QUESTIONS ABOUT NUTRITION AND FOOD QUALITY CONTROL

HUMAN NUTRITION AN FOOD QUALITY
CONTROL EXERCISES.
Session: exams CORRECTION + others notes prepared questions
by MT-Einstein
FEBRUARY 14, 2019
MINANI THEOBALD Einstein
UNIVERSITY OF RWANDA
COLLEGE OF MEDICINE AND HEALTH SCIENCES
SCHOOLL OF MEDICINE AND PHARMACY
DEPARTMENT OF PHARMACY
YEAR 4 / 2018-2019

 MINANI THEOBALD EINSTEIN PHARMACY 4 2018-2019
NUTRITION AND FOOD QUALITY CONTROL
Name the following figure bellow Wet mount and Gram stain
C
D
E
F
A B
G

NAMES THE LETTER CORRESPONDING TO
A B C D E F G

Q.WHAT ARE THE PRINCIPLES OF STAINING

APART FORM SAFRANIN AS COUNTER STAIN WHATANOTHER
SUBSTANCE SHOULD BE USED AS COUNTER STAIN

DEFINE THE FOLLOWING TERMS
A. Health: state of complete physical, mental and social welfare and not only the
absence of disease or infirmity (WHO)
B. Nutrition: Nutrition is “a process by which living matter acquires nutrients for
growth, repair and energy”
C. Dietetics: It is the science of applying nutritional principles to the planning and
preparation of foods and regulation of the diet in relation to both health and disease
D. Food: Material, usually of plant or animal origin, that contains or consists of essential
body nutrients, (such as carbohydrates, fats, proteins, vitamins, or minerals) and is
ingested and assimilated by an organism to produce energy, stimulate growth, and
maintain life. Which one takes into the system to maintain life and growth, and supply
waste.

E. Food fortification the addition of nutrients to foods without the intention of
replacing nutrients lost in preparation.
F.Balanced diet: A diet that which contains various groups of foods, such as energy
yielding foods, body building foods and protective foods in the correct proportions, so
that an individual obtains the minimum requirements in all nutrients.
G. Nutrients are the chemical components of food, which perform in producing
energy, promote the growth and repair of tissues or regulate these processes.
H. Nutrients are chemical substances in foods that provide energy, form body
structures, and regulate body processes, and the body doesn’t produce them (Grosvenor
and Smolin).
I. Nutrition is a science that studies all the interactions that occur between living
organisms and food (Grosvenor and Smolin).

DESCRIBE FOUR TYPES OF DIET
 Adequate diet
 Moderate diet
 Balanced diet and
 Varied diet
Define
A. A balanced diet is one that contains the combinations of foods that provide the
proper proportions of nutrients.
B. Adequate diet is one that provides enough of the energy, nutrients, and fiber to
maintain a person’s health. A diet may be inadequate in only one area.
C. Moderate balanced diet is one of the keys to a healthful diet refers to eating any
foods in moderate amounts not too much and not too little. If a person eats too much or
too little of certain foods, health goals cannot be reached.
D. Varied balanced diet is one refers to eating many different foods from the different
food groups on a regular basis.

TOOL USED IN LABELLING FOOD

What are the tool used in planning diet?
What are the daily serving of each food group in pyramids
 Food guide Pagoda
 My food guide pyramid

CLASSIFY NUTRIENTS ACCORDING TO
 ENERGY YIELDING
o Protein: 4kcal/1g
o fat and : 9kcal/1g
o carbohydrates 4kcal/1g
 HOW MUCH THEY NEEDED IN THE BODY
o Macronutrients: amount required in kg or in g eg: water,
carbohydrates, lipid and protein
o Micronutrients: amount required in milligrams (1mg= 1/1000gr)
or in micrograms eg: vitamins and minerals
 CARBON STUCTURE
o Organics : carbohydates,fat,protein,vitamin
o Inorganic: minerals and water

DIFFERNCIATES BETWEEN MALNUTRION AND UNDERNUTRITION
Lack of the necessary minimum amount of any nutrient leads to a state of malnutrition,
while a general deficiency of all nutrients produces under nutrition and, in extreme
cases, starvation.
AMINO ACID POOL

WHAT ARE THE FUNCTIONS OF NUTRIENTS
a) Energy: carbohydrates, lipids and proteins
b)Structure: Water, proteins, lipids and minerals
c)Regulation: All six classes of nutrients have important regulatory roles.
o Water helps to regulate body temperature.
o Proteins, vitamins and minerals help to speed up or slow down the reactions of
metabolism as needed to maintain homeostasis.
o Carbohydrate molecules on the surface of cells are important in regulating body
processes by aiding cell communication
WHAT ARE THE FACTORS THAT DETERMINE THE REQUIRED NUTRIENT
 Sex
 Age
 few other factors Like nutrient interaction
 Adequate fat is essential for the absorption of vitamin A, and
 Vitamin C increases the absorption of iron when they are consumed together.
 Lifestyle factors are also important eg: People who smoke require more vitamin
C and active individuals have higher energy needs than their sedentary
counterparts do.

DEFINE THE FOLLOWING:
 Malnutrition: Any condition resulting from an energy or nutrient intake either
above or below that, which is required.
 Under nutrition: Any condition resulting from an energy or nutrient intake
below that which meets nutritional needs.
 Over nutrition: Poor nutritional status resulting from a dietary intake in excess
of that which is needed to maintain health.
 Risk factor: A characteristic or a circumstance that is associated with the
occurrence of a particular disease. Risk factors includes variables such as genetic
background, dietary and lifestyle habits, and environmental conditions.
FACTORS THAT DRIVE FOOD CHOICES ACCORDING TO F. SIEKIEWICZ S.
AND E. WHITNEY
1.Culture
2.Food availability
3.Income

4.Knowledge
5.Social status and
6.Convenience.
DETERMINANTS OF FOOD CHOICE ACCORDING TO GROSVENOR AND.
SMOLIN
1. Availability:
2. Personal and cultural preferences
3. Health concerns:
THE FACTORS THAT AFFECT FOOD AVAILABILITY
 Geography
 Socioeconomic factors (income and education level, living conditions, and life style
affect the types and amounts of foods that can be selected.)
 Healthy status.
 Digestion: The process of the breakdown of macromolecules of the food into smaller
units. It involves both chemical and physical processes occurring in different organs.
 Digestive system: is the body system composed of organs that break down complex
food particles into smaller, absorbable products.

WHAT ARE THE FUNCTION OF THE FOLLOWING IN FOOD
DIGESTION
 Mouth
 Esophagus
 Stomach
 Small intestine
 Large intestine
 Rectum
 Pancreas
 Liver
 Gall bladder
 Salivary gland
GIVE 3PRINCIPAL DIGESTING ORGANS AND 4 ACCESSORY ORGANS OF
DIGESTIVE SYSTEMS

DEFINE THE FOLLOWING
 Macronutrients: They are essential nutrients required in relatively large amounts, such as
carbohydrates, fats, proteins, or water; [sometimes certain minerals are included, such as
calcium, chloride, Natrium, magnesium and phosphorus]. Their main role is to supply energy
and structural material (proteins, membranes, teeth and bones).
 Micronutrients: These are nutrients needed throughout life in small quantities (Vitamins
and trace minerals). They serve as cofactors for normal metabolism.
 Metabolism: Metabolism is the set of chemical reactions that happen in living organisms to
maintain life. Metabolism is divided into two categories:
 Catabolism: The breakdown of organic matter, for example to harvest energy in cellular
respiration.
 Anabolism: The use of energy to construct components of cells such as proteins and
nucleic acids.
Q.WHAT ARE THE SACCHARIDE THAT ARE USED FOR DIABETIC
PEOPLE--------]]] Fructose

Q.CARBOHYDRATES RESPONSIBLE OF CAUSING DENTAL CARRIES:
sucrose
Q.WHAT ARE THE EFFECT NEGATIVE EFFECT OF OLIGOSSACCHARIDE
TO HUMAN HEALTH
 The most notorious are the trisaccharide raffinose and tetrasaccharide stachyose, found
in large quantities in legumes (peas and beans), especially soya beans. Fermented by
bacteria in the colon, they produce gases CO2, H2 and CH4, causing discomfort and
flatulence.
 The content of oligosaccharides can be reduced by soaking and cooking.
GLYCCOGEN STORAGES: about 90g in the liver, plus 350g in the muscles
WHAT ARE THE INDIGESTIVES SBCES DERIVED FROM THE PLANTS
(DIETARY FIBERS)
 Cellulose

 Hemicellulose
 Pectic substances
 Lignins
CLASSIFY DIETARY CARBOHYDRATES
1.Simple sugars
Monosaccharide: Fructose , glucose,
Disaccharides: sucrose ,lactose
sugar alcohols : sorbitol, xylitol and isomalt in excess cause diarrhea
oligosaccharides: trisaccharide raffinose and tetrasaccharide stachyose
2.Complex carbohydrates (polysaccharides):
Starch from plant origin
glycogen from animal origin
3.Dietary fibers (non-starch polysaccharides).
Cellulose
Hemicellulose
Pectic substances
Lignin

FACTORS REGULATE BLOOD GLUCOSE LEVEL
1.HORMONAL FACTORS
 Insulin
 Glucagon
 Adrenaline
2.NUTRITIONAL FACTORS
 Complex carbohydrates
3.BODY BIOSYNTHESIS
 Gluconeogenesis by use of glucose precursor
 are lactate, glycogenic amino acids, and glycerol
WHAT IS ACRYLAMIDE

In food, acrylamide can be formed in two basic ways.
1. First, acrylamide can be formed when amino acids interact with sugars in the
presence of heat. Many different kinds of sugars and many different amino acids can
interact in this way. However, one particular amino acid—called asparagine—has a far
greater tendency to interact with sugars and to form acrylamide than other amino
acids.
2. Second, it is possible to form acrylamide without the presence of sugars. When fats in
food are oxidized, unique 3-carbon molecules (including acrylic acid and acrolein)
can be formed
1. Fried, processed foods like potato chips and French fries.
2. baked snack foods containing wheat and sugar, including cookies and
crackers
3. Processed foods involving toasted grains, including toasted wheat cereals.

