This Document Contains Chapters 15 to 16 Chapter 15 Trace Minerals Multiple Choice Questions 1. The richest sources of iron in the diet are A. fruits and vegetables. B. nuts and seeds. C. meats and seafood. D. breads and pastries. 2. Most of the iron in the body is found as a part of A. ferritin. B. albumin. C. hemosiderin. D. hemoglobin. 3. Excess intake of zinc supplements can reduce absorption of A. selenium. B. calcium. C. copper. D. iodine. 4. Which type of dietary iron is most efficiently absorbed? A. non-heme iron B. elemental iron C. heme iron D. All these forms of iron are absorbed equally. 5. Athletes commonly believe that the trace mineral ________ helps improve muscle mass and strength despite lack of research evidence. A. chromium B. zinc C. manganese D. selenium 6. Which nutrient increases the absorption of non-heme iron by reducing ferric iron (Fe3+) to ferrous iron (Fe2+)? A. vitamin A B. vitamin C C. vitamin E D. vitamin D 7. Phytic acid and oxalic acid ________ the absorption of dietary iron. A. increase B. decrease C. do not have any effect on 8. Which of the following factors increases iron absorption? A. high intakes of zinc B. high stores of iron C. low gastric acidity D. increased need for iron 9. Which of the following foods is a good source of non-heme iron? A. eggs B. spinach C. grilled chicken D. clams 10. Approximately ____________ of dietary iron is absorbed each day from typical Westernized diets. A. 1-3% B. 14-18% C. 55-65% D. 90-99% 11. The proteins ____________ oxidize ferrous iron to ferric iron to allow iron to be transported to body cells. A. hemosiderin and ferritin B. heme and non-heme C. hephaestin and ceruloplasmin D. ferritin and albumin 12. Iron is stored in the liver as A. hephaestin. B. heparin. C. ceruloplasmin. D. ferritin. 13. Hemoglobin, cytochromes, and myoglobin all contain A. selenium. B. zinc. C. iron. D. iodine. 14. Ceruloplasmin is A. a zinc-containing enzyme in the intestinal wall. B. a copper-containing enzyme that oxidizes Fe2+ to Fe3+. C. the storage form of iron in the liver. D. a component of the electron transport system. 15. The hemoglobin molecule A. contains 4 heme compounds. B. carries oxygen from the lungs to the tissues. C. decreases during iron deficiency anemia. D. All of these choices are accurate. 16. When body cells need more iron, the number of transferrin receptors on the cell surface A. increases. B. decreases. C. remains unchanged. 17. Approximately _______ of iron used each day is recovered and recycled. A. 10% B. 25% C. 75% D. 90% 18. Ferritin and hemosiderin are A. storage forms of iron. B. zinc-containing proteins. C. protein carriers of selenium in the blood. D. iodine-containing enzymes. 19. A low serum concentration of hemoglobin is most often associated with a deficiency of A. zinc. B. iodine. C. copper. D. iron. 20. The transport of iron out of the intestinal cell for incorporation into serum transferrin is aided by the protein A. insulin. B. myoglobin. C. ferroportin. D. thyroxine. 21. Iron-deficiency anemia often causes symptoms of A. fatigue. B. night blindness. C. dental decay. D. dermatitis. 22. Which of the following population groups is at highest risk of iron-deficiency anemia? A. post-menopausal women B. weight-training athletes C. premature infants D. male college students 23. In iron-deficiency anemia, the red blood cells are usually classified as A. macrocytic and normochromic. B. microcytic and hypochromic. C. normocytic and hyperchromic. D. megaloblastic. 24. A major factor contributing to the decline in iron deficiency anemia among poor preschool children in the U.S. is A. better nutrition education of parents, so that foods children need are actually being served. B. the federal Food Stamp Program (now called SNAP). C. the nationwide system of food pantries and soup kitchens. D. the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) that distributes iron-fortified formulas and cereals. 25. Which population group is considered at low risk for iron-deficiency anemia? A. pregnant women B. infants and preschool children C. vegans D. middle-aged businessmen 26. Hemochromatosis is A. a form of anemia common in female athletes. B. a genetic condition causing excess absorption of dietary iron. C. a type of erythrocyte that carries extra iron. D. a genetic form of iron deficiency. 27. Iron plays a role in all of the following functions EXCEPT A. immune function. B. oxygen transport. C. cognitive development. D. synthesis of thyroid hormones. 28. Dietary zinc absorption is increased by A. phytic acid. B. zinc deficiency. C. ferritin status. D. the amount of vitamin C in the diet. 29. When large doses of zinc are consumed, the excess is excreted primarily via A. the sweat. B. the urine. C. the feces. D. expired air. 30. A dietary deficiency of ______ is associated with retarded growth and inadequate sexual development in humans. A. copper B. iodine C. selenium D. zinc 31. Zinc can induce the synthesis of metallothionein, which A. is the primary protein carrier of zinc in the blood. B. can hinder the absorption of zinc from the intestinal cell. C. is the storage form of zinc in the liver. D. is a zinc-containing enzyme in the antioxidant defense network. 32. The RDA for zinc for adults is A. 11 grams for men and 8 grams for women. B. 15 grams for both men and women. C. 11 mg for men and 8 mg for women. D. 15 mg for both men and women. 33. Which group of foods would provide the most bioavailable zinc? A. refined breads and cereals B. oysters and other seafood C. spinach and leafy greens D. black-eyed peas and lentils 34. Which of the following is a symptom of zinc deficiency? A. megaloblastic anemia B. increased taste sensitivity C. poor wound healing D. cretinism 35. Zinc functions as a part of A. immune function. B. antioxidant defense. C. DNA and RNA synthesis. D. Zinc is involved in all of these functions. 36. The enzyme superoxide dismutase contains both copper and zinc. The function of this enzyme is A. to decrease serum cholesterol levels. B. to protect an individual from developing night blindness. C. to act as a scavenger of free radicals, thus protecting the lipid components of the cell. D. to prevent GI reflux and symptoms of heartburn. 37. The symptoms of copper deficiency in humans include all of the following EXCEPT A. anemia. B. thyroid disorders. C. decreased white blood cell counts. D. bone loss (osteopenia). 38. Individuals with Wilson's disease overaccumulate ________ in the liver and brain. A. iodine B. selenium C. copper D. manganese 39. The mineral that partly "spares" the antioxidant vitamin E is A. copper. B. selenium. C. chromium. D. iodide. 40. The amount of selenium in foods A. is consistently high in plant-based foods. B. will depend on the total amount of other minerals in the food. C. depends on the type of water used to irrigate crops. D. depends on the amount of selenium in the soil where crops are grown. 