Lisa Mayo, RDH, BSDH
Concorde Career College
 CHO
 Lipids
 PRO
 Vitamins
 Minerals
 Water
Organic compounds made of carbon, hydrogen, oxygen
Provide energy most abundant during metabolism
Yield 4kilocalories/gram
Monosacchies: Single Sugars. (glucose, fructose, galactose)
Disaccharides: Double Sugars (sucrose, lactose, maltose)
Polysaccharides: Complex. (starch, glycogen, cellulose,
dextrans)
 55-65% diet
 Digestion & Absorption
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 Review overall summary: little digestion in mouth salivary
amylase
 Know absorption routes
1.
Capillaries – bl stream. Water soluble nutrients
2. Lacteals – bl stream. Fat soluble nutrients
Monosaccharides
Glucose: blood sugar/dextrose
1.
 Main fuel for brain and needed for RBCs
 Body uses this form best
 Sources include many foods, such as grapes, oranges, corn,
carrots
Fructose: levulose/fruit sugar
2.
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Sweetest of all sugars
Sources include fruits, honey, corn syrup
Galactose: component of milk sugar
3.
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Body converts glucose to galactose in mammary tissue
during lactation – makes lactose in breast milk
Sources include milk/dairy products
 Disaccharides
1.
Sucrose (table sugar)
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2.
Lactose (milk sugar)
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3.
Furnish 1/3 of total COH intake in the average
Western diet made of glucose and fructose
Sources include sugar beets, sugarcane or maple syrup,
fruits and vegetables
Made up of glucose and galactose
Sources include milk products
Maltose (plant sugar)
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Made up of 2 glucose molecules
Forms as a starch in grains
 Polysaccharides
1.
Starch
Plant storage form of glucose (amylase and amylopectin)
Nutritionally most important CHO
Digestible/breaks down at as low rate
Stores energy
Sources include rice, potatoes, pasta and legumes
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2.
Glycogen
Provides 12-24 hours of stored energy
Animal equivalent of starch
Provides a food storage system in animal/humans (glycogenesis)
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In liver, it regulates blood sugar for the brain
In muscle, it serves as an energy source for muscle
contraction
Not significant as a food course
 Polysaccharides
1.
Dextrans
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2.
An energy source for caries-producing bacteria, such as
S.mutans
Fibers
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Should consume 20-35g/day
Dietary: cellulose/hemicellulose: good source of fiber –
found in bran, legumes, and all vegetables. Not digestible
in water
Functional: added to foods and dissolves in water to form a
gel (sources include legumes, apples, cabbage)
Total fiber: sum of dietary and functional fibers
 Blood Glucose Regulation
1.
2.
3.
Glycogenesis: glucose stored as glycogen
Glycogenolysis: glycogen broken down to glucose
Gluconeogenesis: glucose synthesized from non-CHO
**Will review in BIOCHEM slides**
 Hormones
1.
Insulin
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2.
Released in response to high bl sugar from pancreases Bcells. Increase glucogenesis in liver and muscle cells also
promotes fat storage
Glucagon
 Released in response to low bl sugar from pancreas A-cells.
Stimulates glucogenolysis in liver also gluconeogenesis
3.
Epinephrine
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4.
Produced in adrenal glands in response to fight or flight
Promotes glycogenolysis in muscle and some liver cells
Kidneys
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Glucose spills into urine if excessive
 Digestion: digestive enzymes come from pancreas and cells
of intestinal walls
1.
Polysaccharides (Starch)
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2.
Disaccharides (SLM)
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3.
Initial digestion begins in the mouth will enzyme salivary amylase
(breaks down into maltose)
Digestion occurs in the walls of the small intestine
Sucrose: enzyme sucrose breaks down sucrose into glucose and
fructose
Lactose: enzyme lactase breaks down lactose into glucose and
galactose
Maltose: enzyme maltase breaks down maltose into 2 molecules
of glucose
Monosaccharides: enter capillaries and glucose goes into
blood to be used as energy
 Functions
 Provide energy (4kcal/gram)
 Needed for the brain and RBCs
 Spare PRO – PRO can supply energy, however its main
function is to build tissue and replace cells (ie:growth)
 Aid in the oxidation (burning) of fats to prevent ketosis
 Furnish fiber for normal peristalsis
 Dietary requirement and nutrient sources – 130g per day,
easy to obtain
Carbohydrates may be clinically defined as
a. Polyhydroxyl aldehydes
b. Polyhydroxyl ketones
c. Compounds with carbon, hydrogen, oxygen as
a ratio of 1:2:1
d. None of the above
e. All of the above
Carbohydrates may be clinically defined as
a. Polyhydroxyl aldehydes
b. Polyhydroxyl ketones
c. Compounds with carbon, hydrogen, oxygen as
a ratio of 1:2:1
d. None of the above
e. All of the above
Question
Which of the following complex carbohydrates (CHO)
CANNOT be digested by humans?