SOURCES OF ACRYLAMIDE: LIST OF FOODS HIGH IN ACRYLAMIDE
Are you looking for a list of foods that are high in acrylamide, a chemical compound that has
been shown to induce cancer in rats and that is classified as a probable human carcinogen?
Below, we have listed 10 common foods that are known to be particularly high in acrylamide.
For each food, a low acrylamide alternative is given.
Note, however, that from an overall nutritional and health point of view the alternative may
not be any better than the actual food listed. For example, milk chocolate – which is low in
acrylamide – is thought to be much worse from an overall health point of view than dark
chocolate, despite the fact that dark chocolate typically contain higher levels of acrylamide.
1. FRENCH FRIES
According to data provided by the FDA, French fries are the single biggest dietary contributor
to an average American's acrylamide load. It has been estimated that French fries account for
nearly a quarter of all the acrylamide in our diets. But beware: switching to roasted or baked
potatoes will not shield you from acrylamide, either. Both roasting and baking trigger the
process that leads to the formation of acrylamide in potatoes. Steamed and boiled potatoes, in
contrast, do not contain significant levels of this suspected human carcinogen.
Alternatives: Boiled, steamed and mashed potatoes

2. PRUNE JUICE
Next up on our list of foods high in acrylamide is prune juice. Although prunes and prune juice
do offer some interesting health benefits (see Health Benefits of Prunes), prune juice ranks
relatively high on the acrylamide index. However, as most people do not consume prune juice
on a regular basis, it is not a major contributor to the overall acrylamide load of Western
consumers.
Alternatives: Freshly pressed fruit juice
3. SOME CEREALS
Breakfast cereals, such as corn flakes and all-bran flakes, are a major source of acrylamide in
an average American's diet. It has been estimated that 12% of the acrylamide in modern diets
come from cereals. However, there are huge differences between brands, products, and even
samples. Consequently, it is difficult to estimate exactly how much acrylamide your breakfast
cereal contained today. Therefore, if you are trying to follow a low-acrylamide diet and want
to be on the safe side, it is best to go for breakfast alternatives that are known to contain no
or little acrylamide such as porridge made from steel-cut oats.
Alternatives: Oatmeal made from steel-cut oats

4. SOME BREADS
Some breads, especially crispbread and toasted bread, contain significant levels of acrylamide,
and it has been estimated that bread accounts for a fifth of an average American's dietary
exposure to the toxin. To reduce your intake of acrylamide from bread, remove the crust
before you eat your bread (especially if the crust seems exceptionally dark), and if you bake
your bread yourself, use recipes that call for low baking temperatures. For even more ideas,
check out the article Acrylamide Levels in Bread & How to Reduce Those Levels.
Alternatives: Bread with crust removed
5. TOASTED NUTS & PEANUT BUTTER
Some toasted and roasted nuts – such as many roasted almonds and peanuts – have been
found to be a significant source of acrylamide. As most pea nut butters are made from roasted
peanuts, also peanut butter tends to be high in acrylamide. If you are looking for a healthy

alternative to roasted nuts, simply go for their raw counterparts. In addition to being virtually
free of acrylamide, raw un-salted nuts won't damage your heart with excess salt.
Alternatives: Raw, un-salted nuts
6. CANNED BLACK OLIVES
Recently, also canned black olives have been shown to contain significant levels of acrylamide
due to the pasteurization methods used in the canning process of black olives. California black
ripe olives, for example, have been shown to contain 200-2000 ng/g of acrylamide. These
levels are substantially higher than in many other well-known sources of acrylamide, such as
French fries (100-1300 ng/g). However, the acrylamide levels found in canned green-ripe olives
– whether Spanish-style or Greek-style – have been significantly lower.
Alternatives: Green olives
7. POTATO CHIPS
Potato chips – or crisps if you grew up in England – are one of the major sources of
acrylamide in the American diet. An estimated 11% of an average person's exposure to

acrylamide from foods has been attributed to potato chips alone. Also other types of chips,
such as corn chips, are a significant source of acrylamide (see Acrylamide in Chips: Potato vs
Tortilla (Corn) Chips).
Alternatives: Bite-sized pieces of fresh vegetables (great for dipping)
8. COOKIES AND CRACKERS
Biscuits, cookies and crackers are yet another significant source of acrylamide in modern diets.
Together, they account for a whopping 13% of an average American's exposure to dietary
acrylamide. If you bake cookies at home, you can reduce the acrylamide content of your
cookies by using recipes that use a relatively low baking temperature and by making sure that
the surface color of the cookies is as light as possible when you take them out of the oven.
Alternatives: Home-made cookies baked at low temperatures

WHAT ARE THE FOOD RICH IN PAH

GRILLED, BAKED, FRIED, ROASTED, TOASTED, CANNED FOODS -----ACRYLAMIDE
AND PAH SOURCES
1.HOW DOES THE OLIGOSACCHARIDE ARE PREPARED
2.WHAT DOES BACTERIA DO ON IN INTESTINE
 In large intestine, dietary fibers go through partial bacterial fermentation and produce
gas and short chain fatty acids
 Fermented by bacteria in the colon, they produce gases CO2, H2 and CH4,
causing discomfort and flatulence.
 The content of oligosaccharides can be reduced by soaking and cooking.
SATURATED FATTY ACID

WHAT ARE EXAMPLE OF UNSATURATED FATTY ACID

WHAT ARE SOURCES OF TRANSFATTY ACID

DISCUSS THE MAIN ROLE AND FUNCTIONS OF ESSENTIAL FATTY ACID
W6FA AND W3FA

SOURCES OF TG
 TGs rich in cis mono or polyunsaturated fatty acids tend to be liquid at room
temperature
 (E.g. sunflower oil, olive oil and fish oil).
 Butter, palm oil and partially hydrogenated oils such as margarine
SOURCES OF PPL
 Abundant sources of phospholipids include egg yolk, liver, soybean and peanuts.

CLASSIFY LIPID
o Triglycerides
o Phospholipid
o Sterols
o Essential And Non Essential
WHAT ARE THE FUNCTIONS OF STEROL
 major structural components of the cell membrane, and it is abundant in the
brain and nerve tissues
 a precursor to vitamin D, steroid hormones and bile acids
DESCRIBE THE LIPID DIGESTION ABSORPTION PROCESSES
MECHANISM

WHAT IS PROTEIN DENATURATION/ ASSESSMENT OF PROTEIN QUALITY

 Kwashiorkor :dry and fleshy skin, dry and brittle hair and change in the skin color
 Marasmus: The hair is sparse and falls out easily. Marasmus can stunt brain development
and impair learning abilities
WATER IN COMPARTMENT.

IMPORTANCE OF VITAMINS

o Rich sources of vitamin A: liver, cod liver oil, egg yolk and milk fat.
o Average requirement of vitamin A for an adult is 750 mg RE or 2500 IU.
o Requirement is increased by about 10% during pregnancy
o Requirement is doubles during lactation
 Adequate amounts of vitamin D are synthesized by exposure of the
chicks of the face to 10 minutes of strong sunlight each day
 Major sources of vitamin D include fortified milk and other fortified foods
Vitamins E
o Also called Tocopherol, this vitamin acts as an antioxidant in different tissues.
It is a factor essential for normal reproduction
o The richest sources are vegetable sources such as sunflower and nuts oil.
Wheat germ oil is the richest source of vitamin E
o Deficiency: fat malabsorption syndromes such cystic fibrosis, or may result
from increased lipid oxidation.

VITAMIN K
 Riboflavin (B2): heat-stable vitamin, but sensitive to visible light
 Skin lesions particularly of mucous membranes of the reproductive organs
and at the angles of the mouth (angular stomatitis).
 Increased incidence of nuclear cataracts (cause of blindness).

 Main sources of this vitamin include milk, meat, fruits, and vegetables. Daily
requirement is from 1 to 2 mg / day.
 Biotin OR B7 is the essential growth factor in many organisms
 Some biotin is also synthesized in the lower gut
 Refined cereal products, fruits and vegetables
PANTOTHENIC ACID OR VITAMIN B5
Best sources include chicken, liver, yeast, egg yolk and potato.
 component of coenzyme A
 intermediary metabolism including the
 Synthesis and breakdown of fatty acids and oxidation of carbohydrates.
THE VEGETARIAN ARE UNDER RISK OF MISSING VITAMIN B12 AND THEIR NEUROLOGICAL
FUNCTIONING AND BLOOD FORMATION GETTING AFFECTED

VITAMIN B9
VITAMIN B6

WHAT ARE THE DIFFERENCE BETWEEN MAJOR MINERAL FROM TRACE
MINERAL
 Mineral is considered major, when the requirement is greater than 100mg/ day
o Sodium; potassium; chloride; calcium; phosphorus; magnesium
and sulfur.
 Trace mineral is the one that is required to the amount less than 100mg/day.

o iron; zinc; selenium; iodine; copper; fluoride; chromium;
manganese and molybdenum
CONSEQUENCES OF NA DEPLETION: include muscle weakness, cramps and wasting, taste
abnormalities
WHAT ARE THE POSSIBLE CAUSE OF EDEMA DUE TO SODIUM IONS
Excessive Na retention leading to edema can occur in
 chronic renal failure,
 in the heart failure or through
 Excessive aldosterone secretion.

Consequences of excessive sodium retention include the increase in blood pressure.
WHAT ARE THE CONSEQUENCE OF NEGATIVE IMBALANCE AND POSITIVE
IMBALANCE OF POTASSIUM IN THE BODY?