41. The richest sources of copper are A. oranges and melons. B. refined grains and pastries. C. nuts and dark chocolate. D. dark leafy greens. 42. A deficiency of dietary iodine is characterized by A. osteoporosis. B. goiter. C. dental caries. D. decreased glucose tolerance. 43. Cretinism may form as a consequence of a severe deficiency of A. chromium. B. selenium. C. copper. D. iodine. 44. In a situation where there is an insufficient intake of dietary iodide, the thyroid-stimulating hormone promotes the enlargement of the thyroid gland. This condition is called A. Graves' disease. B. goiter. C. hyperparathyroidism. D. Wilson's disease. 45. Iodide in the blood is trapped by the A. pancreas and incorporated into insulin. B. adrenal glands and incorporated into aldosterone. C. pituitary gland and incorporated into calcitonin. D. thyroid gland and incorporated into thyroxine. 46. The most dependable and abundant source of iodide in the American diet is A. saltwater fish. B. dark leafy greens. C. enriched cereal grains. D. fortified salt. 47. Goitrogenic foods that can inhibit iodide metabolism include A. cabbage, broccoli, and cauliflower. B. yogurt, buttermilk, and cheese. C. oranges and grapefruit. D. beef, poultry, and fish. 48. Excessive fluoride exposure during tooth development can cause A. glucose intolerance. B. mottling of the teeth. C. dermatitis. D. bleeding of the gums. 49. The fluoridation of public drinking water is A. responsible for a 40% to 60% reduction in dental caries in children. B. an effective means of providing dietary selenium. C. not as effective as fluoridated toothpaste. D. mandatory in all states in the U.S. 50. The role of hydroxyfluorapatite is to A. enhance insulin sensitivity and prevent diabetes. B. prevent dental caries. C. improve the rate of growth in children. D. prevent the development of anemia. 51. Fluoride is typically provided by sources such as A. toothpaste. B. fluoride treatments by the dentist. C. drinking water. D. All of these choices are accurate. 52. In humans, impaired glucose tolerance and weight loss have been associated with a dietary deficiency of A. selenium. B. manganese. C. molybdenum. D. chromium. 53. Which of the following is NOT classified as an ultratrace mineral? A. arsenic B. boron C. selenium D. vanadium 54. Which of the following is associated with selenium deficiency? A. Wilson's disease B. Keshan disease C. Grave's disease D. Lou Gehrig's disease 55. Which of the following enzymes contains selenium? A. glutathione peroxidase B. superoxide dismutase C. lysyl oxidase D. pancrease 56. Which of the following has been associated with a decreased risk of cancer? A. low intakes of calcium B. high intakes of nitrates C. adequate intake of vitamin D D. low intakes of lycopene 57. Which of the following is the leading type of cancer in males and females? A. brain B. liver C. lung D. colon 58. Which may increase cancer risk? A. viruses B. radiation C. dietary fat D. All of these factors may increase cancer risk. True / False Questions 59. Dietary heme iron is obtained mainly from plant-based foods. FALSE 60. Ferritin is a key iron-binding protein in the intestinal mucosa that prevents it from entering the bloodstream. TRUE 61. In the U.S., accidental iron overdose is the leading cause of poisoning in young children less than 6 years of age. TRUE 62. High intakes of polyphenols, meat protein factor, and manganese aid in the absorption of non-heme iron. FALSE 63. Copper plays a role in connective tissue formation as a component of lysyl oxidase. TRUE 64. In the United States, salt can be purchased either with or without added iodine. TRUE 65. Copper absorption is the primary means of regulating copper balance. TRUE 66. Manganese plays a role in antioxidant defense as a part of the superoxide dismutase enzyme system. TRUE 67. Whole grains, nuts, legumes, and tea are the best sources of manganese. TRUE 68. Approximately 90% of dietary manganese is absorbed and then transported by transferrin to the liver. FALSE 69. Adequate selenium intake may lower risk of prostate, lung, and other cancers. TRUE 70. Cancers can metastasize to distant parts of the body via the blood or lymph to form invasive tumors. TRUE 71. Molybdenum functions as a cofactor for several enzymes in human metabolism. TRUE 72. The ultratrace mineral boron does not yet have an established UL. FALSE 73. All community water systems in the United States are currently fluoridated. FALSE 74. Zinc supplementation is a scientifically proven means of preventing the common cold. FALSE 75. Marginal deficiencies of zinc and copper may be of concern in some population groups in the U.S. even if they do not result in physical symptoms. TRUE 76. Zinc is transported in the blood to tissues by the proteins albumin and alpha-2 macroglobulin. TRUE 77. Iodine deficiency and iron deficiency are the most common mineral deficiencies worldwide. TRUE 78. Manganese deficiency and toxicity rarely have been reported in humans. TRUE Essay Questions 79. List 2 characteristics of trace minerals. Answer: Trace minerals are essential nutrients required by the body in very small amounts but are crucial for various physiological functions. Here are two characteristics of trace minerals: 1. Required in Small Amounts: Trace minerals are needed by the body in minute quantities, typically measured in milligrams (mg) or micrograms (mcg) per day. 2. Vital for Metabolic Processes: Despite their small quantities, trace minerals play essential roles as cofactors for enzymes involved in metabolism, growth, development, and other physiological processes. 80. How does vitamin C increase the absorption of iron? Answer: Vitamin C, also known as ascorbic acid, enhances the absorption of non-heme iron (the form of iron found in plant-based foods) in the intestines. Here’s how it works: • Reduction of Ferric Iron (Fe³⁺) to Ferrous Iron (Fe²⁺): Vitamin C acts as a reducing agent, converting the oxidized form of iron (Fe³⁺) found in plant-based foods into the more easily absorbed ferrous form (Fe²⁺). • Chelation: Once converted to ferrous iron, vitamin C also forms a soluble complex with iron, known as a chelate. This complex is more stable and less likely to bind with other compounds in the intestines, thereby improving its absorption. • Enhanced Transport: Vitamin C also facilitates the transport of iron across the intestinal mucosa into the bloodstream, ensuring that more iron is absorbed and utilized by the body. By consuming foods rich in vitamin C along with iron-rich plant-based foods (such as spinach or beans), individuals can enhance their body’s absorption of iron, particularly important for those following vegetarian or vegan diets. 81. List 2 food sources for zinc. Answer: Zinc is an essential trace mineral that plays a vital role in numerous physiological processes, including immune function, wound healing, and protein synthesis. Here are two food sources rich in zinc: 1. Oysters: Oysters are one of the best food sources of zinc. They provide high bioavailability of zinc, meaning the body can easily absorb and utilize the zinc from oysters. 