Dental Hygienists Guide to Nutritional Care 4th Edition By Cynthia A. Stegeman A+

Description

Chapter 06: Lipids: The Condensed Energy

Test Bank

MULTIPLE CHOICE

1. Three fatty acids attached to a glycerol is a triglyceride. Each of the fatty acids attached to a particular triglyceride is the same.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: C

Each of the fatty acids attached to a triglyceride can be different. They can be long, medium, or short, and saturated or unsaturated. Medium-chain and short-chain fatty acids are readily digested and absorbed, but most fats in foods contain more difficult to digest long-chain fatty acids.

REF: p. 103

1. Lipids provide more energy per gram than carbohydrate, because lipids contain more oxygen in proportion to hydrogen and carbon.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: C

Structurally, lipids contain less oxygen in proportion to hydrogen and carbon. Note that lipids provide more energy per gram than carbohydrates or protein do.

REF: p. 102

1. Saturated fatty acids (SFAs) contain only single bonds. Palmitic and stearic acids, both SFAs, are structural components of the periodontium.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: C

Palmitic and stearic acids, both SFAs, are structural components of tooth enamel and dentin. Note that saturated fatty acids are classified according to their degree of saturation, which depends on the number of hydrogen atoms attached to the carbon. SFAs also contain only single bonds, with each carbon having two attached hydrogen atoms.

REF: p. 103

1. Oleic acid is classified as a trans fatty acid because it is hydrogenated.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: D

Although it is true that trans fatty acids are hydrogenated, oleic acid is neither hydrogenated nor is it a trans fatty acid. Oleic acid is classified as a monounsaturated fatty acid because it contains only one double bond.

REF: p. 103 | p. 104

1. Excess dietary carbohydrates and protein are converted to fat. These substances are first converted into triglycerides and then stored in adipose tissue.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: D

Excess dietary carbohydrates and protein are not converted to triglyceride before being stored in adipose tissue. Triglycerides are the primary form of fat in the body.

REF: p. 103 | p. 106

1. Stearic acid is associated with heart disease because it has a detrimental effect on serum cholesterol.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: E

Stearic acid, found in beef and cocoa butter, does not have a detrimental effect on serum cholesterol.

REF: p. 113

1. The strongest dietary determinant of blood cholesterol is dietary saturated and trans fatty acid because they reduce concentration of lipids in the blood.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: C

Dietary saturated fats and trans fatty acid (known as trans fat) are the strongest dietary determinant of blood cholesterol. The reason is that they significantly increase the concentration of lipids in the blood, referred to as hyperlipidemia. Total dietary fat content also affects serum (blood) lipid levels, but it is the dietary saturated and trans fats that are most detrimental.

REF: p. 113

1. Patients should be counseled to substitute foods with trans fats for those with saturated fat, because saturated fat has a less detrimental effect on blood lipids.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: E

Substituting trans fats with saturated fat is not recommended. Both substances have undesirable effects on blood lipids.

REF: p. 108

1. Lecithin, a phospholipid used for energy, is present in all cells. Lecithin is present in thromboplastin, which is necessary for blood clotting.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: C

Cephalin, another phospholipid, is present in thromboplastin, which is necessary for blood clotting. Phospholipids include lecithin, cephalin, and sphingomyelin.

REF: p. 104

1. Fats with a high proportion of saturated fatty acids can deteriorate and become rancid, because they are converted to peroxides as they oxidize and decompose.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: D

Unsaturated fatty acids are much more likely than saturated fatty acids to become rancid as they decompose. Through oxidation of decomposition unsaturated fatty acids form peroxides that may be toxic in large amounts.

REF: p. 104

1. Each of the following is true of fatty acids except one. Which one is the exception?

a.	The carbon chain length is a determinant of flavor and hardness.
b.	The degree of saturation is a determinant of melting point.
c.	Melting point is the temperature at which a product becomes a gel.
d.	Most saturated fatty acids are solid at room temperature.

ANS: C

Melting point is the temperature at which a product becomes a liquid. The carbon chain length and degree of saturation determine various properties of fats, including their flavor and hardness or melting point. Note that most animal fats, being solid at room temperature, are predominately saturated fats.

REF: p. 104

1. Which fatty acid has the most hydrogen atoms?

a.	Saturated
b.	Monounsaturated
c.	Polyunsaturated

ANS: A

Saturation of a fatty acid depends on the number of hydrogen atoms attached to a carbon atom. A saturated fatty acid has two hydrogen atoms attached to each carbon. Monounsaturated and polyunsaturated contain fewer hydrogen atoms in this arrangement. Note that these differences are also due to variations in the type of bond between the carbon and hydrogen atoms.

REF: p. 103

1. Hydrogenation results in naturally unsaturated vegetable oils being changed to saturated fatty acids (SFAs). This process changes the proportion of the SFAs, but does not influence the shape of the fatty acid.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: C

Hydrogenation not only changes the proportion of the SFAs, it also alters the shape of the fatty acid. When hydrogen atoms are rotated so that they are on opposite sides of the bond, in the “trans” position, the fatty acid is called a trans fatty acid. Note that many foods such as margarines and cooking oils are partially hydrogenated.

