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142 Cards in this Set
- Front
- Back
65% of North American adults
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overweight
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most reliable therapy for the problem of being overweight
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-decreased caloric intake
-increased physical activity -diet modifications |
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Definition of Energy Balance
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energy input matches energy output
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energy input represents
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calories from food intake
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energy output represents
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-metabolism
-the digestion, absorption and transport of nutrients -physical activity |
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Positive Energy Balance
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energy intake is greater than energy expended
-storage of excess energy in adipose tissue -generally results in weight gain in adults |
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positive energy balance is normal and healthy
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-required in pregnancy where surplus energy supports growth of the developing fetus
-infants and children require a positive energy balance for growth and development |
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Negative Energy Balance
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-energy intake is less than energy expended
-generally results in weight loss -in adults, weight loss is a combination of lean and adipose tissue |
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Maintenance of Energy Balance
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-maintenance of energy balance contributes to health and well-being in adults
-minimizes the risk of developing many common health problems -creeping weight gain in adulthood can lead to obesity if unchecked |
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-problems of energy balance can stem from lifestyle contributions
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-excess food intake
-reduced physical activity -slower rate of metabolism |
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“food hunts man” rather than man hunting for food
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-vending machines
-social gatherings -convenient fast-serve restaurants and drive-up windows -“super-sized” portions |
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“defensive eating” is a good response
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careful and conscious food choices especially related to portion size
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determining the caloric (energy) content of foods
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bomb calorimeter
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bomb calorimeter
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-food is burned in a calorimeter chamber that is surrounded by water
-as food burns, heat is released which raises the temperature of the water -an increase in water temperature is a reflection of energy in a food -increase in water temperature indicates the number of kcals contained in the food -one kcal is the amount of heat (energy) required to increase the temperature of one kilogram of water one degree Celsius |
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carbohydrates and proteins represent
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4 kcals/gram
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lipids represent
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9 kcals/gram
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alcohol represents
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7 kcals/gram
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Basal Metabolism (Basal Metabolic Rate (BMR))
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-minimal amount of calories expended during a fasting state to keep a resting,
awake body alive in a warm, quiet environment -maintains heartbeat, respiration by the lungs and the activity of other body organs (liver, brain and kidney) -accounts for 60% to 70% of the total energy use by the body (for a sedentary person) |
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resting metabolism (resting metabolic rate (RMR))
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-a person not fasting or completely rested
-typically the RMR is 6% higher than the BMR |
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-determination of energy needs related to basal metabolism
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-individual’s weight is converted into kilograms
-a rough estimate of BMR is 0.9 kcals/kg/hour for females and 1.0 kcals/kg/hour for males -take the hourly BMR times 24 hours to yield the entire BMR for one day |
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some factors that increase basal metabolism
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greater lean body mass
larger body surface area per body volume (a greater surface area results in increased heat loss) gender (males average higher energy use; have a greater lean body mass, -body temperature (fever increases metabolic rate) -thyroid hormones (increase metabolic rate) -pregnancy (increases metabolic rate) -caffeine and tobacco use (increase metabolic rate) |
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lean body mass
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body weight minus fat storage weight
includes organs with high energy needs and show high metabolic activity at rest -skeletal muscle, kidney, brain and liver |
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tobacco use
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the practice of smoking to control body weight is not recommended
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factors that decrease basal metabolism
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low calorie intake
-age (decreases metabolic rate) |
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age (decreases metabolic rate)
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-as aging occurs, basal metabolism declines 1% to 2% each decade past the
age of 30 |
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low calorie intake
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-extreme diet regimes can lower basal metabolism 10% to 20% per day
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physical activity aids in maintaining lean body mass
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-lean body mass helps maintain high basal metabolism and aids in weight control
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Energy for Physical Activity
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-increases energy expenditure 25% to 40% beyond basal energy needs