2. Beef: Red meat, such as beef, is also a good source of zinc. Other meats like pork and lamb also contain zinc, though typically in slightly lower amounts compared to beef. In summary, including zinc-rich foods like oysters and beef in the diet helps ensure adequate intake of this essential mineral, supporting overall health and immune function. 82. Describe 2 functions of iron. Answer: Iron is an essential mineral that serves several important functions in the body. Here are two key functions of iron: 1. Oxygen Transport: Iron is a crucial component of hemoglobin, the protein in red blood cells that binds to oxygen in the lungs and carries it to tissues throughout the body. This process is essential for cellular respiration and energy production. 2. Energy Metabolism: Iron is also a component of myoglobin, a protein found in muscle cells that stores oxygen for muscle use during physical activity. Iron is necessary for the proper functioning of enzymes involved in energy metabolism, including the citric acid cycle (Krebs cycle) and electron transport chain. 83. List 2 food sources for manganese. Answer: Manganese is a trace mineral that plays a role in various physiological processes, including metabolism, bone formation, and antioxidant defense. Here are two food sources rich in manganese: 1. Whole Grains: Whole grains such as brown rice, oats, and whole wheat are good sources of manganese. They provide not only manganese but also fiber and other essential nutrients. 2. Nuts and Seeds: Nuts (e.g., almonds, pecans) and seeds (e.g., pumpkin seeds, flaxseeds) are rich in manganese. They are also sources of healthy fats, protein, and dietary fiber. 84. List 3 population groups at risk for iron deficiency. Answer: Iron deficiency is a common nutritional deficiency worldwide and can lead to anemia if not addressed. Several population groups are particularly at risk for iron deficiency: 1. Pregnant Women: Pregnancy increases the body's demand for iron to support fetal growth and development, as well as to compensate for blood volume expansion. 2. Infants and Young Children: Rapid growth during infancy and early childhood requires sufficient iron intake. Breastfed infants may require iron supplementation after about 4-6 months of age, as breast milk alone may not provide adequate iron. 3. Adolescent Girls and Women of Childbearing Age: Menstruation leads to monthly blood loss, which can deplete iron stores if dietary intake is inadequate. Adolescent girls and women who have heavy menstrual bleeding are at higher risk. In summary, understanding the functions of iron, dietary sources of manganese, and population groups at risk for iron deficiency provides insights into the importance of balanced nutrition and targeted interventions to prevent nutrient deficiencies and promote overall health. 85. Describe the symptoms of iodine deficiency. Answer: Iodine deficiency occurs when there is insufficient iodine intake, which is essential for the production of thyroid hormones. Symptoms of iodine deficiency can vary depending on the severity and duration of the deficiency. Here are common symptoms: 1. Goiter: An enlarged thyroid gland, visible as a swelling in the neck, is one of the most visible signs of iodine deficiency. This occurs as the thyroid gland enlarges in an attempt to produce more thyroid hormones. 2. Hypothyroidism: Insufficient iodine can lead to decreased production of thyroid hormones (triiodothyronine or T3 and thyroxine or T4). This can cause symptoms such as fatigue, weight gain, cold intolerance, dry skin, and hair loss. 3. Pregnancy Complications: Iodine deficiency during pregnancy can result in miscarriage, stillbirth, preterm birth, and intellectual disabilities in the baby (congenital hypothyroidism). 4. Mental and Developmental Issues: Severe iodine deficiency, especially during infancy and childhood, can lead to impaired cognitive function, reduced IQ, and developmental delays. 5. Other Symptoms: Dry skin, brittle hair, constipation, and increased susceptibility to infections may also be observed in individuals with iodine deficiency. In areas where iodine deficiency is common, such as certain regions with low dietary iodine intake or lack of iodized salt, these symptoms can be more prevalent. Adequate iodine intake, typically through iodized salt or dietary sources like seafood and dairy products, is essential for preventing iodine deficiency disorders. 86. What trace mineral toxicity causes tooth mottling? Answer: Fluoride toxicity can cause tooth mottling, which is also known as dental fluorosis. Fluorosis occurs due to excessive ingestion of fluoride during tooth development, typically from sources like drinking water with high fluoride levels or excessive fluoride supplements. The excessive fluoride interferes with enamel formation, leading to white spots, streaks, or brown stains on the teeth. 87. List 3 factors that can increase iron absorption. Answer: Iron absorption is influenced by various factors that enhance or inhibit its uptake in the intestines. Here are three factors that can increase iron absorption: 1. Vitamin C: Ascorbic acid (vitamin C) enhances the absorption of non-heme iron (the form of iron found in plant-based foods) by converting ferric iron (Fe³⁺) to ferrous iron (Fe²⁺), which is more easily absorbed. 2. Meat, Fish, and Poultry: Animal-based sources of iron (heme iron) are more readily absorbed compared to plant-based sources (non-heme iron). The presence of meat, fish, or poultry in a meal can increase overall iron absorption. 3. Acidic Environment: A mildly acidic environment in the stomach promotes iron absorption. Gastric acid helps convert dietary iron into a soluble form that can be absorbed in the small intestine. Factors that inhibit iron absorption include phytates (found in whole grains and legumes), tannins (found in tea and coffee), calcium, and certain medications. Enhancing iron absorption is important for individuals at risk of iron deficiency, such as pregnant women and those with low iron stores. 88. Explain why a deficiency of selenium can impair iodine metabolism. Answer: Selenium is an essential trace mineral that plays a critical role in thyroid hormone metabolism. Here’s how selenium deficiency can impair iodine metabolism: • Thyroid Function: Selenium is required for the enzymatic conversion of the inactive form of thyroid hormone (T4) to the active form (T3) in the thyroid gland and other tissues. Without sufficient selenium, this conversion process is impaired, leading to decreased levels of active thyroid hormones. • Iodine Utilization: Selenium is also involved in the metabolism and utilization of iodine within the thyroid gland. It helps maintain the balance of thyroid hormones by regulating the activity of enzymes involved in iodine metabolism. • Thyroid Autoimmunity: Selenium has antioxidant properties that help protect the thyroid gland from oxidative damage and inflammation. Selenium deficiency may contribute to autoimmune thyroid disorders, such as Hashimoto's thyroiditis and Graves' disease, which can affect iodine metabolism and thyroid hormone production. In regions where both selenium and iodine deficiencies are prevalent, there is an increased risk of iodine deficiency disorders due to impaired thyroid hormone synthesis and function. Ensuring adequate intake of both selenium and iodine through a balanced diet or supplementation is crucial for maintaining optimal thyroid health and metabolic function. 