REF: p. 103

1. Lipoproteins are compound lipids composed or each of the following except one. Which one is the exception?

a.	Linoleic acid
b.	Triglycerides
c.	Phospholipids
d.	Cholesterol

ANS: A

Linoleic acid is a polyunsaturated fatty acid. Lipoproteins are compound lipids composed of triglycerides, phospholipids, and cholesterol combined with protein.

REF: p. 104

1. Each of the following is true of phospholipids except one. Which one is the exception?

a.	They contain phosphorus and a nitrogenous base.
b.	They contain fatty acids and glycerol.
c.	They cannot be absorbed intact.
d.	They are a structural component of tooth enamel, dentin, and cell membranes.
e.	They are used for energy.

ANS: E

Phospholipids are not used for energy, even in a state of severe starvation. Although not completely understood, phospholipids are involved in the initiation of calcification and mineralization in teeth and bones. They are present in higher amounts in the enamel matrix of teeth than in dentin. Because phospholipids cannot be absorbed intact, they must be broken down into their chemical components before absorption.

REF: p. 104

1. Each of the following is true of the recommendations in the Dietary Guidelines except one. Which one is the exception?

a.	Consumption of SFAs and trans fats should be as low as possible.
b.	Less than 10% of kilocalories should come from saturated fats.
c.	Replace saturated fats with monounsaturated and polyunsaturated fats.
d.	Substitute saturated fats with high carbohydrate foods.

ANS: D

The Dietary Guidelines recommend restriction of SFAs, but studies do not support substituting saturated fats with high carbohydrate (starchy) foods. Rather, they recommend modifying the type of fat to protect better against heart disease.

REF: p. 108

1. Linoleic and arachidonic acids are omega-6 fatty acids because their first double bond occurs on the sixth carbon from the omega (terminal) end.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: A

This question accurately explains the meaning of the term omega-6 fatty acid. Likewise, the first double bond on omega-3 fatty acids occurs three carbon atoms from the omega end of the molecule. Note that both omega-3 and omega-6 fatty acids are polyunsaturated fatty acids.

REF: p. 105 | p. 106

1. Each of the following is a true of cholesterol except one. Which one is the exception?

a.	Cholesterol is a precursor of vitamin D.
b.	Lipoproteins transport cholesterol in the blood.
c.	It has a complex hexagonal structure.
d.	Cholesterol intake is not essential.
e.	Cholesterol is a sterol derivative.

ANS: C

Cholesterol has a complex ring structure. Because the body frequently produces more cholesterol than is absorbed, cholesterol intake is not essential. Note that cholesterol has important functions as a constituent of brain, nervous tissue, and bile salts.

REF: p. 105

1. Manufacturers must reserve descriptions such as “zero or no trans fat” to foods void of trans fat because USDA guidelines require this strict interpretation.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: E

Unfortunately for consumers, both the statement and the reason are incorrect. The U.S. Food and Drug Administration (USDA) allows manufacturers to label a food as “zero” trans fats if the product contains less than 0.5 g per serving. Canadian regulations set the labeling threshold at 0.2 g per serving. As some “servings” are small, trans fat consumption of such a “zero trans fat” food can be significant.

REF: p. 112

1. Interesterification blends highly saturated fats with oils to produce trans fatty acid alternatives. This process shows promise in reducing the detrimental effect of SFAs on blood lipids.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: C

Interesterification is a modification of the hydrogenation process that produces trans fats. Highly saturated fats are blended with oils to produce alternative fats with intermediate characteristics called intersified fats. Many of the trans fat alternatives, especially those made from tropical fats containing SFA, have undesirable effects on blood lipids. Although the consensus is that while the newer alternative fats are overall less damaging, some intersified fat margarines are more damaging than their conventional counterparts.

REF: p. 114

1. Researchers have associated all the following with cancer except one. Which one is the exception?

a.	Saturated fat
b.	Omega-3 fatty acids
c.	Kilocalories contributed by fat
d.	Increased body weight

ANS: B

Omega-3 fatty acids and other polyunsaturated fatty acids have not been associated with an increased risk of cancer. Also considered safe are monounsaturated fatty acids. Despite many uncertainties about the relationship between dietary fat and cancer risk, the consensus is to limit total fat intake, especially saturated fat.

REF: p. 114

1. Fats contribute to a feeling of fullness for a longer time than carbohydrates or protein because digestion of high-fat meals more efficiently deposits fat molecules in adipose tissue.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: C

Although it is true that fats contribute to fullness for a longer time that carbohydrates or proteins, the reason is that digestion of fat occurs more slowly. A pertinent point to convey to patients is that the higher the fat content of a meal, the longer the food remains in the stomach. Regardless of the time that fat lingers in the stomach, 95% of ingested fat is absorbed. Note that fat, which is not used for energy production, insulation, cushioning of vital organs, is stored in adipose tissue as fat.