a. Starch
b. Glycogen
c. Amylose
d. Cellulose
Answer
Which of the following complex carbohydrates (CHO)
CANNOT be digested by humans?
a. Starch
b. Glycogen
c. Amylose
d. Cellulose
Question
Which of the following is (are) an important site(s) for
CHO digestion?
a. Mouth
b. Stomach
c. Small intestine
d. A and B
e. B and C
Answer
Which of the following is (are) an important site(s) for
CHO digestion?
a. Mouth
b. Stomach
c. Small intestine
d. A and B
e. B and C
 Artificial Sweeteners: nonnutritive sweeteners, non-
CHO and non-caloric
1.
Aspartame
 Active ingredient in NutraSweet and Equal
 Composed of 2 aa aspartate acid, phenylalanine, methanol
 Not stable in heat therefore not suitable for cooking; used in
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beverages and chewing gum
Adverse effects – headaches, dizziness, and seizures
Provide calories, but little is needed for sweeting
200 times sweeter than sucrose
Not recommended of epileptics or pt’s with PKU
4kcal/g
 Artificial Sweeteners: nonnutritive sweeteners, non-CHO
and non-caloric
2.
Saccharin
2.
3.
4.
3.
Active ingredient in Sweet-n-Low
Used in soft drinks and table sweeteners, 300 time sweeter than
sucrose
Promoter (not a cause) of cancer tumor development. Zero
kcal/g
Acesulfame-K,
2.
3.
4.
5.
Active ingredient in Sunette and Sweet One
Stable in heat
Used in gums, creamers, gelatin products
200 sweeter than sucrose
Sucralose
4.
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Active ingredient in Splenda
Stable in heat
600 times sweeter than sucrose
Sucralose made from sugar. Made by chlorinating sucrose.
 Artificial Sweeteners: nonnutritive sweeteners, non-
CHO and non-caloric
5.
Neotame
2.
3.
4.
5.
6.
Approved in 2002 by FDA
Often blended with other sweeteners
No amino acids are absorbed – therefore does not need to
carry PKU warning
Stable in heat
8000 times sweeter than sucrose – little is needed
 Sugar Alcohols
 Sorbitol: made from glucose
 Mannitol: made from mannose and galactose
 Xylitol: derived from cellulose products, such as wood straw and
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pulp cane
 5 carbon sugar alcohol (polyol); sucrose is a 6-carbon sugar
 Absorbed slowly and completely from the small intestines –
little or no insulin is metabolized during the absorption process
 Antimicrobial – S.mutans are attracted to xylitol over other
sugars; however, the bacteria cannot metabolize xylitol and
therefore die
Nutritive sweeteners, CHO, sugar-like compounds that provide
calories
Do not promote tooth decay because they metabolize at a slower
rate
Not readily absorbed by small intestine, therefore can cause
diarrhea
Not metabolized by oral bacteria so considered non-cariogenic
4kcal/g
The main function of CHO is to:
a. Repair body tissues
b. Neutralize acids and bases
c. Provide energy
d. Regulate metabolism
The main function of CHO is to:
a. Repair body tissues
b. Neutralize acids and bases
c. Provide energy
d. Regulate metabolism
CHO can be stored in the liver and muscle as:
a. Lipids
b. Fiber
c. PRO
d. Glucose
e. Glycogen
CHO can be stored in the liver and muscle as:
a. Lipids
b. Fiber
c. PRO
d. Glucose
e. Glycogen
Carcinogenicity of sugar containing foods
1. Increases when sweets are in liquid form
2. Increases with frequency intake
3. Decrease when eaten with non-cariogenic foods
4. Decreases if sucrose is replaced by honey and
baked goods
a. 1,2
b. 2,3
c. 2,4
d. 3,4
Carcinogenicity of sugar containing foods
1. Increases when sweets are in liquid form
2. Increases with frequency intake
3. Decrease when eaten with non-cariogenic foods
4. Decreases if sucrose is replaced by honey and
baked goods
a. 1,2
b. 2,3
c. 2,4
d. 3,4
 Organic compounds composed of carbon, hydrogen,
oxygen
 Triglycerides account for 95% of all lipids (fats and oils)
1.