89. Why are children at risk of iron toxicity? Answer: Children are at risk of iron toxicity, also known as iron poisoning or iron overdose, due to several factors: 1. Accidental Ingestion: Children may accidentally ingest iron supplements or multivitamins containing iron, mistaking them for candy or treats due to their colorful appearance and sweet flavor. 2. Higher Absorption Rate: Young children have a higher rate of iron absorption compared to adults. Even small amounts of iron supplements or fortified foods can lead to significant increases in blood iron levels in children. 3. Limited Capacity to Metabolize Excess Iron: Children's bodies have limited capacity to metabolize and excrete excess iron compared to adults. Excess iron can accumulate in tissues, leading to toxicity and potentially severe health complications. 4. Symptoms of Iron Toxicity: Symptoms of iron toxicity in children can include nausea, vomiting, abdominal pain, diarrhea, lethargy, and in severe cases, organ failure and death. To prevent iron toxicity in children, it is important to store iron supplements and vitamins containing iron out of reach and sight, use child-resistant packaging, and follow dosing instructions carefully under the guidance of healthcare providers. 90. List 2 transport proteins for iron. Answer: Iron in the body is transported and stored with the help of specialized proteins. Here are two transport proteins for iron: 1. Transferrin: Transferrin is a glycoprotein that binds to iron in the bloodstream and transports it throughout the body. It carries iron from absorption sites in the intestines (where iron is taken up from food) to cells that require iron for various metabolic processes. 2. Ferritin: Ferritin is an intracellular protein complex that serves as the primary storage form of iron in cells, particularly in the liver, spleen, and bone marrow. It stores excess iron in a non-toxic, soluble form until it is needed for cellular functions or until it can be safely excreted. These transport proteins play crucial roles in maintaining iron homeostasis, ensuring that iron is distributed and stored appropriately in the body to meet physiological needs. 91. Should fluoridation of water be mandatory for all municipal water supplies? Answer: The question of whether fluoridation of water should be mandatory for all municipal water supplies is a topic of ongoing debate and consideration. Here are some points to consider for an essay on this topic: Arguments in Favor of Mandatory Fluoridation: 1. Dental Health Benefits: Fluoridation of water has been shown to significantly reduce the incidence of dental caries (cavities) and improve oral health, particularly among children and socioeconomically disadvantaged populations who may not have access to regular dental care. 2. Cost-Effectiveness: Fluoridation is considered a cost-effective public health measure, potentially saving healthcare costs associated with treating dental diseases and improving overall community health outcomes. 3. Community-wide Impact: Fluoridation benefits everyone who consumes the public water supply, regardless of socioeconomic status or access to dental care. It helps address disparities in oral health outcomes. Arguments Against Mandatory Fluoridation: 1. Ethical Concerns: Some individuals and groups argue that mandatory fluoridation infringes on personal choice and medical ethics, as it involves mass medication without individual consent. 2. Potential Health Risks: While fluoridation at optimal levels (0.7-1.2 parts per million) is considered safe and effective, there is concern about potential adverse effects of long-term exposure to high levels of fluoride, such as dental fluorosis and skeletal fluorosis. 3. Alternative Sources of Fluoride: In areas with access to fluoridated dental products (e.g., toothpaste, mouthwash) and preventive dental care, the necessity of water fluoridation as a universal measure is debated. Conclusion: The decision to mandate fluoridation of water supplies involves balancing public health benefits, ethical considerations, and potential risks. Local governments and health authorities often weigh scientific evidence, community preferences, and public health priorities when making decisions about water fluoridation policies. Ensuring access to dental care, promoting oral health education, and considering alternative strategies for improving dental health are also important aspects of the debate. 92. What population areas are at increased risk of iodine deficiency? Answer: Certain population areas are at increased risk of iodine deficiency due to factors such as dietary habits, geographical location, and iodine availability. These include: 1. Regions with Low Dietary Iodine: Areas where dietary intake of iodine-rich foods, such as seafood and iodized salt, is limited or insufficient. 2. Inland and Mountainous Regions: Inland and mountainous regions may have iodine-deficient soils, affecting the iodine content of crops grown in these areas. 3. Landlocked Countries: Countries that are landlocked and have limited access to iodine-rich seafood may be at higher risk of iodine deficiency unless iodized salt or other sources of iodine are widely available. 4. Pregnant Women and Breastfeeding Mothers: Women who are pregnant or breastfeeding have higher iodine requirements to support fetal brain development and milk production, increasing their susceptibility to iodine deficiency if dietary intake is inadequate. 5. Infants and Young Children: Infants and young children are also at risk due to their rapid growth and development, which requires sufficient iodine for thyroid hormone synthesis. Efforts to address iodine deficiency include iodized salt programs, dietary diversification, and supplementation where necessary, particularly for vulnerable populations such as pregnant women and children. 93. Why is fluoride not always classified as an essential trace mineral? Answer: Fluoride is not always classified as an essential trace mineral due to the following reasons: 1. No Known Biological Function: Unlike essential trace minerals such as iron, zinc, and selenium, fluoride does not have a recognized essential biological function in human physiology. It is not required for enzymatic reactions, protein synthesis, or other vital processes in the body. 2. Beneficial in Small Amounts: While fluoride is beneficial for dental health at optimal levels (0.7-1.2 parts per million in drinking water), excessive fluoride intake can lead to dental fluorosis (mottling of teeth) and skeletal fluorosis, indicating a narrow margin between beneficial and harmful effects. 