REF: p. 105

1. Each of the following is true of characteristics of fats except one. Which one is the exception?

a.	Soft fats that are liquid at body temperature are digested more quickly than hard fats.
b.	Hard fats are digested more quickly than soft fats that are liquid at body temperature.
c.	Fats that contribute to palatability and flavor of foods.
d.	Cooked fats improve texture of foods.

ANS: B

Hard fats, such as meat, take longer to digest than soft fats, such as margarine. Margarine becomes liquid at body temperature, whereas meat does not. The improved palatability and texture that fats contribute to food make them difficult to eliminate from the diet. As a result of health concerns regarding dietary fats, numerous foods are being manufactured containing less fat. Those that replace fat with other substances are called fat replacers.

REF: p. 105

1. Which of the following has the most satiety value?

a.	Complex carbohydrates
b.	High-quality protein
c.	Low-quality protein
d.	Fat

ANS: D

Fats contribute to a feeling of fullness (satiety value) for a longer time than carbohydrates or protein. This validates descriptions of food containing fat that are described as “sticking to the ribs.” The higher the fat content of a meal, the longer the food remains in the stomach.

REF: p. 105

1. High-density lipoproteins are considered detrimental to cardiovascular health because they contain only trace amounts of protein and large amounts of lipid.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: E

High-density lipoproteins (HDLs) are thought to protect against development of heart disease, because they contain larger amounts of protein and less lipid than low-density lipoproteins (LDLs). An important concept is that lipoproteins are carriers that transport cholesterol to and from the cells. HDLs are known as the “good” cholesterol, whereas LDLs are known as the “bad” cholesterol. The ratio of lipid to protein content that determines density. In a lipoprotein, density increases as lipids decrease and protein increases.

REF: p. 114 | Dental Considerations

1. Patients should be counseled to select foods labeled as “low cholesterol.” Stick margarine, a cholesterol-free product, is a good selection because it is low in saturated fat and only partially hydrogenated.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: B

“Low cholesterol” on a food label can be misleading. A cholesterol-free product such as stick margarine can still be high in detrimental saturated fat and trans fatty acids. Partially hydrogenated foods are high in trans fatty acids, which should be avoided because saturated fats have been modified through processing to an unhealthy alternative. The dental hygienist should teach patients to read the Nutrition Facts Label for saturated and trans fats to avoid substituting one unhealthy fat for another.

REF: p. 113 | p. 114 | Nutritional Directions

1. To distinguish obesity from edema, the skin should be palpated and observed through light magnification. The skin of an obese patient will exhibit a flabby consistency in contrast to the spongy consistency found in edematous skin.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: D

It is not necessary to observe palpation of skin through light magnification. Note that edema is the presence of fluid in interstitial spaces, which means that fluid has leaked from blood vessels into the spaces between cells. This results in swelling that should be differentiated from fat. A patient with congestive heart failure often has edematous lower legs, and a simple sprained ankle will appear large because of edema.

REF: p. 114 | Dental Considerations

1. Which of the following food groups in MyPyramid always contains fat?

a.	Fruits
b.	Vegetables
c.	Milk
d.	Grains
e.	Meat

ANS: E

Although fat content varies, meat always contains fat. It is possible to consume skim milk, which is very low in fat, but it is not possible to consume meat without a far higher fat content.

REF: p. 115

1. The best way for a patient without cardiovascular disease to increase consumption of omega-3 fatty acids is to:

a.	increase intake of oils from seeds.
b.	consume a variety of fish at least twice a week.
c.	limit intake of polyunsaturated fats.
d.	take fish oil supplements.

ANS: B

The American Heart Association recommends that patients without cardiovascular disease eat a variety of fish, preferably oily, at least twice a week. Salmon, sardines, and shellfish are oily fish. Note that intake of foods with healthy unsaturated fats can be found in nuts, seeds and vegetable oils. Fish oil supplements provide benefits, but the best benefit comes from food.

REF: p. 107 | Dental Considerations

1. Which of the following fats is the most saturated?

a.	Soybean
b.	Canola
c.	Palm
d.	Oliver

ANS: C

Palm oil, a tropical oil, is high in unhealthy saturated fat. Other substances high in unhealthy saturated fat are butter, hard margarines, lard, shortening, and coconut oil. Conversely, vegetable oils such as canola, olive, and soybean oil contain more healthy omega-6 fatty acids. These products are referred to as n-6 polyunsaturated fatty acids.

REF: p. 108

1. The diet of a patient who consumes 120 g of fat from eating 3000 kcal/day is 36% fat. Each gram of saturated fat has 9 calories, while each gram of unsaturated fat has only 4 calories.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: C

Each gram of saturated fat, no matter which type, has 9 calories. Note that protein and carbohydrate each contain 4 calories per gram. To calculate the percentage of kilocalories from fat, multiply grams of fat by 9 kcal per gram of fat. Next, divide this result by the total number of calories consumed. In this case: Step 1) 120 g fat ´ 9 kcal from fat per gram of fat = 1080 kcal from fat. Step 2) 1080 kcal from fat ÷ 3000 calories consumed = 36% kcal consumed from fat.