-choosing to be active or inactive determines total calorie expenditure -varies widely from person to person as compared to basal metabolism -general inactivity is linked to an increased risk of obesity |
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Thermic Effect of Food (TEF)
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-energy required to digest, absorb and process food nutrients
-5% to 10% of total kcals -analagous to “sales tax” -food composition influences TEF |
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-food composition influences TEF
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-TEF value of a protein-rich meal is higher than that of a carbohydrate-rich or fat-rich
meal -more energy is required to metabolize amino acids into fat than to convert glucose to glycogen or transfer absorbed fat to adipose tissue -large meals result in higher TEF values than the same amount of food eaten over many hours |
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Thermogenesis
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-increase in non-voluntary physical activity triggered by cold conditions or overeating
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-types of non-voluntary activities
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-fidgeting
-shivering when cold -maintenance of muscle tone -maintenance of body posture |
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contribution of thermogenesis to overall calorie output
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is small
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brown adipose tissue
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specialized form of adipose tissue that participates in thermogenesis
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brown adipose tissue
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-found in small amount in infants
-brown appearance is a reflection of a rich blood flow -contributes to thermogenesis by releasing energy into the environment as heat -hibernating animals contain large amounts of brown adipose tissue |
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-hibernating animals contain large amounts of brown adipose tissue
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allows them to generate heat needed to survive a long winter
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Direct Calorimetry
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-measures body heat released by a person
-method resembles the bomb calorimeter method for measuring the energy content of a food -advantage -almost all energy used by the body eventually leaves as heat -disadvantages include expense and complexity |
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Indirect Calorimetry
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-measures the amount of oygen a person uses
-the human body needs one liter of oxygen to burn 4.85 kcals of energy -newly developed handheld instruments (Body Gem) can measure oxygen consumption |
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Estimation of Energy Needs
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-based on weight, height, gender, degree of physical activity and age
-the Food and Nutrition Board has published formulas to estimate energy needs called EER (Estimated energy Requirements) -MyPyramid calorie guidelines |
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“personal” healthy weight based on
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-weight history
-fat distribution patterns -family history of weight-related disease -current health status |
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weight-related conditions in determining health weight
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-high blood pressure (hypertension)
-elevated LDL cholesterol -family history of obesity, cardiovascular disease or certain forms of cancer -body fat distribution patterns -elevated blood glucose -lowest weight held as an adult for one year -clothing size -weight maintained while dieting without being constantly hungry |
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Body Mass Index (BMI)
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-current method used for calculating healthy body weight
-preferred weight-for-height standard because it is the clinical measurement most closely related to body fat content -calculation -body weight (kilograms)/height2 (meters) -convenient to use because the values apply to men and women (gender-neutral) -healthy weight for height is a BMI between 18.5 to 24.9 |
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BMI > 25
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-can start leading to increased health risks
-cut-off value for overweight |
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-BMI > 30
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-leads to increased health risks
-cut-off value for obesity |
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-BMI > 40
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indicates severe obesity and could involve major health risks
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BMI should not be applied to the following groups
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-children and growing adolescents
-highly muscular individuals -frail, elderly adults -lactating and pregnant women |
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BMI values for active men
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may be greater than 25 due to extra muscle mass
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BMI should only be used as a
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screening test for overweight or obesity
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major considerations when maintaining an appropriate height/weight value
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-listening to the body for hunger cues
-regularly eating a healthy diet -remaining physically active |
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-individual’s diagnosis for obesity
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-total amount of fat in the body
-the location of the body fat -the presence of absence of weight-related medical problems |
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Health Problems Associated With Excess Body Fat
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-surgical risks
-pulmonary disease and sleep disorders -type 2 diabetes -hypertension -cardiovascular disease -bone and joint disorders -gallstones -cancers -skin disorders -pregnancy risks -reduced agility and physical ability -infections and liver damage -menstrual irregularities and infertility -premature death |
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desirable amounts of body fat
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-8% to 24% for men
-21% to 35% for women |
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women need more body fat because