High intake of NaCl has been associated with high blood pressure but neither KCl nor
Na2CO3 have this effect. WHY?
 Calcium, Phosphorus, Magnesium and fluoride: skeleton, forming the rigid
mineral support to the body.
 About 60% is absorbed in the intestine, and this is negatively affected by
vitamin D deficiency
WHAT ARE THE FUNCTION OF MAGNESIUM
• About 70% of the body’s 25g of Mg is in bone.
• Most of the rest is within cells, where it is involved in energy metabolism
• DNA replication and RNA synthesis.
• 1% of Mg is in extracellular fluid, where it maintains a stable electrical gradient accross the
membranes of nerves, muscles and the heart.
DEFICIENCY IN MAGNESIUM LEADS TO
 Muscle weakness
 Tetany
 Tachycardia and
 Ventricular fibrillation.

Inorganic Fe absorption is enhanced by the presence of ascorbic acid in the diet. On the other
hand, a number of substances impair the Fe absorption, including dietary fibre, phytate and
tannins
HYPOMAGNESAEMIA CAN OCCUR IN HUMANS AS A
• result of starvation,
• excessive vomiting,
• diarrhea or
• Excessive urinary loss.
FLUORIDE: are fish and tea, drinking water.
IRON DEFICIENCY results in impaired capacity for exercise and work. It also leads to
impairment of a some brain functions.
 Iron is consumed in 2 forms: (1) Haem iron, present foods of the animal origin (2) Non-
haem (inorganic) form, from foods of plant origin
 Haem iron is relatively well absorbed (about 25%) in the small intestine, while none (haemic
iron is less efficiently absorbed (only about 5%).

 Inorganic Fe absorption is enhanced by the presence of ascorbic acid in the diet.
On the other hand, a number of substances impair the Fe absorption, including
dietary fibre, phytate and tannins.
HOW MUCH IRON ARE LOST DURING MENSTRUATION
Fe is regularly lost in the menstrual blood, which is an average of 0.56mg/day, averaged
over the whole cycle.
DISCUSS ABOUT COPPER ROLE, SOURCES, DEFFICIENCY AND IT EXCESS
IN THE HUMAN BODY

WHAT ARE THE FUNCTION OF SELENIUM IN HUMAN BODY

CHROMIUM

Define the Following Term
1.Metabolism
2.Anabolism And
3.Catabolism
Enumerate the Stages Of Catabolism
 METABOLISM is the set of chemical reactions that happen in living organisms allow
organisms to grow and reproduce, maintain their structures, and respond to their
environments( to maintain life).
 METABOLIC PATHWAY is a series of chemical reactions, through which a chemical is
transformed into another, by a sequence of enzymes
 THE METABOLIC RATE is the speed of metabolism.
 CATABOLISM is the set of metabolic processes that break down large molecules into
simpler ones with the aim of providing the energy and components needed by anabolic
reactions

CATABOLIC REACTIONS IN ANIMALS CAN BE SEPARATED INTO THREE
MAIN STAGES
1. Digestion of large organic molecules such as proteins, polysaccharides and
lipids into their smaller components outside cells.
2. Conversion of these molecules inside cells, giving Acetyl Coenzyme A
(Acetyl CoA) which releases some energy.
3. Oxidation of Acetyl CoA to water and CO2 in the citric acid cycle and
electron transport chain, releasing the energy that is stored by reducing the
coenzyme NAD+ into NADH.
ANABOLISM INVOLVES THREE BASIC STAGES:
1. Production of precursors such as amino acids, monosaccharides and
nucleotides.
2. Activation of precursors into reactive forms using energy from ATP.
3. Assembly of these precursors into complex molecules such as proteins,
polysaccharides, lipids and nucleic acids.

DESCRIBE THE CATABOLISM OF CARBOHYDRATES

WHAT ARE THE 3 STAGE OF THE LIPID OXIDATION

 CITRIC CYCLE: AcetycoA FROM THE CARBOHYDRATES
 KREBS CYCLE : Acetyl CoA from the lipid
HOW DOES BODY CONTROL THE AMINO ACID WHEN EXCEED THE
NORMAL BODY REQUIREMNT

Toxic nitrogen of amino acids is eliminated via
 transamination,
 deamination, and
 Urea formation.
The carbon skeletons are generally conserved as carbohydrate, via gluconeogenesis, or as fatty
acid via fatty acid synthesis pathways
SPECIFIC CONDITION
 During pregnancy, there is weight gain, resulting from maternal and fetal tissues and fluids.
Women with the normal body weight gain about 12 to 18 kg during pregnancy, most of
which are gained during the second and third trimesters.
 Birth, the baby of 3 kg has about 500g of proteins, 30g of calcium, 0.4g of iron and
different vitamins. This has a nutritional and dietary implication on the pregnant woman

THE 1ST
TRIMESTER OF PREGNANCY
What is going on pregnancy at?
 30h
 4day
 2week
 35day

• Nearly 900g of protein is deposited in the fetus and maternal tissues during pregnancy.

 energy and other nutrients are higher during lactation than pregnancy
 An average output of milk is between 600-800g/day
EXPLAIN HOW THE MILK ARE PRODUCED BY HUMAN
During pregnancy,
 cells in the breast form milk producing cells,
 Milk producing cells called lobules.
 Placental hormones stimulate this.
After birth,
 The hormone of prolactin stimulates the synthesis of milk.
 Infant suckling stimulates the release of prolactin,
 Allowing the production of more milk.
• For Fe, requirements are the same during pregnancy and lactation.
• For vitamins D and K other increase
EFFECT OF UNDERNUTRITION ON GROWTH

 Babies are born with minimal stores of vitamin K, so a new born should get a single
dose of vitamin K. Breast-fed infants from vegetarian mothers should get vitamin
B12 supplementation
 The first 4-6 months of age, human milk fulfills the requirements in water.
 Once the solid food is introduced, infants need additional water. Infants need 1.5 ml of
water/kcal.
 Exclusive breastfeeding is recommended up to 6 months of age,

 continued breastfeeding along with appropriate complementary foods up to two years of
age or beyond
 Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is
recommended by WHO as the perfect food for the newborn, and feeding should be
initiated within the first hour after birth.
WHAT ARE THE IMPORTANCE OF BREASTFED TO ADULT

TRIMESTER I EXAMINATIONS – ACADEMIC YEAR 2017-2018
SCHOOL : MEDICINE AND PHARMACY
CAMPUS : HUYE
DEPARTMENT : PHARMACY
LEVEL OF STUDY : 4 year
MODULE NAME : NUTRITION & FOOD QUALITY CONTROL
MODULE WEIGHTING: 10 credits
DATE: DURATION: 2 hours
MAXIMUM MARKS: 100
INSTRUCTIONS
1. This paper contains questions in 2 Sections:
2. Answer to all questions
3. No written materials allowed into the examination room
4. Write all your answers only in the examination booklet provided
5. Do not forget to write your registration number
6. Do not write any answers on this question paper
7. No unauthorized material is allowed in the Examination Room
Part I: Food Quality Control (50pts)
1) Define following terms. (5 pts)

a. Food : Material, usually of plant or animal origin, that contains or consists of essential body
nutrients, (such as carbohydrates, fats, proteins, vitamins, or minerals) and is ingested and
assimilated by an organism to produce energy, stimulate growth, and maintain life.
b.
c. Proximate analysis ; is a partitioning of compounds in a feed into six categories based on the
chemical properties of the compounds. The six categories are: moisture. ash. crude protein (or
Kjeldahl protein)
d. Food matrix : The nutrient and non-nutrient components of foods and their molecular
relationships, i.e. chemical bonds, to each other.
e. Quality of food : characteristics of food that is acceptable to consumers. This includes external
factors as appearance (size, shape, colour, gloss, and consistency), texture, and flavour; factors
such as federal grade standards (e.g. of eggs) and internal (chemical, physical, microbial).
f. Safe food or safety food:
g. Samples : a Small part or quantity intended to show what the whole is like
h. Sampling : the action or process of taking samples of something for analysis.
i. Sampling plan : s a detailed outline of which measurements will be taken at what times, on
which material, in what manner, and by whom.
j. Moisture : water or other liquid diffused in a small quantity as vapour, within a solid, or
condensed on a surface.
k. Total solids : the dry matter remain after removal of water content / moisture
2) List factors that can affect a sampling plan? (1.5 pts)
 Availability of resources
 Purpose and limitations of the research/practical

 Research / practical type that is going to be processes
3) Why do we analyze food? Give at least 4 reasons. (1.5 pts)
1. To monitor food composition and to ensure the quality and safety of the food supply
2. Nutritional Labeling
3. To determine food composition and characteristics for food sciences.
4. Quality management program throughout the development process.
5. To answer specific questions for regulatory purposes and quality control
regarding food characteristics
6. Government regulations require it for certain products with standards of
identity.
4) Explain difference between moisture content and dry matter content, dry ashing and wet ashing?
(1.5 pts)
1. Moisture content are quantity of the free water that is contained in the sbces (food)
2. Dry matter content is the sbces remaining after complete removal of moisture (free water)
3. Dry ashing : is the process of igniting completely the organic sbces by the use of maffle furnace
at high temperature between 500-600 0
C remaining with the inorganic residues
4. Wet ashing : is the process of complete oxidizing/digesting the organic matter by using agent
such as sulphuric acid under heat and catalyst for purpose of remaining with inorganic residues
5) Explain the important distinctions between food quality and safety attributes? List them. (2pts)

 Food quality attributes: is the degree of excellence of food in terms of nutrients needed by
consumers and labelling to by the manufacture
 Food safety attributes: is the characteristics of food to do not cause harms to the consumers
6) Give and briefly explain the criteria of selecting an analytical technique? (1.5 pts)
 Accuracy
 Precisions
 Specificity and selectivity

 Sample size
 Reagent
 equipment
 Cost
 Personal safety and procedure
 Speed (time)
 Reliability and need
7) Give extraction methods for fat from food samples? Explain them briefly. (1.5 pts)
Solvent extraction method
 Semi-continous : soxhlet
 Continuous : Goldish may cause channeling result in incomplete extratction
 Discontinuous : acid or base hydrolysis followed by Majonner and
chloroform methanol
Non solvent extraction
 Babcock method use only acid
 Gerber method use both acid and amyl alcohol
Other extraction method
 Gas chromatography : foe nutrional labelling