REF: p. 108 | Box 6-1

1. The body synthesizes linoleic acid, an omega-6 fatty acids. Deficiency symptoms include growth retardation, skin lesions, and reproductive failure.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: D

Linoleic acid cannot be synthesized by the body and must be supplied from dietary sources. For this reason, linoleic acid is an essential fatty acid. Linoleic acid is an omega-6 fatty acid with 18 carbon atoms and two double bonds. The manifestations of deficiency stated in the question are correct.

REF: p. 105

1. Stated in milligrams per deciliter (mg/dL), each of the following optimal levels are correct except one. Which one is the exception?

a.	Total cholesterol should be less than 150.
b.	Low density lipoprotein (LDL) should be less than 100.
c.	High density lipoprotein (HDL) should be greater than 60.
d.	Triglyceride should be less than 150.

ANS: A

The National Cholesterol Education program (NCEP), a report issued by the National Institutes of Health, states that total cholesterol should be less than 200 mg/dL. The remaining selections are accurately stated as per the same report.

REF: p. 105

1. Which food has the most polyunsaturated fatty acids?

a.	One large whole egg
b.	3 oz of canned salmon
c.	3 oz of atlantic salmon
d.	3 oz of shrimp

ANS: D

Three ounces of shrimp has 5 g of PUFA, whereas the egg, the canned salmon, and the Atlantic salmon has 0.95, 1.52, and 2.8 g, respectively. Note that total fat is highest for the Atlantic salmon. Total cholesterol for the egg and shrimp are both 185 mg. Total cholesterol for the canned and Atlantic salmon are similar: 67 and 60 mg, respectively.

REF: p. 104

1. While counseling patients on limiting fat kilocalorie intake, good strategies for the dental hygienist to offer include all the following except one. Which one is the exception?

a.	Marinate leaner cuts of meat in lemon juice, flavored vinegars, or fruit juices.
b.	Small amounts of olive or canola oil in salads increases absorption of antioxidants.
c.	Avoid saturated fats such as butter, lard, and palm and coconut oil.
d.	Choose cream cheese as a spread for sandwiches.

ANS: D

Cream cheese is a poor choice for any food. Ninety percent of the kilocalories in cream cheese are from fat. At 9 kcal/g, the fat content on a sandwich will increase significantly. Instead of fat-laden spreads to add moisture to sandwiches, alternatives include mustard, salad greens, shredded carrots, tomato slices, and sweet peppers.

REF: p. 111 | Box 6-2

1. Dental hygienists should recommend that patients avoid beef graded “select,” because this grade contains a high level of fat and marbling.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: E

The grade of “select” is a good selection because it contains fewer kilocalories as a result of less fat and marbling. Although fat content of meats also depends on the type of cut, leaner cuts such as flank steak, sirloin, or tenderloin are good selections. Also recommended is marinating leaner cuts of meat in flavored vinegars and fruit juices. Lemon juice is particular effective at tenderizing meat.

REF: p. 111 | Box 6-2

1. Proactive health care providers are wise to encourage patients to lower total dietary fat consumption because replacing fats with carbohydrates decrease cardiovascular risk factors.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: E

One of the most important facts for decreasing risk of cardiovascular disease (CVD) is the types of foods chosen to lower saturated fat intake. Current research indicates that while total dietary fat might not be a risk factor for CVD, the types of fat eaten have a greater impact. Health care providers should be thorough when educating patients about the risks and benefits of various fats. Replacing damaging saturated and trans fats with polyunsaturated fatty acids can benefit lipid profiles, but replacing them with refined carbohydrate foods would increase risk factors. It is thought that previous recommendations to decrease total dietary fat intake have resulted in increased consumption of refined carbohydrates. The unfortunate consequences include increased CVD risk.

REF: p. 116 | p. 117

1. The American Heart Association dietary guidelines recommend that egg consumption be limited to three per week. One large egg contains 212 mg of cholesterol.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: D

The American Heart Association recommendations do not limit the number of eggs as long as total daily dietary cholesterol is limited to about 300 mg per day. One large egg contains 212 mg of cholesterol. Note that by eating one egg, 1 cup of ice cream (58 mg cholesterol), and 1 oz of cheddar cheese (30 mg cholesterol), the recommended 300 mg will be exceeded.

REF: p. 117 | Box 6-3

1. In the Unites States plant sterols are added to products to indirectly reduce cardiovascular disease (CVD) because they may interfere with cholesterol absorption.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: A

Plant sterols are bioactive compounds found in all vegetable foods and inhibit cholesterol absorption. If foods rich in plant sterols are consumed instead of animal and dairy products, it is thought that CVD can be reduced indirectly because plant sterols are absorbed at the same sites in the small intestine as cholesterol. Their ability to interfere with cholesterol absorption results in a 5% to 17% reduction of low-density cholesterol (the “bad” cholesterol). In the United States, sterols are added to margarine spread, orange juice, and other products. An important caveat is that a low-fat diet increases effectiveness of these products.