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some fat is associated with reproductive functions
(including estrogen production) |
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percent body fat associated with obesity
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greater than 24% body fat for men
greater than 35% body fat for women |
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-both body weight and body volume have to be known
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known to determine body fat content
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underwater weighing
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-most accurate of typical methods used to estimate body volume
-fat tissue is less dense than lean tissue (fat floats) -the more fat tissue present, the less a person will weigh submerged |
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air displacement
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-body volume is quantified by measuring space a person takes up inside a measurement
chamber (BodPod) |
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water displacement
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-submerge individual in a tank of water and determine the amount of water displaced
-water displacement is least accurate |
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body density =
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body weight/body volume
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% body fat =
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(495/body density) – 450
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skinfold thickness
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-common anthropometric method used to estimate total body fat
-clinicians use calipers to measure the fat layer directly under the skin -accuracy limitations |
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bioelectrical impedance
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-uses a painless low-energy electrical current
-adipose tissue resists electrical flow since it is low in electrolytes and water (as compared to lean tissue) -more fat means greater electrical resistance -body fat calculators that use bioelectrical impedance are available for home use -can provide information whether weight gain is coming from fat or muscle |
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-Dual Energy X-Ray Absorptiometry (DEXA scan)
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-most accurate method for determining body fat content
-equipment is expensive and not widely available for body fat determination -uses multiple low energy X-rays to measure body composition and bone mass/density -assesses bone mineral density and determines the risk for osteoporosis -allows a clinician to separate body weight into three separate components -fat -fat-free soft tissue -bone minerals -infrared light |
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infrared light
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-procedure is called Near-Infrared Reactance
-assesses interactions of the infrared light beam with fat and lean tissue in the bicep muscle of the arm -although convenient and inexpensive, this method is not very accurate |
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the location of body fat is an important predictor of
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health risks
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-upper body (android) obesity
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-fat stored primarily in the abdominal area
-associated with cardiovascular disease, hypertension and type 2 diabetes -fat released from abdominal adipose cells goes straight to the liver -interferes with the liver’s ability to use insulin -negatively affects lipoprotein metabolism by the liver -these abdominal adipose cells also make substances that increase insulin resistance, blood clotting, blood vessel constriction and inflammation -encouraged by alcohol intake, smoking, high glycemic load and high blood testosterone levels -“apple on a stick” shape -characteristic male pattern -pot belly (large abdomen); small buttocks and thighs -waist circumference -greater than 40 inches in males and 35 inches in females -if BMI > 25, health risks significantly increase |
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-lower body (gynoid) obesity
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-fat storage primarily located in the buttocks and thigh area
-encouraged by the hormones estrogen and progesterone -typical female pattern -“pear-like” shape -small abdomen; large buttocks and thighs -after menopause -blood estrogen levels decrease -this encourages upper body fat deposition |
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genes account for up to 70% of
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weight differences between people
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genes help determine
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metabolic rate, fuel use and differences in brain chemistry
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nurture (eating habits, nutrition, environment) has less to do with obesity than
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nature
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inherited specific body types
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-endomorph
-stocky build, short trunk; wide chest and hips -short stubby bones -round head -ectomorph -tall and slender; narrow chest and hips -long, thin bones -thin/narrow head -mesomorph individuals will have a medium, muscular build |
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-tall, thin people use more calories than shorter individuals (even while resting)
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-increased surface area results in increased basal metabolism
-tall, thin people have an easier time maintaining a healthy body weight |
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-thrifty metabolism
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-enables an individual to store fat more readily
-require fewer calories to get through the day -allows the body to use energy frugally -tends to promote weight gain -in past human history, when food supplies were scarce, thrifty metabolism helped protect against starvation -there is a general abundance of food in today’s society -this requires high energy output and wise food choices to prevent obesity |
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-set point theory
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-proposes that humans have a genetically predetermined body weight or body fat content
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some research suggests that the hypothalamus monitors
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the amount of body fat in humans
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physiological evidences supporting the set point theory