3. Wide Variability in Intake: Fluoride intake varies widely based on factors such as drinking water fluoridation, dietary sources, and use of fluoride-containing dental products. It is not universally essential in the same way as minerals required for fundamental physiological processes. For these reasons, fluoride is typically considered a beneficial trace element rather than an essential trace mineral necessary for human health and functioning. 94. What suggestions would you provide to a client to decrease cancer risk? Answer: To decrease cancer risk, here are evidence-based suggestions that can be provided to clients: 1. Maintain a Healthy Weight: Aim for a balanced diet and regular physical activity to achieve and maintain a healthy weight. Obesity is associated with increased risk of several types of cancer. 2. Eat a Balanced Diet: Emphasize a diet rich in fruits, vegetables, whole grains, and lean proteins. Limit red and processed meats, and reduce intake of sugary drinks and high-calorie foods. 3. Be Physically Active: Engage in regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week. 4. Avoid Tobacco: Avoid smoking and exposure to secondhand smoke. Smoking is a leading cause of lung cancer and contributes to other cancers as well. 5. Limit Alcohol: If you drink alcohol, limit consumption. Alcohol consumption is linked to an increased risk of several types of cancer, including breast, liver, and colorectal cancers. 6. Protect Against Sun Exposure: Use sunscreen, wear protective clothing, and avoid excessive sun exposure to reduce the risk of skin cancer. 7. Get Vaccinated: Vaccines such as the HPV vaccine can reduce the risk of certain cancers, including cervical cancer. 8. Screening and Early Detection: Follow recommended screening guidelines for cancers such as breast, colorectal, and cervical cancers. Early detection can improve treatment outcomes. These suggestions aim to promote overall health and reduce modifiable risk factors associated with cancer development. 95. What dietary suggestions would you provide to a vegan to prevent iron deficiency? Answer: Iron deficiency can be a concern for vegans who do not consume animal products, as plant-based iron (non-heme iron) is less readily absorbed compared to heme iron from animal sources. Here are dietary suggestions to prevent iron deficiency in vegans: 1. Include Iron-Rich Foods: Consume a variety of iron-rich plant foods such as lentils, beans, tofu, tempeh, chickpeas, quinoa, fortified cereals, and spinach. Pair these foods with sources of vitamin C (e.g., citrus fruits, bell peppers) to enhance iron absorption. 2. Cook in Cast Iron Cookware: Cooking foods in cast iron cookware can increase the iron content of meals, especially acidic foods like tomatoes or foods containing vitamin C. 3. Avoid Inhibitors of Iron Absorption: Limit intake of foods and beverages that can inhibit iron absorption, such as coffee, tea, and high-fiber foods consumed with iron-rich meals. 4. Consider Iron Supplements: If dietary intake alone is insufficient to meet iron needs, consider taking iron supplements under the guidance of a healthcare provider, particularly during periods of higher iron requirements (e.g., pregnancy, menstruation). 5. Monitor Iron Levels: Regularly monitor iron levels through blood tests, especially if following a vegan diet long-term or experiencing symptoms of iron deficiency (e.g., fatigue, weakness). By focusing on a well-planned vegan diet that includes adequate sources of iron and enhances iron absorption, individuals can meet their nutritional needs and reduce the risk of iron deficiency. 96. Should individuals with a family history of cancer take selenium supplements? Explain your answer. Answer: Whether individuals with a family history of cancer should take selenium supplements depends on several factors, including current selenium status, overall health, and specific cancer risks within the family. Here are considerations for making an informed decision: 1. Role of Selenium: Selenium is an essential trace element that functions as an antioxidant and is involved in immune function and thyroid hormone metabolism. Adequate selenium intake may support overall health and potentially reduce oxidative stress, which is implicated in cancer development. 2. Mixed Evidence on Cancer Prevention: Research on selenium supplementation and cancer prevention has shown mixed results. Some studies suggest potential benefits of selenium in reducing the risk of certain cancers, while others have not found significant effects. 3. Individualized Approach: The decision to take selenium supplements should be individualized and based on a thorough assessment of personal health history, current diet, and selenium intake from food sources. 4. Risks of High-Dose Supplementation: High doses of selenium supplements can be harmful and may increase the risk of adverse effects, including gastrointestinal disturbances, hair loss, and even toxicity. 5. Healthy Diet vs. Supplements: It's generally recommended to obtain nutrients, including selenium, through a balanced diet that includes selenium-rich foods like Brazil nuts, seafood, and whole grains. For individuals at higher risk or with specific health concerns, consulting with a healthcare provider or registered dietitian can help determine if selenium supplementation is appropriate and at what dosage. In conclusion, while selenium plays a role in overall health and may have potential benefits in reducing cancer risk, supplementation should be approached cautiously and tailored to individual needs and risks, especially for those with a family history of cancer. Regular health monitoring and guidance from healthcare professionals are essential to make informed decisions about supplementation. Multiple Choice Questions 97. The signs and symptoms of iron-deficiency anemia are reflective of this condition. A. Hyperthyroidism B. Anemia C. Hypothyroidism D. Osteomalacia Short Answer Questions 98. Design a general diet that would be cancer preventative. Answer: A cancer-preventative diet should include: 1. High in Fruits and Vegetables: Rich in antioxidants, vitamins, and minerals that help reduce oxidative stress and inflammation. 2. Whole Grains: Providing fiber and phytonutrients that support digestive health and overall immunity. 3. Lean Proteins: Including sources like fish, poultry, beans, and nuts for essential amino acids without excess saturated fats. 4. Healthy Fats: Incorporating sources like olive oil, avocados, and nuts, which contain beneficial monounsaturated and polyunsaturated fats. 5. Limiting Processed Foods and Sugars: Minimizing intake of processed meats, sugary drinks, and refined carbohydrates to reduce inflammation and maintain a healthy weight. 