REF: p. 116 | p. 117

1. Hyperlipidemia, or increased plasma cholesterol and low-density lipoprotein (LDL), seems to be a major risk factor for cardiovascular disease (CVD). Each of the following is true of this condition and efforts to treat it except one. Which one is the exception?

a.	A fasting lipoprotein profile for all adults older than 20 years should be taken every 5 years.
b.	LDL cholesterol levels less than 200 mg/dL throughout life are associated with a low risk of CVD.
c.	Reducing LDL cholesterol reduces likelihood of acute coronary syndromes.
d.	Drug treatment can be added if the lipoprotein profile does not normalize after implementing American Heart Association guidelines.

ANS: B

LDL cholesterol levels less than 100 mg/dL throughout life are associated with a low risk of CVD. An improvement in statistics from 2001 to 2008 may be attributable to changes in trans fatty acids in the food supply, use of statin mediations, or overall dietary changes. Experts worry that improving trends may have stalled in more recent years.

REF: p. 116 | p. 117

1. Although overconsumption of fat is a primary concern in healthcare, underconsumption also has serious health consequences. In each of the conditions, underconsumption of fat is a concern except one. Which one is the exception?

a.	Malabsorption syndromes
b.	Cystic fibrosis
c.	AIDS
d.	Hypertension

ANS: D

Obesity is a major factor in hypertension (high blood pressure). Patients who underconsume fats are more prone to developing low blood pressure. In malabsorption syndrome, cystic fibrosis, and later stages of AIDS, essential fatty acid deficiency results in poor growth, dermatitis, reduced resistance to infection, and poor reproductive capacity.

REF: p. 114

Chapter 07: Use of the Energy Nutrients: Metabolism and Balance

Test Bank

MULTIPLE CHOICE

1. The macronutrients supplying physiologic energy are carbohydrate, protein, fat, and alcohol. After conversion to glycogen and glycerol, these basic nutrient units are delivered to the cells.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: C

The macronutrients responsible for physiologic energy are carbohydrate, protein, fat, and alcohol. These substances are converted to glucose, fatty acids, and amino acids and delivered to the cells for utilization. Glycogen is a carbohydrate derived from glucose that is stored in the muscles and liver. Glycerol is a portion of the chemical structure of triglycerides.

REF: p. 122

1. Catabolism is also called the Krebs cycle. During the Krebs cycle glucose, fatty acids, and amino acids are converted to a usable form of energy.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: D

Catabolism, one of the two major chemical reactions, splits complex substances into simpler substances. Its counterpart, anabolism, builds or synthesizes more complex compounds. The Krebs cycle, also called the citrus acid cycle, utilizes enzymes to convert glucose, fatty acids, and amino acids into usable forms of energy.

REF: p. 122

1. Hormones stimulate, but do not retard, the functions of other cells. Hormones act as messengers that principally control metabolic functions that affect the skeletal muscular and nervous systems.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: B

Hormones are “messengers” produced by a group of cells that stimulate or retard the functions of other cells. Hormones principally control different metabolic functions that affect growth and secretions.

REF: p. 122

1. Each of the following is a function of the liver except one. Which one is the exception?

a.	Regulatory control of nutrients in the bloodstream
b.	Conversion of monosaccharides to triglycerides
c.	Breakdown of polysaccharide glycogen into glucose
d.	Oxidation of digestive end products to provide energy

ANS: B

The liver converts monosaccharides to glucose to provide energy for utilization by the cells. Its major role is regulatory; it controls the kinds of quantities of nutrients within the bloodstream. The polysaccharide glycogen is stored in the liver (and muscle) and converted to glucose. In this form, glucose can be supplied to the bloodstream and delivered to the cells as needed. Other end products of digestion can be oxidized to be converted to glucose, protein, fat, or other substances as needed by the cells and tissues of the body.

REF: p. 122

1. During times of low caloric intake, high-protein diets successfully build muscle mass because this type of diet utilizes the amino acid metabolic pool to stimulate anabolism of muscle.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: E

High-protein diets are neither safe nor effective as a means to increase (anabolize) muscle mass. The amino acid metabolic pool, a small reservoir containing approximately 70 g of amino acids, is not intended for this purpose. This pool contains less amino acid than most Americans consume in a day and is not intended to supplement proper nutrition, nor is it capable of building muscle mass in the absence of caloric intake and exercise.

REF: p. 124

1. The major waste product of protein catabolism is ammonia. The liver converts ammonia to urea to be excreted by the kidneys.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: B

The roles of urea and ammonia are reversed in the question. Urea is the major waste product of protein catabolism (breakdown of a compound into simpler substance). The liver converts urea to ammonia to be excreted by the kidneys. The levels of urea and ammonia vary directly with dietary protein levels.