Triglycerides
 3 fatty acids with glycerol backbone
 Includes saturated (no double bonds) and unsaturated
(mono/poly unsaturated)
2.
Phospholipids
 Includes lecithins and are part of lypoPRO
 VLDL, LDL, HDL, Chylonicons
3.
Sterols
 Cholesterol is the most well know
1.
2.
Saturated fatty acids
 Less than 10% total calories needed
 Carry minimum number of hydrogen atoms
(hydrogenation)
 Remain solid at room temperature
 Increase serum cholesterol levels
 Sources include beef, lard, animal fats
Monounsaturated fatty acids
 Less than 10% total calories needed
 Contain a point of unsaturation linkage (double bond)
with no hydrogen atom
 Viscous in form
 Maintain serum cholesterol levels
 Sources include canola and olive oils
3.
4.
Polyunsaturated fatty acids
 No more than 10% of total calories needed
 Contain 2 or more points of unsaturation (double bond)
 Liquid in consistency
 Decrease serum cholesterol levels
 Sources include vegetable oils
Essential fatty acids (NBQ)
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Must be obtained from diet
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Linoleic: Omega-6. Sources: vegetable oils, sunflower
and safflower
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Linolenic: Omega-3. Sources: fish, mackerel, tuna,
salmon, plant oils, canola, olive, peanut
 Provide concentrated source of energy – 9kcal/g
 Provide insulation to maintain body temperature and
protect organs
 Carry fat-soluble vitamins A,D,E,K
 Provide satiety (fullness)
 Provide flavor and texture to foods
 Fat-soluble
 Will not dissolve in water. Must be carried by lipoPRO
carriers
 Food Sources
 Saturated: hard when cold except tropical oils
 Mostly animal sources
 Mono: canola oil, peanuts, olive oil
 Poly: corn oil, safflower oil, fish, margarine
 LioPRO Carriers
 HDL: take un-needed CHO back to liver
 LDL: deliver CHO to all cells in the body
 Chylomicrons: dietary triglycerides. Compromise bulk
of carriers in our system
 VLDL: takes triglycerides manufactured from excess
CHOs to fat cells for deposit as fat
Lipids provide
a. essential aa
b. essential fatty acids
c. vit C
d. sodium
Lipids provide
a. essential aa
b. essential fatty acids
c. vit C
d. sodium
Question
Which of the following organs is(are)
important for the digestion of fat?
a. Pancreas
b. Stomach
c. Gall bladder
d. Intestinal mucosa
e. All of the above
Answer
Which of the following organs is(are)
important for the digestion of fat?
a. Pancreas
b. Stomach
c. Gall bladder
d. Intestinal mucosa
e. All of the above
Question
Which of the following statements is true about
essential fatty acids?
a.
b.
c.
d.
Are linoleic and linolenic in humans
Should compose about 20% of total kcal
A and B
A and C
Answer
Which of the following statements is true about
essential fatty acids?
a.
b.
c.
d.
Are linoleic and linolenic in humans
Should compose about 20% of total kcal
A and B
A and C
 Made of many amino acids (aa) linked together by peptide
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bonds: linkage of amine grp and carboxy
Contain the elements carbon, hydrogen, oxygen, nitrogen
(sometimes sulfur)
Main function = repair/build tissue
Structure unique among other nutrients because contains
Nitrogen
Yield 4kcal/g
 Essential (Indispensable) aa – body cannot synthesize,
must obtain from the diet, 9 are essential
 PVT MY HILL (acronym)
Phenylalanine, Valine, Threonine, Methionine,
Tyrptophan, Histidine, Isoleucine, Leucine, Lysine
 Nonessentail (Dispensable) aa- body synthesizes as long as
nitrogen is present, not required in the diet (11 of them)
 Complete PRO (High Quality)
 Foods that contain all 9 aa
 Sources: animal foods (fish, meat, eggs, cheese, milk,
soybeans)
 Incomplete PRO (Low Quality)
 Lack 1 or more essential aa (Plant PRO)
 Complementary PRO
 Need to combine 2 or more PRO to compensate for
deficiencies in aa content
 Use of whole grains is important
 Physiology begins in the stomach
Functions
1.