8) Give the importance of analyzing proteins in food samples? (1.5 pts)
1) Nutritional labelling
2) Biological value determination
3) Functional properties investigations
4) Pricing
Q. What Are The Analytical Method Used For Analysis Of Protein
1) Kjeldhal method
2) Dumas method
3) Biuret method
4) Lowry method: biuret together with tryptophan and tyrosine
5) Dyes binding , unionic and bradford
6) Bicinchoninic acid method
7) Infrared spectroscopy
8) Ultraviolet absorption method
Q. Why Do We Analyse Fat:
 Nutritional labeling
 Standard of identity
 to ensure that the product meets manufacturing specifications.
 Quality and functionality of foods products

9) You wish to have a coefficient of variation (CV) below 5% with your ash analyses.The following ash
data are obtained: 2.15%, 2.12%, 2.07%.Are these data acceptable, and what is the CV? (2pts)
10.Give and explain briefly methods for analyzing proteins in food samples. Give also advantages and
disadvantages.(2pts)
Titratable acidity is the measurement of the total acid
11.Define and explain the important distinctions between titrable acidity and pH ? Give an example of
each if possible.(2 pts)
Titratable acidity
deals with measurement of the total acid concentration contained within a food.
Titratable acidity :Simple estimate of the total acid content of food
Titratable acidity : Better predictor of acid impact on flavor
EXAMPLE : Lactic acid in the milk, tartaric acid in rape fruit, citric acid in citrus fruit, acetic acid in
vinegar
PH : Depend on the strength of acid condition , Orange juice , soda PH=3, LEmon and vinegar with
PH=2
PH predict the growth of microorgnisms in the food
12. What are the frequent causes of food borne diseases? (2pts)
1. Insufficient cooking or re-heating of food
2. inadequate storage conditions
3. Cross-contamination in the food preparation areas

4. Infected or colonized persons in charged of the preparation
13. Give the correct names of the following (2pts)
A. Organisms that can be transmitted to susceptible hosts and cause disease: pathogen
B. The entry and development or multiplication of infectious agents in the body of humans or
other animals
C. Disease caused by pathogenic organisms or toxins transmitted to humans by food
D. Transfer of harmful microorganisms or their microscopic stages (eggs, larvae) from one source
to another
E. Diseases transmitted from animals to humans

F . pathogen that multiply only within the host organism: virus
G. Protozoa that is strictly to human infection causing : cyclospora
I. Protozoa that cause both human and nimal disease: toxoplasma,giardia
k. infectious dose of campylobacter : 500cfu
L. Infectious dose of the E.coli0157 : 10-100cfu
m. Infectious dose of virus : 10-100particles
n. the main cause of food spoilage is invasion of microorganism such as bacteria , yeast and mold
e. pathogen Microorganisms that do not cause food spoilage : virus
f. major cause of food spoilage with reduced water activity: mold
g. major cause of the food spoilage with high water activity: bacteria
I.Microbe that can grow below the PH of 2: yeast and mold
j. The bacteria able to grow in strong acid and strong base : Mycobacteria
k. the moisture content in food express the free water in the food Aw = VPFood/VPWater
l. A ssturated salt solution has the water activity equal to : 0.75
m. what are microorganisms are likely to grow in the canned food= anaerobic or facultative anaerobic
spore former
n.what are microorganism are likely to grow in the vacumm packed food= microaerophilic bacteria
o.microorganisms are likely grow on surface of raw meat: aerobic bacteria

p.microorganisms that are likely to grow in insuffient dried or salted product: aerobic mold
14. What should be done to prevent food borne illness by:
A. the government (5pts)
1. Food legislation to provide norms and guidance for industry to comply with
2. To educate food producers (farmers) & consumers
3. Seek to create a single food safety agency to prevent uncoordinated actions and overlap
4. Surveillance is crucial for raising awareness of magnitude
5. trend and early detection of foodborne diseases and to evaluate impact of interventions.
6. Information gathered essential for risk assessment
7. Assure health-related infrastructures
B. the industries (2 pts)
1. Farm to table paradigm : each partner take adequate steps to mitigate risks
2. Codex Code of Food Hygiene + HACCP + labelling to inform
B. The consumers (2pts)
1. Share equal responsibility: know Safe Food Handling
2. Understand that zero-risk related to food is non-existent
15. Why do we preserve food? (2pts)

1. is a process through which physical and /or chemical agents are used to prevent microbial
spoilage of food.
2. Food preservation aims at treating food in a manner to prolong its storage life.
3. In food preservation, efforts are made to destroy organisms in the food.
4. Increase the period taken by microorganism to adapt to the food environment
 Increasing / or prolonging the storage time of food by keeping its nutrients integrity
 Avoiding the contamination of food by worsen microbe or bad microbe
 Fight againsted food rancidity
16. Enumerate some of the preservation methods you know (2pts)
Inhibitions methods
 Salting, sugar use and drying : to reduce the water activity sun/air dry , electrical dry or freeze
drying
 Fermenting and addition of acid : to decrease PH monosaccharide is more efficient in drying that
disaccharide
 Uses of preservation: sodium benzoate
 Chilling and freezing : reduce temperature arrest microbial growth and duplications 0-15 chilling
common 4-5 0-(-35) this is freezing: retard reactions and action of food enzymes
 Smoking
Killing methods

 Heat treatment by pasteurization and sterilization
 Irradiation such as x ray , gamma ray target the DNA and production chemical
 Gases such as ethylene ooxide ozone
17. What is the role of vinegar in salad dressing or marinade? (2pts)
 Vinegar is used as the preservatives and flavoring
 Marinade is used to enhance the flavoring and aroma of the meat
 Marinating helps in reduction of Heterocyclic amines (HCAs)eg : PhIP (2-Amino-1-
methyl-6-phenylimidazo[4,5-b]pyridine) and polycyclic aromatic hydrocarbons (PAHs)
when the chicken are roasted under high temperature
 Notice : that the marination decrease the PhiP But simultaneously increase MelQx which
is mutagenenic and carcinogen hence marination is likely to be unvalue unless is important
for reduction of the risk of PhiP

18. Cite different factors that influence the growth of microorganisms in a food
A. Physical chemical factors of food.: Intrinsic Factors : Ph, Water Activity,Antimicrobial Sbces,
Biological Structure,Nutrients And Moisture Contents.

B. Environment factor1pt: EXTRINSIC FACTORS : RELATIVE HUMIDITY IN STORAGE AREA,
TEMPERATURE OF STORAGE , PRESENCE OF GASES IN ENVIRINMENT.
C. Processing factors2pts (Washing,slicing,packing,irradiation and pasterisation)

19. Meat and fish products are traditionally dried by adding table salt to it. Can you suggest why salting
enables the meat to be stored for a long time. (3pts)
 Salting is used because most bacteria, fungi and other potentially pathogenic
organisms cannot survive in a highly salty environment, due to the hypertonic nature
of salt and salt reduce the water activity by osmosis processthat is not favr to microbial
growth
 most often works through dehydration, removing many of the water molecules
that bacterianeed to live and grow.
20. Microorganisms that live and reproduce:
a. only in the presence of oxygen are.....aerobics microorganis.. eg B.CEREUS.(1pts)
b. only in the absence of oxygen......anaerobics microorganisms....Eg. Clostridium ........1pts
c. fill in the below graph by types of microorganisms according to temperature range

The Z value: Is the number of degrees the temperature has to be increased in order to reduce the
thermal death time tenfold.
D VALUE Is the time required at any temperature to destroy 90% of the spores or vegetative cells of a
given organism.
From a ‘survivor curve’ the decimal reduction value can be calculated

2 D-concept (12-D values): is the accepted standard requirement for sterilisation in the preservation
industry
21. Classify the microorganisms according to their shape on the bellow microscopic field. Under which
magnification do you visualize this picture? 3pts

Q. EXPLAIN HOW THE FOOD INTOXICATION SHOULD BE CONTROLLED
Control of food intoxication:
 control of microbiological quality of ingredients
 rigorous control of time/temperature combination of heating process (if
involved)
 avoid cross-contamination
 respect hygienic working conditions
 rapid cool-down (10-50°C most critical)
 rigorous control of temperature of storage and distribution
 sufficient reheating (if involved)

Q. WHAT ARE CONDITIONS NEEDED FOR FOOD INFECTIONS
 The infectious agent must be present in the food
 The food product should enable survival and/or growth of the pathogen in order to attain the
infective dose
 The time/temperature must be sufficient to allow growth to the infective dose
 The amount of food consumed must be sufficient inorder to ingest the infective dose
The following are salt tolerant bacteria : vibrio and S.aureus
Q. HOW DOES PROTOZOA INFECTIOUS ARE TRANSMITTED IN HUMANS:
Mainly waterborne
infected food handler
sewage contaminated water used for irrigation of (unprocessed) produce
contact with faeces of wild animals
Thus need: GHP & Quality of water & Waste management (Global GAP) in fresh p
Q. WHAT ARE SOMES ZOONOTIC PROTOZOA
1. Cryptosporidium
2. Toxoplasma
3. Giardia