REF: p. 124

1. Each of the following accurately describes aspects of lipid metabolism except one. Which one is the exception?

a.	Insulin increases fat synthesis.
b.	The liver regulates fat metabolism and lipoprotein.
c.	Modification of fatty acids deactivates their properties.
d.	Liver metabolism results in triglycerides being transported to tissues for energy and other uses.

ANS: C

An important concept is that the liver is the principal regulator of fat metabolism and lipoprotein synthesis (building of new substances). Fatty acids are an important component of this function, and they can be modified in many ways before they are released from the liver into the circulations. Modification, also known as hydrolysis, of fatty acids can be by shortening, lengthening, or adding double bonds.

REF: p. 124

1. The liver performs each of the following actions upon cholesterol except one. Which one is the exception?

a.	Produces cholesterol
b.	Converts cholesterol to urea
c.	Removes cholesterol from the blood
d.	Uses cholesterol to make bile salt

ANS: B

The liver does not convert cholesterol to urea. Instead, the liver converts urea to ammonia, which is then excreted by the kidneys. Urea is the major waste product of the breakdown (catabolism) of protein.

REF: p. 124

1. During oxidation of triglycerides, 1 lb of fat results in 1000 kcal of energy. Ketones are formed when excessive amounts of fat are oxidized for energy.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: D

During oxidation of triglycerides, 1 lb of fat results in 3500 kcal of energy. Ketones are formed when the liver becomes overwhelmed because of excessive amounts of fat being oxidized for energy. Ketones are acidic metabolic products that are not oxidized in the liver, but they are carried to the skeletal and cardiac muscle, where under normal circumstances, they are rapidly metabolized. Note that production of 3500 kcal is more energy than most individuals use in a 24-hour period.

REF: p. 124 | p. 125

1. In addition to producing excessive water within cells, ketoacidosis is a dangerous condition because the brain and nerve cells use ketones for some of their fuel requirements when glucose levels remain low for several days.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: D

Ketoacidosis is an extension of a condition known as ketosis. Dangerous dehydration can occur because an accumulation of ketone bodies upsets the acid-base balance. This condition, called acidosis, results in loss of large amounts of water and sodium ions and a disruption in the glucose balance. When blood glucose levels remain low for several days, brain and nerve cells adapt to use ketones for some of their fuel requirements. Ketoacidosis frequently occurs in patients with uncontrolled diabetes mellitus or individuals who are not eating because they are burning fat rather than carbohydrate because of illness or weight reduction.

REF: p. 125

1. The best source for assuring optimal glycogen stores is:

a.	carbohydrates.
b.	proteins.
c.	fats.
d.	glycerol.
e.	amino acids.

ANS: A

Adequate carbohydrates must be consumed to assure optimal glycogen stores. In fact, glycogen stores are depleted with a carbohydrate-poor diet even when high levels of fat and protein are eaten. A patient who ingests a carbohydrate-poor diet has decreased energy reserves and is prone to having prolonged healing periods and fatigue.

REF: p. 124

1. For adults of all ages, one to two alcoholic drinks daily results in the lowest mortality rate because moderate alcohol consumption provides protective effects on the cardiovascular system.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: D

The Dietary Guidelines for Americans advise moderation in alcohol consumption. Specifically, its recommendation of one to two drinks daily applies to middle-aged and older adults only. Alcohol consumption seems to provide little, if any, health benefit for younger individuals. Alcoholic beverages should be avoided by women who may become pregnant or are pregnant or breastfeeding.

REF: p. 125

1. Regardless of whether excessive food intake is in the form of protein, carbohydrate, alcohol, or fat, most excess energy intake is stored in the liver. Fat is a good source of energy, but protein is the preferred fuel.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: B

Regardless of the source of excessive food intake, most excess energy intake is stored in adipose tissue. Fat is a good source of energy, but the preferred fuel is carbohydrate. Note that in the absence of adequate carbohydrates, the body cannot metabolize excessive amounts of fat without some side effects—ketoacidosis, hyperlipidemia, and accumulation of fat in the liver. Glycogen is another storage form of energy; however, the amount of glycogen stored in the body is limited.

REF: p. 125

1. Each of the following is true of metabolic interrelationships except one. Which one is the exception?

a.	Carbohydrates can be used in forming nonessential amino acids.
b.	Glucose can be converted to fatty acids and some amino acids.
c.	Proteins contribute to synthesis of some lipids.
d.	The glycerol from triglycerides can be used for synthesis of carbohydrates.

ANS: B

There are many interrelationships between macronutrients and micronutrients responsible for metabolism. In some situations, one nutrient can be substituted for another because of their interrelationship. Proteins, carbohydrates, and fats contribute to anabolism and catabolism (buildup and breakdown) of products, but glucose is not converted to fatty acids or amino acids. Rather, fatty acids and some amino acids can be converted to glucose.