2.
3.
4.
5.
6.
7.
8.
9.
Structure
Enzymes
Hormones
Antibodies
Blood clotting
PRO carriers
Fluid balance
pH balance
Energy – always last resort
Sources and RDA (recommended dietary allowances)
Animal: egg, vegetables, legumes, rice, grains
PRO is the only fuel with an RDA. 8g/8kg body weight
Dietary guidelines: 12% daily cal come from PRO
Vegetarians:
Lacto-ovo veg: People who include milk/milk products
and
eggs but exclude meat, poultry, fish, seafood
Lactoveg: People who include milk and milkproducts but exclude meats, poultry, fish/seafood
and eggs
Vegan: excludes all animal derived foods including
meats, poultry, fish, eggs and dairy products.
Also called pure-vegetarians because they eat only
plants
1.
2.
Phenylketonuria: PKU
-Liver cannot metabolize essential aa phenylalanine into
non-essential aa tyrosine
-Diet must restrict phenylalanine and avoid nutra-sweet
PRO-Malnutrition or PCM
Kwashiorkor: severe PRO deficient manifests itself with
severe wasting of body fat. Edema in legs
and abdomen
Marasmus: Prolonged Inadequate Food Intake, and/or
Deficiency in PRO-cal (starvation)
Muscle waste and weaken and no edema
 Water Soluble: B, C
 Fat Soluble: A, D, E, K
 Organic nutrients needed by the body in small
quantities
 Do not contribute energy to the body bur are needed
as facilitators of body processes
 Fat-soluble Vitamins
 Soluble in fats and fat solvent
 Not readily excreted and therefore can build up to toxic
levels
 Stored in liver and fatty tissues
 Water-soluble Vitamins
 Include all B,C vitamins
 Easily absorbed and excreted, therefore, it is
unlikely to reach toxic levels
 Main functions include metabolism of CHO, fats,
PRO, blood formation (hemopoiesis)
 Deficiency of these vitamins affects the mouth
(cheilosis and glossitis)
1.
Vitamin A
 Prevents night blindness, maintain normal
mucous membranes
 Sources
1. Retinols: Preformed vit A. Found in animal
foods such as liver, fish, fortified milk
2. Caritinoids: Vitamin precursors. Found in
orange-yellow and dark green vegetables
and fruits
2.
Vitamin D
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Function as a hormone
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Sources: sunlight, fortified milk, fish liver oils
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Nutritional Deficiency and Disease
1.
Rickets: in kids, softenng of bones due to failure to
calcify normally. Symptoms include bowed legs,
enlarged head/joints/rib cage, deformed pelvis
2. Osteomalacia: adults, calcium is taken from bones
to make up for insufficient absorption in intestine.
Symptoms include bowed legs, bent posture and
pain in ribs/pelvis/legs
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Assists as
1.
Absorption of calcium and phosphorus
2. Formation and mineralization of teeth and bones
3.
Vitamin E
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Tocopherol – tool in the battle against cancer and
heart attack
Function: preserves fats (antioxidants)
Sources: vegetable oils, green leafy vegetables,
whole grains
Toxicity: interferes with blood coagulation vit K
4.
Vitamin K
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Function: aids in the formation of blood-clotting factor
prothrombin and helps increase bone density
Sources: green leafy vegetables, synthesized by intestine
Which of the following vit interferes with the action of
vit K?
a. C
b. E
c. D
d. B1
Which of the following vit interferes with the action of
vit K?