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-when calorie intake is reduced, blood concentrations of thyroid hormones decrease
(slows basal metabolism) -as weight is lost, the calorie cost of weight bearing activity decreases -with weight loss, the body becomes more efficient in storing fat -increased activity of lipoprotein lipase (takes fat into cells) |
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-when a person gains weight and stays at that weight for a period of time, the body tends to
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set a new set point
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-opponents of the set point theory
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-weight does not tend to stay constant through adulthood
-average person tends to gain weight slowly through adulthood -weight can be altered if an individual is placed in a different social, emotional or physical environment -arguments suggest that humans settle into a particular stable weight based on their circumstances -referred to as “a settling point” |
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“Health at Every Size”
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-indirectly refers to a set point for weight by defining healthy weight as the natural weight the body adopts
-includes a healthy diet and meaningful levels of physical activity -overall the set point is weaker in preventing weight gain than preventing weight loss |
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nurture
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a reflection of eating habits, nutrition and environmental factors
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eating habits, nutrition and environmental factors of nurture
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-large portion sizes
-availability of food -high-fat diet -inactivity |
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-husbands and wives playing a role in nurture
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-no genetic link
-may develop similar behaviors toward food -may influence each other’s eating habits |
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-adult obesity in women
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-often linked to childhood obesity
-contributing factors to female obesity -relative inactivity -periods of stress and boredom -excess weight gain during pregnancy |
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-adult obesity in males
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-not strongly linked to childhood
-tends to appear after the age of 30 -this pattern suggests a primary role of nurture in obesity, with less genetic influence |
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-Americans of lower socioeconomic status (especially females) are more likely to be
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obese than those in upper socioeconomic groups
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factors that promote fat storage
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-lower socioeconomic status
-overweight friends and family -a cultural/ethnic group that prefers higher body weight -lifestyle that discourages healthy meals and adequate exercise -excessive television viewing -easy availability of inexpensive high-calorie food |
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factors That Encourage Excess Body Fat Storage and Obesity
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-age, race and gender
-menopause -physical activity -positive energy balance -diet composition -fat metabolism and uptake -social and behavioral factorsv |
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obesity
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chronic disease
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Characteristics of a Sound Weight-Loss Plan
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control calorie intake, increase physical activity
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-control calorie intake
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-decrease calorie intake by 100 kcals/day (and increase physical activity by 100 kcals/day)
-allows a slow and steady weight loss |
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-increase physical activity
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-maintenance of a healthy weight requires lifelong changes in habits
-control problem behaviors |
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-appropriate weight-loss programs have the following common characteristics
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-meet nutritional needs
-can adjust to accommodate habits and tastes -emphasize readily obtainable foods -promote changing habits that discourage overeating -encourage regular physical activity -help change obesity-promoting beliefs and rally healthy social support |
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-the majority of rapid weight-loss programs do not
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promote fat loss
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to lose 1 pound of fat stores per week, calorie intake must be
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decreased ~ 500 kcals/day or
physical activity must be increased by ~ 500 kcals/day |
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iets that promise 10 to 15 pounds of weight loss per week do not efficiently attack fat stores
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-these types of diets reflect lean tissue and fluid (water) loss
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to lose one to two pounds of fat stores per week often requires limiting kcal intake
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-1200 kcal per day for women
-1500 kcal per day for men -calorie allowance could be higher for very active individuals |
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-at this time the low-fat
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high-fiber approaches have been the most successful
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monitoring total calorie intake
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-read labels to monitor calorie intake
-many foods are more energy-dense -record food intake for 24 hours and calculate calorie intake -consider eating healthy a lifestyle change, rather than a weight loss plan -liquid calories do not stimulate satiety mechanisms to the same extent as solid food -try to use beverages that have few or no calories (limit sugar-sweetened beverages) |
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2005 Dietary Guidelines advice related to physical activity for adults
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-60 minutes of physical activity per day to maintain body weight and prevent weight gain
-60 to 90 minutes per day for maintaining weight loss |
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pedometers
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monitor activity as steps