99. Why is obesity specifically linked to an increased risk of breast cancer but not all cancers? Answer: Obesity is specifically linked to an increased risk of breast cancer due to several factors: 1. Hormonal Imbalances: Excess fat tissue can lead to higher levels of estrogen, which can promote the growth of hormone-sensitive breast cancers. 2. Inflammation: Obesity is associated with chronic inflammation, which can contribute to cancer development and progression. 3. Insulin Resistance: Obesity often leads to insulin resistance and higher insulin levels, which may also promote cancer cell growth. 4. Adipose Tissue Effects: Adipose tissue (fat cells) can produce hormones and growth factors that influence cancer cell behavior, particularly in breast tissue. These factors may not be as prominently linked to other types of cancers, where different mechanisms and risk factors may play more significant roles in cancer development. Multiple Choice Questions 100. Which of the following nutrients have all been linked to a decreased risk in the development of cancer? A. Vitamin E, vitamin C, selenium, vitamin D B. Saturated fat, sodium, chloride, manganese C. Protein, cholesterol, vitamin A, folate D. Vitamin B-12, vitamin B-6, biotin, fluoride True / False Questions 101. Processed food is a good source of iodine because of the high amount of salt found in processed food. FALSE Multiple Choice Questions 102. A friend has been complaining of weight gain and fatigue. She has recently cut out all table salt in an effort to decrease her sodium intake. Which of the following minerals is your friend most likely to be deficient in that is causing her symptoms? A. Iron B. Iodine C. Zinc D. Sodium Chapter 16 Nutritional Aspects of Pregnancy and Breastfeeding Multiple Choice Questions 1. A characteristic of a favorable pregnancy outcome is ________. A. a gestation period longer than 37 weeks B. a live, healthy infant C. an infant who weighs at least 5.5 pounds D. All of these are characteristics of a successful pregnancy. 2. A low birth weight infant weighs ________. A. less than 7.5 pounds B. less than 7 pounds C. less than 6 pounds D. less than 5.5 pounds 3. The time to focus on nutrition and pregnancy is ________. A. during childbearing years B. immediately after conception C. during the first trimester D. during the second trimester 4. Infants born after 37 weeks' gestation and weighing less than 5½ pounds are labeled ________. A. usual birth weight B. premature C. typical D. small for gestational age 5. A small-for-gestational-age (SGA) infant ________. A. weighs less than 5.5 pounds B. is likely to have nutritional complications C. is likely to have medical complications D. All of these choices are correct. 6. During the first two weeks after conception, the developing offspring is known as ________. A. a zygote B. an embryo C. a fetus D. an ovum 7. After the eighth week of pregnancy, the developing offspring is known as ________. A. a zygote B. an embryo C. a fetus D. an ovum 8. On average, a full-term infant at birth ________. A. weighs 5 to 6 pounds and is about 18 inches long B. weighs 7 to 8 pounds and is about 20 inches long C. weighs 8 to 9 pounds and is about 26 inches long D. weighs 9 to 10 pounds and is about 22 inches long 9. About 1 in _____ pregnancies results in a spontaneous abortion, often before a woman even realizes she is pregnant. A. 2 B. 3 C. 4 D. 5 10. Maternal nutrient deficiencies or exposure to toxins can cause _____ in the fetus. A. toxic levels of nutrient stores B. high birth weight C. abnormal organ function D. longer than normal gestation period 11. Excessive calorie intake during pregnancy can result in a fetus that ________. A. has a high birth weight B. suffers from cretinism C. has decreased bone density D. has thyroid disorders 12. Serious fetal malformations may occur when pregnant women consume very large doses of vitamin ________. A. K B. C C. B-12 D. A 13. Neural tube defects may occur when women consume too little ____ before becoming pregnant. A. iron B. calcium C. folate D. zinc 14. The fetus receives nourishment through ________. A. the placenta B. amniotic fluid C. antibodies D. meconium 15. Which of the following is NOT true about the placenta? A. It provides nourishment to the zygote. B. It synthesizes fatty acids, cholesterol, and glycogen. C. It produces hormones that affect the mother and fetus. D. It grows throughout pregnancy. 16. The fetus accumulates most of its body fat and mineral stores ________. A. during the first trimester B. during the second trimester C. during the third trimester D. at any time during development 17. During the second trimester, a pregnant woman needs an additional _______ kcal per day. A. 100 B. 350 C. 450 D. 500 18. For pregnant woman, the RDA for protein increases by ___ over prepregnancy needs. A. 10% B. 15% C. 20% D. 50% 19. Severe zinc deficiencies during pregnancy can cause ________. A. premature birth B. fetal growth retardation C. birth defects D. All of these are effects of zinc deficiencies during pregnancy. 20. An increased requirement for _________ during pregnancy is partly due to its role in the synthesis of red blood cells. A. vitamin E B. vitamin K C. folate D. calcium 21. Maternal iron deficiency anemia can cause ________. A. premature birth B. infant death C. labor complications D. All of these are effects of iron deficiency. 22. Physiological anemia that occurs during pregnancy ________. A. is the same as iron deficiency anemia B. is caused by insufficient intake of vitamin B-12 C. occurs because the plasma expands more than the number of red blood cells D. signals grave danger for the mother 23. The practice of eating non-food substances, such as clay or laundry starch, during pregnancy is called ________. A. hyperemesis B. pica C. pregnancy-induced hunger D. diuresis 24. During pregnancy, women should try to ________ each day. A. drink 3 cups of milk or milk products B. eat 4 cups of fruits C. minimize intake of strong tasting vegetables to 1 serving D. restrict their protein intake 25. Under what condition(s) is/are the use of nutrient supplements advisable? A. Adolescent pregnancy B. Multiple fetuses C. Poverty D. Inadequate maternal diet E. All of these choices are accurate. 26. A pregnant woman who is a vegan needs to take ______ nutrient supplements. A. vitamin E and riboflavin B. calcium and iron C. protein and vitamin A D. thiamin and vitamin C 27. The RDA for iron during pregnancy increases greatly. To reach this level the pregnant woman may ________. A. need to take a low-dose iron supplement B. need to double or triple the number of multivitamin-mineral tablets taken every day C. need to do all her cooking in iron cookware D. need to increase her intake of iron-rich fruits and vegetables 28. Which condition increases the risk of a poor pregnancy outcome? A. young maternal age B. fasting during pregnancy C. food contaminants D. eating disorders E. All of these responses are correct. 