a. C
b. E
c. D
d. B1
Vitamin
Functions
Deficiencies
Sources
Properties
A
Normal vision,
PRO synthesis,
helps remold bone
Night blindness,
imapired tooth
formation, keratinized
epithelial tissues
Retinols-animal
sources,
Caritinoids (deep
yellow-orange,
dark-green veg &
fruits)
Found in
preformed (active)
vit A & provit A
D
Bone growth w/the
assistance of Ca &
Phosphorus
Rickets, osteomalacia,
osteoporosis, Cadeficiency
Sun, fortified milk
& products
E
Antioxidant
Rare
Found in many
foods including
polyunsaturated
veg oils
K
Clots blood
Hemorrhaging
Bacteria in GI,
liver, cabbage,
leafy green veg
Easily destroyed by
heat & exposure to
air, toxicity
interferes w/blood
coagulation
Question
Characteristics of fat-soluble vitamins include all of the
following EXCEPT:
a. Contain carbon, hydrogen, oxygen
b. Must be emulsified before they can be absorbed
from the diet
c. Deficiency symptoms are slow to develop
d. Unstable to light, heat, oxygen
e. Toxic with chronic excessive intake
Answer
Characteristics of fat-soluble vitamins include all of the
following EXCEPT:
a. Contain carbon, hydrogen, oxygen
b. Must be emulsified before they can be absorbed
from the diet
c. Deficiency symptoms are slow to develop
d. Unstable to light, heat, oxygen
e. Toxic with chronic excessive intake
1.
Thiamin (B1)
 Function: helps provide energy to brain, heart, CNS
 Nutritional Deficiency and Disease: Beri-Beri which
damages nervous and cardiovascular systems
 Sources: pork, enriched whole grains, legumes, milk,
nuts, peas
2.
Riboflavin (B2)
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Function: essential for growth and production of RBC,
prevents cheilosis, glossitis, anemia
Sources: milk, green leafy veg, legumes
Properties: sensitive to light (milk should be stored in
cardboard/opaque containers)
3.
Niacin (B3)
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Function: needed in RNA and DNA synthesis
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Nutritional Deficiency and Disease
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Pellagra
 Rough, painful skin
Dementia
 Diarrhea
 Dermatitis
 Death
Sources: meat, fish, enriched grains, green leafy veg
Properties: aa tryptophan can be converted to niacin
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4.
Folate (Foclain, Folic acid)
 Function: assists in forming DNA, RNA and RBC
formation
 Nutritional Deficiency and Disease
 Megaloblastic anemia
 Glossitis
 Diarrhea
 Birth defects (spina bifida)
 Sources: liver, dark green and leafy veg, OJ
5.
Cobalamin (Cyanocobalamin B12)
 Function: helps build tissues, maintain nerve cells,
essentail for RBC development, also needed for folate
metabolism
 Nutritional Def and Disease: found in strict
vegetarians, pernicious anemia (weakness, sore
tongue, apathy)
 Sources: animal or fortified foods
 Properties
 Intrinsic factor: PRO made in stomach, needed for
absorption of B12
 Extrinsic factor: must be obtained through foods
6.
Vitamin C (Ascorbic Acid)
 Functions: promotes synthesis of PRO collagen
(ct), acts as an antioxidant
 Nutritional Def and Disease: Scurvy: ruptured
blood vessels, swollen and bleeding gingiva,
delayed wound healing
 Sources: strawberries, broccoli, cantaloupe, citrus
fruits, potatoes, tomatoes
 Properties: no extensive storage, smoker and
women on BC pills have increased need
Vitamin
Function
Deficiencies
Sources
Thiamin (B1)
Energy to brain,
heart, CNS
BeriBeri
Pork, enriched
grains, milk,
legumes, nuts
Riboflavin (B2)
Growth, repair,
prod. RBCs
Cheilosis,
glossitis, fatigue
Milk, enriched
grains, eggs,
poultry, fish,
nuts, legumes
Niacin (B3)
RNA/DNA
synthesis &
metabolism
Pellegra
Meat, enriched
grains,
legumes,
yogurt
Pantothenic
Acid
Coenzyme in
energy
metabolism
Rare
Many foods
Biotin
Coenzyme in
energy
metabolism,
glycogen
synthesis
Rare
Cauliflower,
cooked eggs,
peanut, cheese
Properties
Amino acid
tryptophan can
convert to niacin
Vitamin
Function
Deficiencies
Sources
Properties
Pyridoxine (B6)
Brain function,
prod of RBCs
Irritability,
depression, muscle
weakness, anemia
Meat, poutltry,
fish, bananas,
white/sweet
potatoes
Folate
Helps form
DNA/RNA/RBC
Megaloblastic
anemia
Spina Bifida
Dark green leafy
vegetable, orange
juice
Need more if on
birth control
Cobalamin (B12)
Builds tissues,
develops RBCs
Pernicious
anemia
Sore tongue
Animal foods
Fortified foods
Lack of intrinsic
/extrinsic factor
Vitamin C
Synthesis of PRO
collagen,
antioxidant,
wound healing
Scurvy
Fruits,
vegetables,
fortified foods
Smokers
Need more if on
birth control
Question
Which of the following is a general function of water
soluble vitamins?