Q. LIST THE PROTOZOA THAT ONLY TRNASMITTED FRO HUMAN TO HUMAN
(NON ZOONOTIC PROTOZOA)
1. Cyclospora
Q. ENUMERATE THE AREA OF MICROBIAL SAFETY PRACTICE IN THE FOOD
CHAIN AND GIVE SOME EXAMPLE OF MICROBE TO BE CONTROLLED
 1.Food safety in (raw) meat : Salmonella, Campylobacter sp., E.coli O157 & Viruses
 2.Food safety in (raw) fruits & vegetables : Salmonella , E. coli O157 also virus & protozoa and Shigella
 3.Food safety in (raw) seafoods : Salmonella,Norovirus,Vibrio, marine biotoxins
 4.Food safety in dairy (including eggs) : Salmonella ,Listeria monocytogenes , B. cereus / Staph. Aureus
 5.Food safety in processed food (smoked fish, meat) : Listeria monocytogenes , Bacillus cereus – Cl. Botulinum,
Staph. Aureus, Salmonella in low moisture foods, E. coli O157 in fermented
 8. Food safety in catering/ institutional serving : Cl. Perfringens,Viruses, Sta aureus – B. cereus, Salmonella
 9. Food Safety in water used in Primary Production/Food Processing: emerging attention
Q. EXPLAIN HOW THE FOOD SAFETY SHOULD BE ENSURED IN FOOD CHAIN
 Food Safety should be Control via testing of
 GAP : maintain good agricultural practice in agricultural
 GMP : good manufacturing practice in industry
 HACCP : high active critical control point
 At primary production , processing and catering

Q. EXPLAIN HOW CAN YOU PREVENT AND CONTROL THE FOOD BORNE ILNESS
1. Improve hygienic quality of raw food stuffs at the
agri/aqua-cultural level: By applying and testing the GAP and eradicating the pathogens.
2. Utilization of food processing technologies: pasteurization, sterilization, fermentation, irradiation,
control accidental contamination during processing, introduction of GMP & HACCP
3. Education of food handlers in the principles of safe food
storage & preparation.
Q.WHAT ARE THE CAUSES OF FOOD SPOILAGE
1. Growth and activity of microorganisms
2. Enzyme activity
3. Chemical reactions : OXIADTION AND RANCIDITY
4. Vermin : weevils, ants, rats, cocroaches, mice, birds, larval stages
5. Physical changes
Absor Rancidity, Oxidative And Hydrolytic
To,Light ,Moisture And Oxygen Speed Up Rancidity
Q.WHY VERMIN IS SO IMPORTANTS
1. Aesthetic(beaty) aspect of presence
2. Transmission of pathogens
3. Consumption of food

Q.WHY DO SOME MICROORGANISMS ARE HEAT RESISTANTS (FACTORS
AFFECTING THE HEAT RESISTANCE OF M.O)
1. Type of microorganis MS
2. Number of cells
3. Age of cells
4. The physiological state and Stage of growth
5. Growth temperature
6. Composition of the food product
Part II: NUTRITION (50 pts)
1. GIVE SIGNS OF GOOD NUTRITION JUST BY LOOKING AT AN INDIVIDUAL (10 PTS)

2. Answer by giving names or response to the following statements (10 pts)
A. grain products with added nutrients are called: fortified
B. Milk and milk products are the best dietary source of which mineral: CALCIUM
C. How many servings of vegetables do we need each day?: 8 SERVING
D. This mineral is essential for healthy blood red cells and a deficiency might cause anaemia: IRON
E. this nutrient is most important for healthy vision:
F. Fruits are a good source of which nutrients: vitamins

G. what are the good sources of vitamin D in our diet: cod liver oil, other fishes oil, liver and organ
meat, egg yolk and butter from animal
Q.WHAT ARE THE FUNCTION OF VITAMIN D
 Regulation of the blood calcium level directly by calcitriol or indirect by
calcitonine&PTH
 Calcitriol inhibit cell proliferation and enhances differentiation activity.
H. lipids contain how many kilocalories per gram of energy: 9 calories
i. Minerals that are responsible for intra-extracellular osmolality of fluids: Na,K, and Cl

j.In Parenteral Nutrition solution when dextrose, lipids and amino acids are used together:3-1
3. What are the effects of too much fat on an individual health? (10pts)
1)Overweight
2)Obesity
3)Cardiovascular disease
4)Anteroscelorisis
5)Hypertensions
6)Myocardial infractions
7)Strokes
8)Diabetes
9)Cancer development
Give the correct answer for the following multiple choices (10 pts):
4. If a product is high in trans fatty acids the first ingredient listed on the food label will be 5pts
A. omega 3 fatty acids
B. high fructose corn syrup
C. hydrogenated fat
D. Margarine

5. What fatty acid is necessary for growth, reproduction and maintenance of the skin integrity?
A. Omega 3
B. Omega 6
C. Trans fatty acids
D. Polyunsaturated fatty acids
6.The following play a role in cardio protection
a) Omega 6
b) Omega 3
c) Fatty acids
d) Trans fatty acid
7.The following fatty acid play role in retina and brain functioning
a) Polyunsaturated fatty acid
b) Omeg 7 fatty acid
c) Omega 3 fatty and 6 fatty acids
d)Omega 3 fatty acids
Q.DISCUSS THE DIGESTION AND ABSORPTION OF LIPID
 In the mouth : lingual lipase
 In the stomach : gastric lipase
 In intestine: release of hormones: secretin stimulate the pancreases releasing pancreating
juice while the CCK stimulate the gall bladder to release the bile salt.

6. How do we assess the nutritional status of an individual? (10 pts)
A nutritional assessment is used to determine the nutritional status of a person or group of people.
Learn about the ABCDs of nutritional assessment:
1) anthropometric assessment : The questionnaire included sociodemographic variables such as
age, formal education, civil status, family situation and income. The measures analyzed were
weight, height, body mass index (BMI), body circumferences (arm, waist, hip and
calf), waist to hip ratio (WHR), elbow amplitude and knee-heel length

2) biochemical assessment : albumin, prealbumin, CRP, transferrin, hemoglobin, urea and creatine,
lymphocytes and point deficiencies.
3) clinical assessment : the malnutrition disorder , diabetes ,Kwashiorkor,
marasmus,overweight,obesity , etc,….
4)dietary assessment

Good Luck !!!!!
ADDITIONAL INFORMATIONS
1.Explain the digestion mechanism of Lipid in the GIT process
2.Explain the mechanism of lipid absorption in the intestine
3. Mention the biological functions of proteins
4. Briefly, describe the digestion mechanism of proteins
5. How do we assess protein nutrition
6. what is positive and negative nitrogen balance
7. distuinguish high quality protein and incomplete protein
8. How nutritional protein quality is assessed
9. what is complementary protein
10. List 3 functions of carbohydrate
11. Enumerate the functions of lipid
12. Distuinguish visible and invisible fat

FOOD LAW
The estate of the food law development in Europe

What are the 3 strategies used by white paper to achieve the food safety control purpose
WHAT ARE THE REGULATORY INSTRUMENTS TO WARD FOOD SAFETY

The regulatory instrument is first of all Dynamics and science based
 Legislation on procedure : official control
 Legislation on the product : pre-market approval due to additives , novel food, etcc, and banned
sbces , MRL
 Legislation on processes : HACCP,Traceability and withdraw &recall
 Legislation on publicity.

The weakness of legislation is that is not applicable to HOME food consumption

REGULATION 178/2002
 Article 2/3= define the food stuff
 Aricle 8 define the objective of this regulation : high level protection of human health and consumer
interest in relation to food.

Q.WHAT ARE THE RESPONSABILITY OF FOOD BUSINESS OPERATORS
(REGULATION 178/2002, SET OUT THE OBLIGATIONS OF FBOS)
o Safety
o Responsability
o Traceability
o Transparancy
o Emergency
o Prevention
Article 6 : Food Law Is Science Based : Risk Analysis Carried Out Independently, Objectively And
Transparently Based On Scientific Evidence.
ARTICLE 7. Precautionary : Risk management in case of scientific uncertainty

Q. WHAT ARE THE PRINCIPLES OF FOOD LAW

Q. WHAT IS THE CODEX ALIMENTARIUS ??????

Q. WHAT ARE GROUP OF FOOD
Q. Discuss the MyPyramid of nutrition
11 GROUP OF FOOD
 Cereals
 Pulses
 Nuts and oilseed
 Vegetable
 Fruits
 Milk and milk products
 Eggs and poultry
 Fat and oils
 Sugars and others
carbohydrates
 Condiments and spice
 Beverages

Q. DIFFERENCIATE BETWEEN KWASHIORKOR FROM MARASMUS

Q.WHAT ARE TOOL USED FOOD LABELLING
1.Statement of identity
2. List of ingredients
3. Names and address of food manufacturer, packer and distributors
4. Net content of the packages
5. Nutritional informations

WHAT ARE HEALTH BENEFITS OF COMPLEX CARBOHYDRATES
1. Decrease the risks of obesity.
2. Type 2 diabetes.
3. CVD (Cardiovascular Disease).
4. Cancer.
5. Gastrointestinal disorders.
HOW THE FOLLOWING RISK ARE BEING REDUCED BY WHICH FACT
1. They offer more volume of food for fewer calories Thus diets are low in fat and energy, This providing a
healthy body weight and lowers the risk of obesity.
2. High intake of soluble fiber delays emptying of the stomach and smoothen the blood glucose response,
thus a low risk of type 2 diabetes.
3. Food Rich in fruits and vegetables contain antioxidants that protect against cell damage and prevent
cancer.
4. High fiber food attracts water and dilutes cancer-causing agents in the gastro-intestinal tract
5. Dietary fiber speeds up the passage of food, decreasing the risk of colon cancer.
6. Soluble fiber lowers the cholesterol level by binding the bile acids in the GIT and preventing their
reabsorption in the body, and thus contributing to the prevention of Cardiovascular Disease
7. Dietary insoluble fiber increases the water in the stool, thus preventing constipation, hemorrhoids and
diverticular disease.