REF: p. 125

1. Symptoms of hypoglycemia include all of the following except one. Which one is the exception?

a.	Weakness
b.	Light-headedness
c.	Flushed color
d.	Rapid, shallow breathing
e.	Confusion

ANS: C

During hypoglycemia, the patient’s coloring fades and is pale. It is also possible for the patient to have no symptoms but have low blood glucose levels.

REF: p. 126

1. Metabolic rate is lowest:

a.	after a few hours of sleep.
b.	immediately upon waking.
c.	after 5 to 6 hours of deep sleep.
d.	during the first few moments after falling asleep.

ANS: A

Metabolic rate is lowest after a few hours of sleep because muscles are more relaxed. Approximately 10% less energy is needed for the basal metabolic rate during this relaxed state.

REF: p. 127

1. During which period of life is the basal metabolic rate (BMR) the highest?

a.	The neonatal period
b.	Birth through 2 years of age
c.	During the first 2 to 3 months of puberty
d.	During the early geriatric years

ANS: B

From birth through age 2 years, growth results in the highest BMR. This rate then decreases until the puberty growth spurt, and is followed by a gradual decline for the rest of the life cycle.

REF: p. 127

1. During the last trimester of pregnancy, the BMR increases approximately 15% to 30%. The amount of energy necessary to produce milk for lactation can increase the BMR 40%.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: A

Basal metabolic rate indicates the energy required for involuntary physiological functions to maintain life. Lactation requires extra energy, which is reflected in a higher BMR. A naturally higher BMR is why pregnant women do not feel as cold as adults under the same weather conditions.

REF: p. 127

1. Thyroxine, produced by the thyroid gland, has a greater influence on the basal metabolic rate (BMR) than secretions from any other gland. The pituitary gland accounts for a 15% to 20% increase in the BMR during growth of children and adolescents.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: A

The iodine-containing hormone thyroxin has a greater influence on the rate of metabolic processes than secretions from any other gland. Adrenal glands affect metabolism to a lesser degree. The pituitary gland accounts for about a 15% to 20% increase in the BMR during growth of children and adults.

REF: p. 128 | p. 129

1. Many patients gain weight after age 25 because the BMR decreases and previous eating habits are maintained without increasing activity.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: A

BMR is highest from birth through age 2 years. It decreases until the puberty growth spurt, then is followed by a gradual decline for the rest of the life-cycle. At age 25 not only is the BMR becoming lower, many young adults no longer have the time for physical exercise.

REF: p. 127 | p. 128

1. Which one of the following individuals would be expected to have the highest basal metabolic rate (BMR)?

a.	One who is sleeping
b.	One who is breastfeeding
c.	One who is undernourished
d.	One who is chronically fasting
e.	One who is sedentary

ANS: B

During the last trimester of pregnancy, the BMR increases approximately 15% to 30%. The amount of energy necessary to produce milk for lactation can increase the BMR by 40%.

REF: p. 127

1. Hunger, also known as appetite, is the physiologic drive to eat. Energy balance is maintained when the kilocalorie intake is within 10% of energy needed for body processes and physical activities.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: B

Although hunger and appetite are frequently used interchangeably, the terms have different meanings. Hunger is the physiologic drive to eat, whereas appetite is the desire to eat. Appetite usually implies desire for specific types of food and is related to the pleasurable sensation of eating. Energy balance is maintained only when the kilocalorie intake equals the amount of energy needed for body processes.

REF: p. 129 | p. 130

1. The thalamus gland, located in the center of the brain, is important in controlling huger because it contains both a satiety and a hunger center.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: D

It is the hypothalamus gland, located in the center of the brain, that is important in controlling hunger because it and contains both a satiety and hunger center. The hunger center is also called the feeding center.

REF: p. 130

1. Stimulation of the satiety center results in a craving for food. If the satiety center of the hypothalamus becomes destroyed, the appetite becomes voracious, resulting in obesity.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: D

Stimulation of the satiety center results in complete satiety. This is different from damage or destruction to the satiety center, which increases the appetite. Destruction of the satiety center can occur with a head injury or stroke and results in a voracious appetite with ensuing appetite.

REF: p. 130

1. Many have hypothesized that the use of noncaloric sweeteners can result in increased caloric intake, because the body’s ability to discern that the taste and feel of food in the mouth are providing caloric intake becomes diminished.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: A

There is concern that the use of noncaloric sweeteners interferes with the body’s ability to gauge intake by discerning food characteristics. It is thought that the body becomes unable to determine how much food is needed to meet its caloric intake. As a result, the body learns that it can no longer use the sense of taste to gauge kilocalories, resulting in increased caloric intake.