a. Function as coenzymes for energy metabolism
b. Are important for vision
c. Are important for regulating Ca levels in the body
d. Are important for normal blood clotting
e. Function to maintain epithelial cells and
mucosal lining
Answer
Which of the following is a general function of water
soluble vitamins?
a. Function as coenzymes for energy metabolism
b. Are important for vision
c. Are important for regulating Ca levels in the body
d. Are important for normal blood clotting
e. Function to maintain epithelial cells and
mucosal lining
 Inorganic nutrient used in the body for building and
regulating functions
 Yield no energy to the body, but assist in regulating
the release of energy
 Macrominerals
 Major minerals present in amts greater than 5g in the
body
 Calcium, Sodium
 Microminerals
 Required in the diet in amts <100mg/day
 Iron, Copper, Iodine, Zinc
 Functions
 Forms and maintains bones and teeth
 Coagulates blood
 Nutritional Deficiency & Disease
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Rickets
Osteomalacia
Osteoporosis
Women at highest risk
 Sources
 Dairy products, broccoli, soy sources
 Calcium-fortified fruit drinks, calcium supplements
 Properties
 Contribute to HBP which can lead to heart disease,
stroke
 Hypertension is not caused by excessive sodium but
aggravates it
 Recommendations
 Reduce sodium intake and increase the use of spices wen
cooking
 Function
 Helps manufacture amino acids and hormones
 Nutritional Deficiency and Disease

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Anemia
Oral lesions
Patchy tongue
Brittle bones
Fatigue
 Sources
 Organ meats (liver), dried beans, nuts
 Not found in milk
 Function
 Formation of hemoglobin
 Sources
 Shellfish, oysters, crab, liver, legumes
 Function
 Helps regulate BMR (thyroid gland)
 Nutritional Deficiency and Disease
 Goiter
 Function
 Wound healing
 Aids in cell and immune system function
 Nutritional Deficiency and Disease
 Skin disorders
 Properties
 Highest concentrations found in bones
 Sources
 Seafood, tofu, milk, eggs, whole-grain breads
 Diabetes Mellitus
 Metabolic disorder characterized by high blood glucose
levels due to insufficient or ineffective insulin function
 When glucose levels are elevated in the blood and cells,
tissue damage will result
 Normal glucose levels: 70-125mg/dl
 Type I or II
Question
The important nucleic acids that carry the
genetic message for protein synthesis to the
cytoplasm are
a. DNA
b. cDNA
c. mRNA
d. rRNA
e. tRNA
Answer
The important nucleic acids that carry the
genetic message for protein synthesis to the
cytoplasm are
a. DNA
b. cDNA
c. mRNA
d. rRNA
e. tRNA
 Type I
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
Insulin-dependent (IDDM)
Involves the minority of cases (5-10%)
Occurs primarily in kids and young adults – 10-14yrs
Islets of Langerhans in pancreas cannot synthesize insulin
Onset assoc with a viral infection or hereditary
Characterized by weight loss with increase appetite
 Type II
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Noninsulin-dependent (NIDDM)
Most common (90%)
Usually develops in people over 40yrs and is assoc w/obesity
Results from insufficient insulin or improper use
Characterized by weight gain and increased apatite
 Signs and Symptoms
 Hyperglycemia: abnormally high blood glucose
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




concentration
Acetone breath: fruity odor as a result of ketosis
Ketonemia: ketones in blood
Ketonuria: ketones in urine
Polydipsia: increased thirst
Polyuria: frequent urination
Polyphagia: increased appetite due to need for energy
 Chronic Complication
 Increase in periodontal disease – 3 times more likely to
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
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
get perio disease, other infections
Xerostomia - increase decay
Blindness
Poor circulation
Heart disease – most frequent cause of diabetes-related
death
Loss kidney function
 Hypoglycemia
 Low blood glucose levels (brain almost entirely fueled by
glucose)
 Less than 70mg/dl
 Symptoms:
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Shakiness
Dizziness
Sweating
Heachaches
Irritability
Hunger
Lightheadedness
Palpitations (not lowered heart rate!)