29. An infant's birth weight is closely related to ________. A. the gestation length B. the mother's prepregnancy weight C. the weight the mother gains during pregnancy D. All of these choices are correct. 30. Obese pregnant women have an increased risk for ________. A. low blood pressure B. gestational diabetes C. ketosis D. inadequate placenta development 31. Women who begin pregnancy underweight have an increased risk for ________. A. low blood pressure B. gestational diabetes C. ketosis D. poor nutrient stores 32. Adolescents often have smaller babies than mature women. They are advised to gain more weight during pregnancy to ________. A. provide calories needed for the infant to be larger than normal at birth B. avoid ketosis C. meet the mother's growth needs D. All of these choices are accurate. 33. For the best pregnancy outcome, overweight women (BMI > 26 to 29) should ________. A. not gain any weight during pregnancy B. gain slightly more weight than women who begin pregnancy at a healthy weight C. gain about 15 to 25 pounds during pregnancy D. lose at least 4 or 5 pounds during pregnancy 34. Which component of weight gain accounts for the greatest amount of increased weight during pregnancy? A. Infant B. Placenta C. Amniotic fluid D. Breast tissue E. Maternal blood supply 35. Women who begin pregnancy at a normal BMI should gain about ____ pounds during pregnancy. A. 15 B. 15 to 25 C. 25 to 35 D. 28 to 40 36. Women who begin pregnancy at a low BMI should gain about ___ pounds during pregnancy. A. 15 B. 15 to 25 C. 25 to 35 D. 28 to 40 37. Which of these conditions indicates that a woman needs to pay particular attention to the quality of her diet during pregnancy? A. eating disorders B. phenylketonuria C. diabetes D. All of these choices are correct. 38. Which of the following factors may deplete a woman's nutrient stores? A. numerous previous pregnancies B. preterm births C. pregnancies after age 35 D. pregnancies more than 3 years apart 39. Pregnancy-induced hypertension ________. A. is a normal and expected condition seen during pregnancy B. occurs because of the increase in maternal plasma that occurs during pregnancy C. can develop into a deadly condition called eclampsia D. is also called hemodilution E. None of these choices are correct. 40. A characteristic of preeclampsia is ________. A. blurred vision B. low blood pressure C. headaches D. strong feelings of thirst E. blurred vision and headaches 41. Gestational diabetes ________. A. is a normal and expected condition seen during pregnancy B. occurs because of the increase in maternal body weight that occurs during pregnancy C. can develop into a deadly condition called eclampsia D. is most common in women with a family history of diabetes E. All of these choices are correct. 42. To keep gestational diabetes under control, recommendations for pregnant women include ________. A. exercise B. eating high glycemic load carbohydrates through the day C. taking chromium supplements D. All of these choices are correct. 43. A maternal practice that can be harmful to the fetus is ________. A. a low-carbohydrate diet B. fasting C. smoking D. All of these choices are accurate. 44. WIC serves low-income ________. A. children up to the age of 5 B. newborns and infants C. pregnant mothers D. All of these choices are accurate. 45. WIC aims to provide ________. A. nutrition education B. nutritional care C. nutritious food D. All of these choices are accurate. 46. Participation in WIC is associated with ________. A. fewer infant deaths B. lower birth weights C. higher medical costs after birth D. All of these choices are accurate. 47. The bacterium Listeria monocytogenes can be fatal to the developing fetus. What foods are possible sources of this bacterium and should be avoided by pregnant women? A. Pasteurized milk B. Yogurt C. Brie and blue-veined cheeses D. All of these choices are accurate. 48. Heavy caffeine intake during pregnancy may ________. A. decrease iron absorption B. increase risk for spontaneous abortion C. increase risk for low birth weight D. All of these choices are accurate. 49. Exposure to alcohol during fetal life may cause ________. A. inadequate prenatal and infant growth B. physical deformities C. mental retardation D. All of these choices are correct. 50. Decreased learning capacity in childhood has been linked to exposure to ____ during fetal life. A. excessive calcium B. alcohol C. inadequate vitamin C D. inadequate vitamin D 51. To avoid constipation, pregnant women should increase intake of ________. A. milk and dairy products B. whole-grain bread, bran, and fruits C. sugars and starches D. lean meat, poultry, and fish 52. Edema during late pregnancy is a problem if ________. A. hypertension is detected B. excess protein is found in the urine C. extreme fluid retention occurs D. All of these choices are correct. E. None of these choices are correct. 53. To reduce heartburn symptoms, pregnant women should ________. A. exercise right after meals B. eat larger meals in the morning C. limit caffeine and chocolate intake D. All of these choices are correct. 54. To minimize nausea during pregnancy, pregnant women should ________. A. wear strong perfume B. drink a large glass of cool water before getting out of bed in the morning C. breathe warm, moist air D. None of these responses are accurate. 55. The ability to produce milk is affected by the hormone ________. A. prolactin B. estrogen C. progesterone D. insulin E. thyroxine 56. The let-down reflex in breastfeeding is controlled by ________. A. oxytocin B. prolactin C. estrogen D. progesterone E. secretin 57. The let-down reflex is inhibited by ________. A. feeling confident and relaxed B. nervous tension C. a sleepy baby D. All of these responses are correct. 58. The first fluid secreted by the mother's breast after giving birth is called ________. A. colostrum B. prolactin C. lactalbumin D. mature milk 59. A factor in human milk that helps prevent the growth of some harmful bacteria in an infant's intestinal tract is ________. A. lactase B. albumin C. let-down reflex D. Lactobacillus bifidus factor 60. Compared to pregnancy, the RDA for nutrients changes during lactation ________. A. only for energy B. only for protein and energy C. for many nutrients, but not proportionately D. None of these responses are correct; nutrient needs during lactation are the same as during pregnancy. 61. Additional dietary energy requirements for lactation are approximately _______ kcal per day. A. 100 - 200 B. 250 - 350 C. 400 - 500 D. 550 - 650 62. To produce human milk, a lactating woman needs ________. A. 100 - 200 extra kcal per day above prepregnancy needs B. twice as much dietary protein as needed during pregnancy C. an extra 32 ounces of fluid daily D. twice as much dietary iron as needed during pregnancy E. All of these choices are accurate. 