Q. EXPLAIN HOW DOES MONOSACCHARIDE ARE ABSORBED
 Facilitated diffusion (case of fructose)
 Active transport (case of glucose and galactose).
In the villi, absorbed monosaccharides pass through the intestinal mucosal cells and enter the liver
through the portal vein.
 In the liver, fructose and galactose are converted to glucose.
Q.DEFINE THE FOLLOWING TERMS
 Glycogenesis
 Glycogenolysis
 Glyconeogenesis
1. Glucagon also stimulates the biosynthesis of glucose (gluconeogenesis) from proteins.
2. The liver is responsible for 90% of glucose biosynthesis, while kidneys are responsible for 10%.
3. The major precursors of glucose are lactate, glycogenic amino acids, and glycerol.
Q.DIFFERENCIATES TYPE 1 DIABETES FROM TYPE 2 DIABETES
DIABETES MELLITUS TYPE 1 DIABETES MELLITUS TYPE 2
1. insulin-dependent diabetes mellitus called noninsulin dependent diabetes mellitus

2. excessive thirst, frequent urination and
significant weight loss
represents 90 to 95% of diagnosed cases of
diabetes.
3. pancreatic β-cells destruction& insulin
deficiency
Risk factors include genetic and environmental
factors
4. hyperglycemia, polyuria, polydipsia, weight loss,
dehydration, electrolyte disturbance and
ketoacidosis.
Risk factors include genetic and environmental
factors, such as family history of diabetes, old age,
obesity, physical inactivity and impaired glucose
homeostasis.
5. are diagnosed in younger people less than 40
years
In most cases, type 2 diabetes results from a
combination of insulin resistance and β-cell failure.
Q.WHAT ARE THE NEGATIVE EFFECTS OF CONSUMING CARBOHYDRATES
 Diabetes
 Dental Carry
 More carbohydrate are converted into fat , hence later should bring about fat like
negative effect such as cancer, CHD, Anteroscelorisis , hypertension etc,…
Apart from the diabetes , Carbohydrate also may cause the dental carry
 DHA is the major metabolite found in the human tissues, where it is concentrated in the
membrane phospholipids, especially in retina and brain.
 Omega 6-----arachidonic-----skin integrity.

FUNCTIONS OF TRIGLYCERIDES: In palm oil and Hydrogenated Oil margarine
 Reservoir of energy.
 Career for fat-soluble vitamins DEKA and essential fatty acids.
 Insulation.
FUNCTIONS OF PHOSPHOLIPID
 Transport of lipids
 Emulsifier
 Components of cell membranes

Most TGs, cholesterol and PLs join protein careers to form chylomicrons ones enter the lymph
system
Glycerol and medium and short chain FAs are absorbed directly into the blood stream.

Dietary fat begins to appear in the blood stream after 1 to 2 hours, and is clear by 10 hours.
Q.WHAT ARE THE EFFECT OF DIETARY LIPID ON HUMAN HEALTH
 Cardio Vascular Disease (CVD): hypertension, coronary heart disease (CHD),
stroke, rheumatic heart disease and congestive heart failure, myocardial infarction
most serious disease.
 Atherosclerosis
 Obesity
Q. WHAT ARE THE POSSIBLE CAUSES OF ANTEROSCLEROSIS
1. Proliferation of smooth muscle cells, macrophages and lymphocytes
2. Formation of smooth muscle cells into a connective tissue matrix
3. Accumulation of lipids and cholesterol in the matrix around the cells.
-The lipids and other materials that build up in the intimal layer are called the plaque or atheroma
-Oméga-3 fatty acids (EPA and DHA) decrease the TGs, and thus have a cardio protective
effect.

Q.WHY DO FAT ARE LIKELY TO CONTRIBUTE MORE TO OBESITY THAN
CARBOHYDRATE AND PROTEIN
 Dense sources of calories : 1g-9kcal
Q. WHAT ARE THE FACTORS ARE LIKELY CONTRIBUTING TO OBESITY
o High fat intake (malnutrition)
o Sociocultural influences: high calorie, highly palatable , social enjoyment of eating create
pressure to overeat
o Genetic factors: Several genes have been identified and linked to obesity.
o Age and lifestyle: People gain most weight between 25 and 35 years of age
 Develop obesity after pregnancy and at menopause : are in highly risk of developing obesity than man.
 Histidine and Arginine are normally not essential for normal adult human beings, but are dietary essential for
infants and children, or during pregnancy and lactation.
Q. WHAT IS PROTEIN DENATURATIONS :
Acid, alkali, heat, alcohol and agitation can disturb chemical forces that stabilize proteins, causing the
protein to unfold and lose its shape.

Q.WHAT ARE BIOLOGICAL FUNCTIONS OF PROTEINS
o Structural proteins: Collagen, keratin
o Mechanical functions: myosin, actin etc,…
o Enzymes: trypsin, pepsin
o Hormones: vasopressin, GH, Insulin etc,…
o Immune functions: antibodies Ig
o Fluid balance: albumen
o Acid-base balance: Zuiterion ions
o Transport functions: some channel k and Na, lipoprotein channel etc,..
o Source of energy: 1g of protein provide 4kcal.
Q. DESCRIBE THE MECHANISM OF PROTEIN DIGESTION BY HUMAN BODY
o Digestion of proteins begins in the stomach, with protein denaturation and unfolding by HCl.
o HCl converts pepsinogen to the active pepsin, which hydrolyses dietary proteins into amino acids and
peptides.
o Amino acids and polypeptides pass into the small intestine, where the pancreas secretes trypsinogen
and chimotrypsinogen, enzymes converted into their active forms: trypsin and chimoyrypsin.
o In the small intestine, trypsin and chimotrypsin hydrolyze the remaining polypeptides into amino acids,
dipeptides and tripeptides.

o After these small units pass accross the macrovilli membranes into the cells, the remaining dipeptides
and tripeptides are hydrolyzed into amino acids, which are absorbed into the blood stream. Any part
of the protein that is not digested in the small intestine continues and pass out of the body through
the feces.

Q. WHAT IS PROTEINS PROTEIN TURNOVER
 It is the constant recycling of proteins in the body
 Is the degree by which the protein degraded is equal to the protein synthesized
Q. EXPLAIN HOW AMINO ACIDE ARE ABSROBED
• More than 99% of diet proteins enter the blood stream as amino acids.
• The absorption of most amino acids take place in the duodenum and jujenum.
• Some amino acids are absorbed by active transport, others by facilitated diffusion.
• After absorption, most A.A. and few peptides are transported to the liver and released into the
circulation.
Q. WHT IS AMINO ACID POOL
The amino acids present in all body tissues and fluids are collectively referred to as « amino acid pool
Q.THE FUNCTION OF AMINO ACID POOL
o The synthesis of proteins
o Production of energy and
o Synthesis of non protein substances

Q. WHAT IS NITROGEN BALANCE :
It is the result of comparison between nitrogen dietary intake and excretion, indicating the protein status
of the body.
Q. DIFFERENCIATE COMPLETE PROTEINS OR HIGH QUALITY PROTEINS FROM
INCOMPLETE PROTEINS OR LOW QUALITY PROTEINS
Q.HOW DO YOU ASSESS THE QUALITY OF PROTEIN
 Amino acid score (chemical score)
 Chemical score
 Protein efficiency ratio (PER)
 Net protein utilization
 Biological value
Q. WHAT ARE THE PHYSIOLOGICAL FUNCTION OF WATER
 Solvent for many chemical reactions in the body
 Transport of substances via blood, lymph and other body fluids.
 Water is essential for elimination of the body wastes
 Facilitation of the regular bowel movement

 Prevention of the urinary tract infection and the formation of kidney stones
 Lubrication in different locations of the body, e.g synovial fluid and mucus
 Metabolic processes in the cell
 Regulation of the body temperature
Q. EXPLAIN THE PHYSIOLOGICAL MECHANISM OF BODY WATER REGULATIONS
 diffuse in all compartments, water takes 2-3 hours
 Water balance is regulated by 2 mechanisms:
 Water intake: The volume is regulated by thirst, under the control of thirst center.
 Water output: Water is removed from the body in form of urine (1.2 to 1.5 L/day),
feces (80-150ml/ day) and respiration.
o 100g of carbohydrate produces 56ml of water
o 100g of protein produces 41ml of water.
o The daily water quantity need 1700 -1800ml/day.
o In case of normal activity, the need can go up to 2500ml/ day.
Q. WHAT ARE THE FUNCTIONS OF VITAMINS IN THE BODY
 normal functioning
 growth
 Maintenance of the body.

Q.WHAT ARE FUNCTIONS OF VITAMIN A FUNCTIONS
1. Night and color Vision
2. Cell differentiation
3. Immune functions
4. Bone health and Growth
5. Reproductions
 Vitamin B9 and Vitamin K: Leafy green vegetables
 1 RE is equal to the activitaminy of 1µg of β-carotene.
 1 IU of vitamin A activitaminy is equivalent to 3.6µg of β -carotene.
 Average requirement of vitamin A for an adult is 750 mg RE or 2500 IU increase 10% in pregnancy
and double during lactations
 Vitamins E: antioxidant and involve in normal reproductions
 defeciency occur in malabsorptyion of fat
 Vitamin k likely to be deficient in patient under parenteral nutrion:hemmorage
 Vitamin B1 : Pork and wheat germ:beriberi
 Niacin: yeast, mushrooms, peanuts, liver and sea food : rich in protein containing
tryptophan :pellagra
 VitB2 : milk, meat and fruits and vegetables : blindness and angular stomatitic

 Pantothenic acid or vitamin B5: synthesis and breakdown of fatty acids and oxidation of
carbohydrates : chicken, liver, yeast, egg yolk and potato
 Vit B12: liver and Kidney: pernicious anemia, abnormal neurological fx
 Vit-B9: mega.anemia, neural tube defect,poor immune response: yeast and yeast extract and Dark
green vegeta
 Pyridoxine or Vitamin B6 : dermatitis, glossitis, anemia, depression, confusion and
convulsions : fish, lean meat, wholegrain cereals, bananas and peanut butter
 Vit-C : Scurvy : citrus fruits, tomato, strawberries, leafy vegetables and potatoes :
Q.ENUMERATE THE ROLES OF VITAMIN C
 collagen synthesis
 antioxidant activitaminy
 absorption of Fe
 synthesis of various compounds in the body (epinephrine, serotonin, thyroxin, bile
acids…)
 immune functions.
MINERAL
 mineral is considered to be major, when the requirement is greater than 100mg/ day: Sodium;
potassium; chloride; calcium; phosphorus; magnesium and sulfur.