 Motivation: motivate patient by
 Involve them in the decision making process
 Allow them to choose what should be eliminated from
diet
 Allow them to be accountable for changing behaviors
 Diet Survey – evaluate
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Frequency of intake – worse times are between meals
Consistency of food – physical form
Amt of sugar added to foods
Total intake
 Remember: lactic acid attack begins within the first
min of exposure
Question
Which of the following is NOT a dietary
recommendation for a diabetic?
a. Eat a low complex CHO diet
b. Limit fat intake to 30% of Kcal
c. regulate CHO and meal spacing during the
day
d. Coordinate food intake, exercise, and
medication
e. Limit simple sugars
Answer
Which of the following is NOT a dietary
recommendation for a diabetic?
a. Eat a low complex CHO diet
b. Limit fat intake to 30% of Kcal
c. regulate CHO and meal spacing during the
day
d. Coordinate food intake, exercise, and
medication
e. Limit simple sugars
 Primary
 Under nutrition: env lack of adequate food
 Under-developed countries
 Secondary
1.
2.
3.
4.
5.
6.
Altered Behaviors: Advanced malignant disease, Infection,
Renal failure, Depression, Anorexia nervosa, Bulimia
Obesity
Disorders interfering with ingestion: Oropharyngeal
disease/tumors, ulcerations, pain, neuralgia, neurological
syndromes (palsies, myasthenia gravis), malocclusion, TMJ
Defective absorption: Chron’s disease, organ failure,
tropical sprue, celiac disease
Excessive loss of nutrient: chronic blood loss (iron)
Increased requirements: pregnancy, periods rapid growth
Minerals: Iron, Ca, Iodine
2. PRO deficiency (next slide)
3. Hypovitaminoses
4. Hypervitaminoses
1.
 Kwashiorkor: not enough PRO
 Oral Manifestations
1.
2.
3.
4.
5.
Glossal edema with scalloping of lateral margins
Glossal papillary atrophy (dorsum is smooth and red)
Angular cheilitis/fissuring
Lip pigmentation
Xerostomia , Saliaosis (enlarged salivary glands)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Constitutional symptoms: not feel good
Angular cheilitis
Atrophic glossitis: smooth bald, smooth patchy red
Gingivitis
Stomatitis: ulcerative, burning
Vitamin C: ascorbic acid
Vitamin B1: thiamine
Vitamin B2: riboflavin
Vitamin B5: niacin, nicotinic acid
Vitamin B12: Cobalamin
Folic acid
Vitamin D
Vitamin K
 Vitamin C
 Scurvy
 GI bleeds
 Petechiae hemorrhages
 Gingivitis, hyperplasia, bleeding
 Exaggerated perio d.
 Tongue normal
 Prevalence controversial except in fad diets
 Vitamin B1
 Beriberi
 Peripheral neuropathy
 Cardiac disease
 Edema
 May have painful or burning
tongue
 Oral symptoms unusual
 B2
 Common in underdeveloped countries
 US: alcoholics
 Severe cold symptoms including sore throat
 Tongue may be sore,
purple, pebbly
 B5
 Pellegra
 Common Africa/Asia
 Gen edema and vesiculobullous lesions
 Severe glossitis, sometimes with severe stomatitis and
gingivitis
 Glossal atrophy, glossal edema, glossal fissuring
 Combined riboflavin-niacin deficiency not as rare as
other hypovitaminoses
 Vit B12
 Pernicious anemia
 Nervous disorders
 Folic acid
 Part of clinical picture of sprue
 Atrophic tongue
 Bright red gingivitis
 Vitamin D
 Rickets: kids
 Octeomalacia: adults
 No basis for dental caries
 No clinical oral symptoms, may be radiographic signs
(bone distortion)
 Vitamin K
 Blood clotting factors
 Severe symptoms
 Headache, fever
 GI: nausea, pain, vomiting, diarrhea, aggravation of peptic
ulcers
 Itching, hay fever. Asthma-like symptoms (thiamine)
 Hypercholesterolemia (ascorbic acid)
 Kidney damage (Vit D)
Swollen gingiva and capillary fragility are signs of
possible deficiency of which of the following?
a. Vit A
b. Vit C
c. Vit D
d. Vit E
e. Vit K
Swollen gingiva and capillary fragility are signs of
possible deficiency of which of the following?