63. A benefit of breastfeeding for mothers is ________. A. reduced risk for ovarian cancer B. less postpartum bleeding C. weight loss D. All of these responses are correct. 64. Women are more likely to choose to breastfeed their infants if they ________. A. know the advantages of breastfeeding B. have a supportive partner C. deliver babies in a hospital that supports breastfeeding D. All of these choices are correct. 65. Consuming alcohol while breastfeeding ________. A. is recommended to help mothers relax B. increases milk output C. causes babies to have disrupted sleep patterns D. causes babies to drink more milk True / False Questions 66. Preterm infants are born before 39 weeks of gestation. FALSE 67. Poor maternal nutrient intakes are linked with low birth weights. TRUE 68. A developing offspring's cells have separated into a stack of 3 layers (mesoderm, endoderm, and ectoderm) when the zygote stage ends. TRUE 69. Most critical periods occur during the second trimester of pregnancy. FALSE 70. The placenta's size and ability to support fetal growth depend on the mother's nutritional status. TRUE 71. Low birth weight infants have a greater risk for chronic disease in adult life. TRUE 72. Insufficient intake of protein during pregnancy is very common in the U.S. FALSE 73. Proportionally, a pregnant woman's calorie needs increase much more than her nutrient needs. FALSE 74. Megadoses of prenatal vitamin and mineral supplements are dangerous for the mother, but not the fetus. FALSE 75. Exercise can help control gestational diabetes. TRUE 76. Pregnant women who have gained too little weight in the first and second trimesters should try to make up for it in the last trimester. FALSE 77. Insufficient weight gain in the last trimester of pregnancy increases the risk for fetal growth retardation. TRUE 78. Insufficient prenatal care increases the risk of delivering a low birth weight baby. TRUE 79. Eclampsia can cause maternal and fetal death. TRUE 80. Hormones synthesized by the placenta decrease the efficiency of insulin. TRUE 81. Uncontrolled gestational diabetes can cause the fetus to experience severe growth retardation. FALSE 82. Herbal products offer a safe way to treat disease in pregnant women. FALSE 83. Smokers secrete nicotine in their breast milk. TRUE 84. Breast size is an indicator of successful breastfeeding. FALSE Multiple Choice Questions 85. Which of the following would you recommend to a friend that is having difficulties breastfeeding her baby? A. Drink alcohol. This will have a relaxing effect. B. Find a relaxing environment to breastfeed your baby. C. Consume more milk. The excess milk will be converted into breastmilk. D. Decrease calorie intake. This will help with the production of more milk. 86. Your sister is pregnant and is very uncomfortable. She is experiencing heartburn daily and is looking for some relief. In your nutrition class, you just learned about heartburn during pregnancy. What advice can you offer her? A. Eat smaller meals more frequently to decrease the volume of food in the stomach. B. Do not lie down after eating to avoid the effects of gravity. C. Talk to her doctor about using antacids for relief. D. All of these choices could give her some relief. 87. Your friend just told you she is pregnant. She is concerned about the amount of weight she will gain during her pregnancy and is looking for some advice so that she and her baby can be healthy. Her pre-pregnancy weight was 155 pounds and she is 5'5" tall. Based on her pre-pregnancy weight, how much weight should your friend gain during her pregnancy? A. 11 to 20 lbs B. 15 to 25 lbs C. 25 to 35 lbs D. 28 to 40 lbs 88. Which of the following exercises would be most appropriate to continue to perform during a healthy pregnancy? A. Kickboxing B. Zumba C. Swimming D. Jogging Short Answer Questions 89. Design an appropriate exercise program for a healthy, pregnant female. Explain the benefits of this program and why this program is associated with the least possible risks. Answer: Exercise Program for a Healthy, Pregnant Female: A suitable exercise program for a healthy, pregnant woman should focus on low-impact activities that promote cardiovascular fitness, muscular strength, flexibility, and overall well-being. Here's an example program: 1. Cardiovascular Exercise: 20-30 minutes of moderate-intensity exercise such as walking, swimming, or stationary cycling most days of the week. 2. Strength Training: Light resistance exercises using body weight or resistance bands to maintain muscle tone and strength, focusing on major muscle groups. 3. Flexibility and Stretching: Gentle stretching exercises to improve flexibility and reduce muscle tension, particularly in the lower back and hips. 4. Pelvic Floor Exercises: Kegel exercises to strengthen the pelvic floor muscles, which can help prevent urinary incontinence and support during childbirth. Benefits of Exercise During Pregnancy: • Improved Cardiovascular Health: Enhances circulation and stamina, which can help manage weight gain and reduce pregnancy-related discomforts. • Mood Enhancement: Releases endorphins that promote feelings of well-being and reduce stress and anxiety. • Muscle Tone and Strength: Helps maintain posture, balance, and strength to support the changing body during pregnancy and prepare for labor. Minimizing Risks: • Low-Impact Activities: Emphasizes exercises that are gentle on the joints and minimize the risk of falls or injury. • Avoiding Overexertion: Monitoring intensity levels to ensure the exercise remains moderate and comfortable. • Consultation with Healthcare Provider: Customizing the exercise plan based on individual health status and any pregnancy-related concerns or conditions. 90. Explain why breastfeeding is beneficial to the mother. Answer: Breastfeeding offers several benefits to the mother: • Promotes Bonding: Enhances the emotional bond between mother and baby through skin-to-skin contact and the release of oxytocin, known as the "love hormone." • Facilitates Postpartum Recovery: Helps the uterus return to its pre-pregnancy size more quickly through the release of oxytocin, which stimulates contractions. • Reduces Risk of Postpartum Depression: Linked to lower rates of postpartum depression due to the release of hormones that promote relaxation and well-being. • Lowers Risk of Breast and Ovarian Cancer: Long-term breastfeeding has been associated with a reduced risk of these cancers, possibly due to hormonal changes and reduced exposure to estrogen. • Convenient and Economical: Provides nutrition on demand without the need for preparation, bottles, or formula, potentially saving time and money. These benefits underscore the importance of breastfeeding as a natural and beneficial practice for both mother and baby's health and well-being. Test Bank for Wardlaw's Perspectives in Nutrition Carol Byrd-Bredbenner, Gaile Moe, Jacqueline Berning, Danita Kelley 9780078021411, 9781259933844, 9780073522722
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