 A trace mineral is the one that is required to the amount less than 100mg/day: : iron; zinc; selenium;
iodine; copper; fluoride; chromium; manganese and molybdenum
A 70 kg body contains about 3.5 mol of sodium

 Adult skeleton contains about 1kg of calcium, deposited on an organic matrix of collagen, by cells
known as osteoblasts.
Iron is consumed in 2 forms:
 (1) Haem iron, present foods of the animal origin
 (2) Non-haem (inorganic) form, from foods of plant origin
Haem iron is relatively well absorbed (about 25%) in the small intestine, while non (haemic iron is
less efficiently absorbed (only about 5%).

Q. WHAT ARE THE FUNCTIONS OF COPPER IN THE HUMAN BODY
 Cu is a component of many enzymes, such as cytochrome oxidase, ferroxidase,
tyrosinase, ascorbic acid oxidase etc.
 Cu is the component of different proteins in the bone marrow, brain and liver.
 It helps in the formation of bone and elastin fibers
 Cu is required for the maintenance of myelin sheath in the nerve fibers.
Q. WHAT ARE THE FUNCTIONAL PROPERTIES OFF SELENIUM
 Important component of solenoproteins, such as glutathione peroxidase in mammals, which protects
cells against the damage by H2O2.
 Synergic antioxidant with vitamin E, and protects cells against free radicals.
 Selenium deficiency may lead to liver necrosis, muscular dystrophy, cardiomyopathy and
dilatation of the heart
 Excess of Se may lead to difficulty breathing, weight loss, hair loss and dermatitis.
IODINE RICH SOURCES : SEAFISH

Q. WHAT ARE THE 3 BASIC STAGES OF ANABOLISMS
 Production of precursors such as amino acids, monosaccharides and nucleotides.
 Activation of precursors into reactive forms using energy from ATP.
 Assembly of these precursors into complex molecules such as proteins, polysaccharides, lipids and
nucleic acids.
Q. WHAT ARE 2TYPE OF THE LIPASE
 Lipoprotein lipase
 Hormone-sensitive lipase
Q.OXIDATION OF FAs OCCURS IN 3 STAGES
o Activation of FAs
o Transport of FAs into the inner mitochondrial membrane
o Process of β-oxidation, to generate Acetyl CoA.
1. Acety coA from the carbohydarte is used mainly in the citric cycle
2. AcetylcoA from the fatty acid is mainly used in kreb cycle
3. Acetyl CoA is also used in the synthesis of FAs, cholesterol, and ketone bodies in the liver

Q. WHICH 2 EXAMPLE EACH, WHAT ARE THE 3 CATEGORIES OF AMINO ACID
THAT IS INVOLVES IN METABOLISM PROCESS
o Glucogenic: 13aa glycine, alanine, serine, aspartic acid, asparagine, glutamic
acid, glutamine, proline, valine, methionine, cysteine, histidine and arginine
precursors to glucose via gluconeogenesis
o Ketogenic: 2aa lysine and leucine only ketogenic
o Glucogenic and ketogenic: 5aa of isoleucine, phenylalanine, threonine, tryptophan,
and tyrosine : rise both fatty acid and glycose precursor
NUTRITION AT SPECIFIC PERIOD

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SOURCES OF NUCLEIC ACID
All meats, including organ meats, and seafood contain high levels of nucleic acids. Meat extracts and
gravies are also notably high. Of these foods, organ meats such as liver have the most nuclei, and are

therefore highest in nucleic acids. Conversely, dairy products and nuts are considered low-nucleic
acid foods.
Q.WHAT ARE THE FACTORS THAT SHOULD AFFECT THE PREGNANCY OUTCOME
1. Nutritional status
2. Low socioeconomic status
3. Closely spaced and multiple births
4. Teenage pregnancy
5. Advanced maternal age
6. Inadequate prenatal care
7. Lifestyle factors
8. Body weight and weight gain
9. Prenatal ketosis
10. Caffeine consumption
11. Aspartame use
12. Listeria and toxoplasmosis infections.
Q.WHAT ARE THE DISADVANTAGES OF MOTHER MILK FROM THE COW MILK
AND HOW MUCH TIME EXPECTED THE INFANT STAY TAKING MOTHERMILK

IN INFANCY
Calories needs in infancy are calculated as:
 (89kcal x weight of an infant in kg) + 75 from 0-3 months
 (89kcal x weight of an infant in kg) + 44 from 4-6 months
 (89kcal x weight of an infant in kg) - 78 from 7-12 months.
HEALTH BENEFITS OF BREASTFEEDING FOR INFANTS
• Breast milk is the ideal food for newborns and infants.
• It gives infants all the nutrients they need for healthy development.
• It is safe and contains antibodies that help protect infants from common childhood illnesses
(such as diarrhea and pneumonia, the two primary causes of child mortality worldwide).
• Breast milk is readily available and affordable, which helps to ensure that infants get
adequate sustenance.
Q. WHAT ARE THE HEALTH BENEFIT OF BREAST FEEDING TO MOTHERS
1. Breastfeeding when done exclusively often induces a lack of
menstruation, which is a natural method of birth control.
2. It reduces risks of breast and ovarian cancer later in life.

3. Helps women return to their pre-pregnancy weight faster.
4. Help women lowers rates of obesity.
Q. WHAT IS PROTEIN REQUIREMENT IN CHILDHOOD?

Q.WHAT ARE ADVANTAGES OF BREASTFEEDING OVER INFANT FORMULA
Long-term benefits for children
• Beyond the immediate benefits for children, breastfeeding contributes to a lifetime of good health.
• Adults who were breastfed as babies often have lower blood pressure and lower cholesterol, as well as
lower rates of overweight, obesity and type-2 diabetes.
• People who were breastfed perform better in intelligence tests.
Breast-feeding:Why not infant formula?
• Infant formula does not contain the antibodies found in breast milk and is linked to some risks
(e.g. water-borne diseases from unsafe water).
• Malnutrition can result from over-diluting formula to "stretch" (augmenter) supplies.
• If formula is used but becomes unavailable, a return to breastfeeding may not be an option due to
diminished breast milk production.

Q. HOW LONG THE CHILD IS NOT ALLOWED TO BREASTFEED FOR HIV POSITIVE
IDENTIFIED MOTHERS AND WHAT CONDITIONS FOR INFANT FORMULAE TO BE
APPLIED

Q.WHY DO ADOLESCENT GILRS AND BOYS NEED MORE IRONS IN THE
NUTRITIONAL PREPARTIONS

Q.WHAT ARE THE EFFECTS FOR ELDERLY FOR CONSUMING LAW FAT DIET RICH
IN CARBOHYDRATES

Q.DECREASE THE PROTEIN, MINERAL AND VITAMINS NUTRITION PROBLEMS IN
THE ELDER PEOPLE

Q.WHAT ARE THE PURPOSE OF NUTRITIONAL ASSESSMENTS /WHY
NUTRITIONAL ASSESSMENTS
 Identify individuals or population groups at risk of becoming malnourished
 Identify individuals or population groups who are malnourished
 To develop health care programs that meet the community needs which are defined
by the assessment
 To measure the effectiveness of the nutritional programs & intervention once initiated
Q.WHAT ARE METHODS USED IN NUTRITIONAL STASUS ANALYSIS

Q.DESCRIBE ABOUT THE ANTROPOMETRIC METHOD

WAIST CIRCUMFERANCE TYPE LEVEL

Q.WHAT ARE ADVANTAGES AND LIMITATIONS OF ANTROPOMETRIC METHOD IN
NUTRITIONAL HEALTH STATUS MEASUREMENTS

Q.WHATARE THE FIVE METHODS USED IN DIETARY SURVEY

Q.DESCRIBE 2 METHOD USED IN INTERPRETATION OF DIETARY DATA

Q.WHAT ARE THE TEST TO CONSIDER IN BILOGICAL METHOD CONDUCTING
NUTRITIONAL STATUS AND WHAT IS THE ADVANTAGE OF THIS METHOD

Q.WHAT ARE ADVANTAGES AND DISADVANTAGES OF CLINICAL SIGN
ASSESSEMENT METHOD

Q. WHAT IS MALNUTRITION
Malnutrition is the ‘cellular imbalance between supply of nutrients and energy that the
body’s demand for them to ensure growth, maintenance and specific functions’, and is the
greatest risk factor for illness and death worldwide.
Q. WHAT ARE THE CAUSES OF MALNUTRIONS
1. Anorexia
1. Inadequate food intake
2. Lack of food supplies
3. Loss of appetite
2. chronic and inflammatory diseases
1. cystic fibrosis
2. chronic renal failure
3. stroke
4. Parkinson’s disease
5. respiratory and orthopedic problems
6. childhood malignancies
Part II. NUTRITIONAL PATHOLOGY

7. chronic inflammatory bowel diseases
8. Fatigue, muscle weakness and difficulties with tasting, chewing and
swallowing can lead to reduced food intake and malnutrition.
3. Nausea and vomiting
1. Certain diseases
2. The use of certain drugs or specific treatments (chemotherapy, radiotherapy)
may have a negative effect on appetite.
4. Psychological
1. Anxiety
2. Depression
3. The presence of dementia.
5. Social causes
1. the institutionalization of individuals (e.g. in hospitals, nursing homes)
2. poverty and famine
3. poor food hygiene
4. inappropriate food supplies
5. The early cessation of breastfeeding.