-recommended goal is 10,000 steps/day |
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calorie counters (Bodybugg)
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track calorie expenditures
-calculate calories by measuring heart rate, sweat rate or heat loss and production |
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Behavior Modifications for weight loss
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chain breaking, stimulus control, cognitive restructuring, contingency management, self-monitoring, relapse prevention
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chain breaking
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-separates behaviors that tend to occur together
-snacking on chips while watching television |
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-stimulus control
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-altering the environment to minimize the stimuli for eating
-remove foods from sight; store foods in kitchen cabinets -push tempting foods to the back of the refrigerator -avoid the path by the vending machine -shop from a list; avoid shopping when hungry -provide a positive stimulus by keeping low-fat snacks available to satisfy hunger/appetite |
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-cognitive restructuring
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-changes one’s frame of mind concerning eating
-substitute other pleasures for rewards -after a hard day, avoid using alcohol or comfort foods as a quick relief for stress -take a relaxing walk or have a conversation with a friend |
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contingency management
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-form a plan of action to respond to situations where overeating is likely or physical activity is
hindered -at parties or buffets try to set limits -if raining, have other options for physical activity |
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-self-monitoring
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-tracking foods eaten and conditions affecting eating
-helps people understand their eating habits -record can encourage new habits that will counteract unwanted behaviors -experts note that this is a key behavioral tool to use in a weight-loss program |
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-relapse prevention
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-series of strategies used to help prevent and cope with weight control lapses
-recognize high risk situations and decide beforehand appropriate responses -maintenance of weight loss is fostered by the “3 Ms” -motivation, movement and monitoring |
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Professional Help
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-primary care (family) physician
-assess overall health and appropriateness for weight loss -registered dietitian -help design a specific weight loss plan -exercise physiologist -provide advice concerning programs to increase physical activity |
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Weight Loss Organizations
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-TOPS (Take Off Pounds Sensibly)
-Weight Watchers -Jenny Craig and Physicians Weight Loss Center are less desirable due to expense (intense counseling and mandatory diet foods/supplements) |
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drug therapy alone has
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not been found to be successful
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three main classes of medications
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-amphetamine-like medications
-sibutramine (Meridia) -orlistat (Xenical) |
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-amphetamine-like medications
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-Fastin or Ionamin
-prolongs the action of epinephrine and norepinephrine in the brain -contraindicated for pregnant/nursing women or individuals under the age of 18 |
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-sibutramine (Meridia)
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-approved by the FDA for weight loss
-reduces the reuptake of neurotransmitter and norepinephrine in the brain -these neurotransmitters remain active in the brain for a longer time period -prolong a sense of reduced hunger -used with caution in individuals with hypertension and cardiovascular disease |
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-orlistat (Xenical)
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-approved by the FDA for weight loss
-inhibits lipase enzyme activity in the small intestine -reduces fat digestion and absorption -increased fat in feces may lead to gas, bloating and an oily discharge -reduced absorption of fat-soluble vitamins may require a supplement -a low dose form of orlistat (AlliTM) is available over-the-counter without a prescription |
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severe, morbid obesity
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(weighing at least 100 pounds over healthy body weight or twice one’s healthy
body weight; BMI > 40) requires professional treatment |
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very-low-calorie diets (VLCD)
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-also known as protein-Sparing Modified Fast (PSMF)
-the main reasons for weight loss are minimal energy consumption and the absence of food choices -physical activity and resistance training can lead to a greater loss of adipose tissue -about 3 to 4 pounds can be lost per week -physician monitoring is crucial -major health risks include heart problems and gallstones |
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very-low-calorie diets (VLCD)
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Optifast program
-allows a person 400 to 800 kcals/day, often in liquid form -120 to 480 kcals are carbohydrates -280 to 400 kcals are high quality protein |
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low carbohydrate intake often causes
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ketosis, which may decrease hunger
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bariatric surgery
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bariatrics focuses on the treatment of obesity
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two types of bariatric operations
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adjustable gastric banding (lap-band procedure)
gastroplasty (gastric bypass surgery) |
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gastroplasty (gastric bypass surgery)
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-stomach stapling
-the most common and effective approach is the Roux-en-Y gastric bypass procedure -reduces the capacity of the capacity and bypasses a short segment of the upper small intestine -overeating solid foods results in discomfort or vomiting -promotes a more rapid satiety |
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adjustable gastric banding (lap-band procedure)
