutrients. D. Select foods with a low percent daily value for saturated fat. Correct answer = D. The percent daily value (%DV) compares the amount of a given nutrient in a single serving of a product to the recommended daily intake for that nutrient. The %DV for the micronutrients listed on the label, as well as for total carbohydrates and fiber, are based on their recommended minimum daily intake, whereas the %DV for saturated fat, cholesterol, and sodium are based on their recommended maximum daily intake. For Questions 27.7 and 27.8, use the following case.	Biochemistry_Lippinco. C. Select foods with a low percent daily value for the micronutrients. D. Select foods with a low percent daily value for saturated fat. Correct answer = D. The percent daily value (%DV) compares the amount of a given nutrient in a single serving of a product to the recommended daily intake for that nutrient. The %DV for the micronutrients listed on the label, as well as for total carbohydrates and fiber, are based on their recommended minimum daily intake, whereas the %DV for saturated fat, cholesterol, and sodium are based on their recommended maximum daily intake. For Questions 27.7 and 27.8, use the following case.