Q. WHAT ARE THE PHYSICAL SIGN OF PROTEIN AND PROTEIN ENERGY
MALNUTRITION

Q. WHAT IS CACHEXIA AND WHAT ARE ITS MAIN SYMPTOMS?
Cachexia is a wasting syndrome, regulated by cytokines, and a condition of general ill
health, malnutrition, undesired weight loss and physical weakness.
o It is characterized by
o Changes in fat, protein and carbohydrate metabolism such as increased lipolysis,
gluconeogenesis and protein turnover, glucose intolerance and hyperinsulinemia,
hyperlipidemia, decreased plasma levels of branched-chain amino acids (BCAAs).
o Cancer cachexia: progressive weight loss, anorexia and persistent erosion of host
body cell mass, as a response to a malignant growth.
o Cancer cachexia : characterised by elevated levels of fibrinogen, are weakness, loss
of appetite, muscle atrophy and fatigue
Q.WHAT ARE THE GROUP OF PEOPLE ARE UNDER RISK OF MALNUTRITION
 Infants and adolescents,
 older people
 people with chronic diseases
 people that are severely ill
 Poor people

 people living in less-developed or developing countries
 patients with neurological diseases such as dementia
 pregnant women
 people living in deprived socioeconomic circumstances, without adequate
sanitation, education or means of preparing food
 individuals at risk of systemic infections

Q.WHICH SCREENINGTOOLS SHOULD BE USEDTO DETECT MALNUTRITION IN
THE HOSPITAL SETTING.
 Screening is essential, must be easy and fast and should be done as soon as patients are
admitted, in order to define and validate whether they are at risk of malnutrition and
what action should be taken.
 The introduction of a malnutrition-screening tool for hospital outpatients can play a crucial role in
improving the detection of disease-related malnutrition.
 THERE ARE VARIOUS NUTRITION SCREENING TOOLS:
 the Malnutrition Universal Screening Tool (MUST)
 Nutritional Risk Screening – 2002 (NRS-2002)
 Mini-Nutritional Assessment (MNA)
 Short Nutritional Assessment Questionnaire (SNAQ)
 Malnutrition Screening Tool (MST) and the Nutrition MedPass
o According to the latest European Society of Parenteral and Enteral Nutrition (ESPEN) guidelines for
nutritional screening, MUST is the most widely used screening tool for adults, mainly in the community,
but also in hospitals settings, where NRS-2002 is the most appropriate tool for undernutrition detection,
with an additional grading of severity of diseases.
o Both these tools have excellent reliability and a high level of validity.
o This tool is MNA, which includes physical and mental parameters and a dietary questionnaire, for the
detection of undernutrition among older people, even in the early stages.

WHAT ARE THE PRINCIPAL OF TREATING MALNOURISHED PATIENTS

HOW CAN YOU TREAT KWASHIORKOR
o If nutrition problem is caused by the lack of Protein and PEM , the treatment should be
designed by administering the Fortified food with protein and energy addition
o If the problem is causes by the protein malabsorption , the parenteral nutrition should be
emergency application while looking forward the cause of malapbroption

Q.PROTEIN DEFICIENCY, IN COMBINATION WITH ENERGY AND MICRONUTRIENT
DEFICIENCY, IS NECESSARY BUT NOT SUFFICIENT TO CAUSE KWASHIORKOR, WHAT
ARE OTHER FACTORS SHOULD CONTRIBUTE TO KWASHORKOR
One of several types of nutrients (e.g., iron, folic acid, iodine, selenium, vitamin C), particularly those
involved with anti-oxidant protection.
o Important anti-oxidants in the body that are reduced in children with kwashiorkor include
glutathione, albumin, vitamin E and polyunsaturated fatty acids.
o Therefore, if a child with reduced type one nutrients or anti-oxidants is exposed to stress (e.g.
an infection or toxin) he/she is more liable to develop kwashiorkor.
o One important factor in the development of kwashiorkor is aflatoxin poisoning.
 Aflatoxins are produced by molds and ingested with moldy foods. They are
toxified by the cytochrome P450 system in the liver, the resulting epoxides
damage liver DNA. Since many serum proteins, in particular albumin, are
produced in the liver, the symptoms of kwashiorkor are easily explained.
o It is noteworthy that kwashiorkor occurs mostly in warm, humid climates that encourage mold
growth.
o Protein should be supplied only for anabolic purposes. The catabolic needs should be
satisfied with carbohydrate and fat.
o Protein catabolism involves the urea cycle, which is located in the liver and can easily
overwhelm the capacity of an already damaged organ.
o The resulting liver failure can be fatal
Ignorance of nutrition can be a cause.

Q.WHAT ARE THE FACTORS THAT CONTRIBUTE TO THE MALNUTRITIONS OR
CELLULAR IMBALANCE OF NUTRIENTS AND ENERGY NEED/OVERWEIGHT

WHAT IS THE POSSIBLE TREATMENT PLAN OF OVERWEIGHT

 CLASSIFY THE OBESITY:
 Notices the Japanese have defined obesity as any BMI greater than 25 while China uses
a BMI of greater than 28.
BMI Classification
< 18.5 underweight
18.5–24.9 normal weight
25.0–29.9 overweight
30.0–34.9 class I obesity (usual obesity)
35.0–39.9 class II obesity (severe obese)
≥ 40.0 class III obesity (morbid obese)
>=45 Class IV (Super obese)
Q.THE CARACTERISTICS OF PERSON LIKELY DEVELOPING THE DIABETES.
High blood sugar produces the classical symptoms of
polyuria (frequent urination)
polydipsia (increased thirst)
Polyphagia (increased hunger).
1.TYPE I DIABETES= Insulin Dependent Diabetes: Considered as Auto Immune or Immune Mediated or
idiopathic: beta cell loss is a T-cell mediated autoimmune attack.

WHY TYPE 1 DIABESTES IS CALLED JUVENILLE DIABETES : because it represents a majority of the
diabetes cases in children
2.TYPE 2 DIABETES : insulin resistance which may be combined with relatively reduced insulin
secretion, it is the matter of irresponsive of the insulin receptor, most common type occur
3.GESTATIONAL DIABETES
Like type 2 involving a combination of relatively inadequate insulin secretion and
responsiveness.it occur during pregnancy
Q.HOW THE BODY DEFEND FOR THE PRESENCE OF THE TYPE 2 DIABESTES
 In the early stage of type 2 diabetes
 The predominant abnormality is reduced insulin sensitivity.
 At this stage hyperglycemia can be reversed by a variety of measures AND
 medications that improve insulin sensitivity OR
 Reduce glucose production by the liver.
Q.WHAT ARE THE SYMPTOMES OF PERSON SUFFERING FROM THE TYPE 2
DIABETES

Q.WHAT ARE THE CAUSE OF DIABETES
 Insufficient production of insulin (either absolutely or relative to the body's needs)
 production of defective insulin (which is uncommon)

 The inability of cells to use insulin properly and efficiently.
NOTICE: This latter condition affects mostly the cells of muscle and fat tissues, and results in a condition known as
"insulin resistance." This is the primary problem in type 2 diabetes.
 The absolute lack of insulin due to autoimmune disorder
 decline of beta cells
 unconstant vigorous insulin release
 the cells' inability to utilize glucose in case of insulin absence for storage gives rise to the
ironic situation of "starvation in the midst of plenty".
Q. WHAT ARE THE CONSEQUENCES OR EFFECT OF DIABETES TO HUMAN HEALTH
o Blindness
o kidney failure and
o Nerve damage:These types of damage are the result of damage to small vessels
(microvascular disease).
Important factor in accelerating the hardening and narrowing of the arteries (atherosclerosis)
o Leading to strokes
o coronary heart disease
o And other large blood vessel diseases. (Macro vascular disease).

1. WHAT IS PARANTERAL AND ENTERAL NUTRITIONS
2. DISTUINGUISH TOTAL PARANTERAL FROM PERIPHERAL PARANTERAL
NUTRIONS

WHAT ARE THE ADVANTAGE OF TPN OVER PPN

WHAT ARE THE ADVANTAGES AND DISADVANTAGES OF PARANTERAL 3 IN 1
NUTRITIONS?

Q.WHY A.A ARE NOT USED IN PERIPHERAL PARENTERAL NUTRITIONS
Cause of high osmolality

Q.WHAT ARE THE MINERAL TO CARE DURING PARENTERAL FORMULATIONS

WHAT ARE THE POSSIBLE COMPLICATIONS OF PN
Q.DETERMINE NUTRITIONAL VALUES, RATE OF INFUSION OF THE
PATIENT IN DEMAND OF KCALS: 1800. PROTEIN: 88 G. FLUID: 2000 CC

SAME QUESTION IN 3 IN 1 OR TNA
WHAT IS DOES IT MEAN NON PROTEIN CALORIES PARENTERAL NUTRITION

o To determine the non-protein calories (NPC) in a TPN prescription, add the dextrose calories to
the lipid calories without protein calories
o For example 1224 kcals (dextrose) + 720 kcals (lipid) = 1944 non-protein kcals

WHAT ARE THE DISADVANTAGES OF PPN
 Hypertonic solution is introduced into a small vein with a low
blood flow, fluid from the surrounding tissue moves into the vein
due to osmosis.
 The area can become inflamed, and thrombosis can occur.
 IV-Related Phlebitis

Q.WHAT ARE THE ADVANTAGES AND LIMITATION OF ENTERAK NUTRITIONS

WHEN AND WHY CAN YOU USE STOMACH ENTERAL FEEDING TUBE
AND INTESTINE ENTERAL FEEDING TUBE

DISTUINGUISH BOLUS FROM CONTINUOUS ENTERAL ADMINISTRATIONS
OF FOOD
Administration technic
o BOLUS
• More physiologic
• Not administered via tubes in duodenum or jejunum
• Administer < 400 mL per bolus
o CONTINUOUS
• High nutritional requirements
• Tubes in the duodenum or jejunum

WHAT ARE THE DIFFERENT CLASS OF ENTERAL FORMULAS?

WHY DO ENTERAL NUTRITION NEED THE FOLLOWING, FIBERS, LOW IS
OSMOLALITY AND HIGH IN WATER

QUESTIONS ABOUT NUTRITION AND FOOD QUALITY CONTROL

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