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-the opening from the esophagus to the stomach is reduced by a hollow gastric band
-creates a small pouch and a narrow passage into the rest of the stomach -this decreases the amount of food that can be eaten comfortably -the band can be inflated/deflated via an access port just under the skin |
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-bariatric surgery advantages
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-when enforced with food reduction, individuals can lose excess body weight
-can lead to dramatic health improvements -reduced blood pressure -elimination of type 2 diabetes |
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-bariatric surgery disadvantages
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-cost; may not be covered by medical insurance
-follow-up surgery to correct stretched skin -surgery promotes lifestyle changes which could require difficult behavior adjustments -diet and physical activity cannot reduce fat deposits in certain body locations -suction lipectomy -surgical removal of fat -“problem” local fat deposits can be reduced in size -risks include infections, lasting depressions of the skin and blood clots (can lead to kidney failure or death) -procedure’s expensive cost is an issue |
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Underweight
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BMI less than 18.5
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Causes of underweight
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-eating disorders (anorexia nervosa)
-cancer -infectious disease -digestive tract disorders -excessive physical activity -genetics -smoking |
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Health Problems of underweight
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-loss of menstrual function
-low bone mass -slow recovery from illness -complications with pregnancy and surgery |
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Interventions of underweight
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-medical intervention through a physician
-increase portion sizes -in growing children, the high demand for calories to support physical activity and growth can cause underweight -gradually increase the consumption of calorie-dense foods (especially those high in vegetable fat) -Italian cheeses, nuts and granola are good energy sources and are low in saturated fats -dried fruits and bananas are good fruit sources -fruit juices and smoothies are good energy sources (to replace diet soft drinks) -regular meal and snack schedule can aid in weight gain and maintenance -some may be too busy to eat -reduce physical activity if excessively active |
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How to Recognize an Unreliable Diet
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-promote quick weight loss
-initial weight loss results from the loss of water and lean muscle mass -limit food selections and dictate specific rituals -use testimonials from famous people and tie the diet to well-known locations -cure-alls; claim to work for everyone -often recommend expensive supplements -no attempts are made to permanently change eating habits -critical and skeptical of the scientific community -claim that there is no need to exercise |
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Types of Popular Diets
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-Low- or Restricted-Carbohydrate Approaches
-Carbohydrate-Focused Diets -Low-Fat Approaches -Novelty Diets -Meal Replacements |
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Quackery
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(people taking advantage of others) is Characteristic of Many Popular Diets
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Vitamins
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-essential organic substances needed in small amounts
-required for normal function, growth and maintenance of the body |
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Characteristics of vitamins (1-4)
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1. Yield no energy (0 kcals/gram)
2. Some are fat-soluble (A, D, E and K) 3. Some are water-soluble (B and C) 4. Many function as coenzymes -coenzymes help enzymes function properly -B vitamins and vitamin K function as coenzymes |
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Characteristics of vitamins (5-6)
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5. Vitamins are essential in human diets
-most cannot be synthesized in the human body -exceptions -vitamin A can be synthesized from certain plant pigments -bacteria in the large intestine synthesize vitamin K and biotin -vitamin D can be synthesized by the body if the skin is exposed to sunlight -niacin can be synthesized from the amino acid tryptophan 6. Two criteria for vitamin classification -the body is unable to synthesize enough of the compound to maintain health -absence of the compound from the diet for a defined period produces deficiency symptoms which (if caught in time) are quickly cured when the substance is resupplied |
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Characteristics of vitamins (7-9)
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7. Vitamin deficiencies can lead to disease
8. A few vitamins have proved useful in treating several non-deficiency diseases (require the administration of megadoses) -megadoses of niacin may be utilized as a blood cholesterol-lowering reducing treatment 9. Both plant and animal foods supply vitamins in the human diet |
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fat-soluble vitamins are
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not readily excreted from the body (except vitamin K)
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water-soluble vitamins are
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excreted rapidly by the kidneys
-vitamin B-6 and B-12 are exceptions and are stored more readily |
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Fat-soluble vitamins (including vitamins A and D) that are not readily excreted may
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accumulate in the body and cause toxic effects
-vitamin A poses the greatest risk of toxicity |
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-some vitamins (including vitamin E, niacin, vitamin B-6 and vitamin C)
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can produce toxic effects
if consumed in large quantities |
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Fat-Soluble Vitamins
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A, D, E and K)
-absorbed with dietary fat -stored mostly in the liver and fatty tissues |
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-problems associated with the normal digestion and absorption of fat also interferes with
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the proper absorption of fat soluble vitamins
-diseases like cystic fibrosis in which fat absorption is hampered |