a. Vit A
b. Vit C
c. Vit D
d. Vit E
e. Vit K
Which of the following is NOT an indicator in the oral
tissues of possible nutritional problems?
a. Dental caries
b. Gingivitis
c. Glossitis
d. Cheilosis
e. Xerostomia
Which of the following is NOT an indicator in the oral
tissues of possible nutritional problems?
a. Dental caries
b. Gingivitis
c. Glossitis
d. Cheilosis
e. Xerostomia
Which of the following is a major gland that affects
BMR?
a. Thyroid
b. Pancreas
c. Endocrine
d. Hypothalamus
A. Thyroid
BMR: Basal Metabolic Rate. Measure of energy needed
to maintain life at rest (breathing, heart beating,
circulation, muscle tone and body temp)
BMI: Body Mass Index: reflects weight in relation to
height. Not a measure of lean body mass
BMI: weight(kg) or weight(lb) x 705/Ht
Vegans are at risk for developing
deficiencies in which of the following
nutrients?
a.
b.
c.
d.
e.
CHO
vit B12
Protein
Vit A
Vit C
Vegans are at risk for developing
deficiencies in which of the following
nutrients?
a.
b.
c.
d.
e.
CHO
Vit B12
Protein
Vit A
Vit C
 Calories from food should equal energy needs of the
body
 Energy needs of the body
 Basal metabolism rate (BMR): measure of energy
needed to maintain life at rest
 Degree of physical activity: voluntary component of
energy which varies from sedentary to strenuous activity
 Specific dynamic activity (SDA): energy required to
digest and absorb foods
Question
Which of the following statements is true about the
basal metabolic rate?
a. Should be measured with a person sleeps
b. Is influenced by climate and altitude
c. Includes the energy necessary for normal muscle
activity
d. Includes the specific dynamic energy (SDE)
e. Should be measured at an environmental
temperature of 98.6 degrees
Answer
Which of the following statements is true about the
basal metabolic rate?
a. Should be measured with a person sleeps
b. Is influenced by climate and altitude
c. Includes the energy necessary for normal muscle
activity
d. Includes the specific dynamic energy (SDE)
e. Should be measured at an environmental
temperature of 98.6 degrees
 Self-starvation due to a distorted body image of being
overweight
 Behavior Profile
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Female, occurs after puberty
Competitive/obsessive behavior
Increased risk with upper SES
Family conflict, overbearing parents
Fear of gaining weight
 Characteristics
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Dramatic weight loss (20-40%) below desirable body weight
Excessive exercise, aversion to foods and altered eating habits
Eats 300-600cal/day
Amenorrhea, Lanugo (soft, fine hair)
Decreased heart rate caused by slowing metabolism
 Tx
 Dietary, psychological, 50% who survive = 6 year recovery
 Episodes of binge eating followed by purging to prevent weight
loss (vomit or laxatives)
 Behavior profile
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Female, college-aged student
Weight is at or slightly above normal
Turns to food for comfort, aware behavior is abnormal
Low self-esteem and impulsive behavior
 Characteristics
 Vomits @ least 2x/wk
 Eats 15,000 or more cal in a binge
 Calluses on knuckles, depressed
 Tx
 Dietary, psychological
 Oral Manifestations
 Erosion, thermal sensitivity, enlarged parotid glands, cheilosis
 Recommend NaF rinses or sodium-bicarb rinses to neutralize acids
 Characteristics
 Consumes non-nutritive
substances (soil, paper, coal, lead,
paint chips)
 Abnormal apatite for things that
may be considered foods (raw
potatoes, ice cubes, flour)
 Causes
 Biochemical or iron deficiency
 Tx
 Psychosocial, environmental,
family guidance approaches
Question
Which of the following statements is false about
anorexia nervosa?
a. A state of PRO-energy malnutrition
b. More prevalent in females then males
c. Treated with psychiatric and/or psychological
counseling
d More prevalent than bulimia
e. Often seen in individuals descried as perfectionists
Answer
Which of the following statements is false about
anorexia nervosa?
a. A state of PRO-energy malnutrition
b. More prevalent in females then males
c. Treated with psychiatric and/or psychological
counseling
d More prevalent than bulimia
e. Often seen in individuals descried as perfectionists
Twice as many people have Bulemia, anorexia more
discussed in media