REF: p. 131

1. Each of the following mechanisms affects the amount eaten at a particular meal except one. Which one is the exception?

a.	Distention of the stomach
b.	Release of cholecystokinin
c.	Fat within the stomach
d.	Secretion of glucagon
e.	Secretion of insulin

ANS: C

Several mechanisms affect the amount eaten at a particular meal. Fat within the duodenum has a strong direct effect on the feeding center. The release of cholecystokinin occurs due to the presence of fat within the duodenum and causes the person to stop eating. Distention of the stomach results in inhibitory signals that suppress the feeding center, reducing the desire to eat. Food in the stomach and duodenum causes secretion of glucagon and insulin, both of which suppress the feeding center.

REF: p. 131

1. The relationship between exercise and food intake is unclear. Generally, acute exercise increases food intake after the activity, whereas regular exercise decreases food intake.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: C

Although the relationship between exercise and food intake is unclear, acute exercise generally decreases food intake whereas regular exercise promotes increased energy intake. These findings may be related to timing or duration of the exercise or individual metabolic differences.

REF: p. 131

1. Each of the following is true of energy expenditure as it relates to control of weight except one. Which one is the exception?

a.	Obese women have a similar or higher metabolic rate than thinner women do.
b.	Activity level seems to be a principal determinant in the development of obesity.
c.	Weight loss from a specific energy deficit is usually predictable.
d.	Adjustments in energy expenditure seem to be adaptive.

ANS: C

Weight loss from a specific energy deficit, such as surgery or an illness, is invariably smaller than expected. Conversely, overconsumption fails to produce the anticipated weight gains. These statements validate the theory that maintaining energy balance at an appropriate body weight is very complex. The consensus is that adjustments in energy expenditure seem to adaptive.

REF: p. 131

1. Dental hygienists should counsel patients on weight control when they recommend that a patient quit smoking because this is within the scope-of-practice.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: E

Counseling patients about weight control is outside the scope-of-practice for dental hygienists. Quitting smoking is linked to weight gain, and it is appropriate for hygienists to encourage patients who smoke to enroll in smoking cessation along with a weight-loss program. Patients should be referred to a registered dietitian for weight loss counseling.

REF: p. 132 | Nutritional Directions

1. Psychologic disorders such as anorexia nervosa can become life threatening because a lack of perception of one’s undernourishment causes a vicious downward spiral of metabolic imbalances.

a.	Both the statement and the reason are correct and related.
b.	Both the statement and the reason are correct but are not related.
c.	The statement is correct, but the reason is not correct.
d.	The statement is not correct, but the reason is correct.
e.	Neither the statement nor the reason is correct.

ANS: A

This statement and reason may sound dramatic, but both are absolutely true. Inadequate energy intake can result in malnutrition and can become a serious problem during a physiologically stressful situation. Note that the extreme metabolic imbalance decreases hunger, which further exacerbates an already life-threatening situation.

REF: p. 131

1. Dental considerations for patients with altered energy intake include each of the following except one. Which one is the exception?

a.	Depression and stress often result in overeating and decreased activity.
b.	A positive energy balance is desirable during periods of growth.
c.	It is a myth that a larger amount of energy is needed by pregnant or lactating women.
d.	When nutrient stores decrease, the feeding center of the hypothalamus becomes active.

ANS: C

Pregnancy and lactation are situations requiring a positive energy balance; that is, a proportionately larger amount of energy is needed during pregnancy and lactation.

REF: p. 131

1. Each of the following recommendations is appropriate for counseling patients with diabetes mellitus except one. Which one is the exception?

a.	In obese patients, modest weight loss can improve insulin resistance.
b.	High-protein diets help adherence to weight loss programs.
c.	The use of glycemic index and load is more beneficial than carbohydrate considerations only.
d.	Moderate alcohol consumption has no acute effect on glucose and insulin concentrations.
e.	Carbohydrate ingested with alcohol can increase blood glucose.

ANS: B

High-protein diets are not recommended as a method for weight loss. The long-term effect of protein intake greater than 20% of calories is unknown. Such diets can produce short-term weight loss and improved glycemia, but effects on kidney function are unknown.

REF: p. 132 | pp. 134-135

1. Each of the following is a symptom of type 1 diabetes mellitus except one. Which one is the exception?

a.	Polydipsia
b.	Polyphagia
c.	Polyuria
d.	Ketoacidosis
e.	Weight gain

ANS: E

Weight gain is a classic symptom of type 2 diabetes, whereas weight in type 1 tends to be more normal. However, in type 1 frequently weight loss occurs, but it is also possible for obesity to occur. Note that polydipsia means increased thirst; polyphagia means increased appetite; and polyuria means the need to urinate frequently.

REF: p. 132 | pp. 134-135

1. Type 1 diabetes is also referred to as juvenile diabetes because adults do not develop this disease.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: C

Although many people still refer to type 1 diabetes as juvenile diabetes, this terminology is incorrect because adults can develop type 1 diabetes.

REF: p. 134

1. Approximately 90% to 95% of Americans with diabetes have type 1 diabetes mellitus. This form of the disease results from insulin resistance.

a.	Both statements are true.
b.	Both statements are false.
c.	The first statement is true; the second is false.
d.	The first statement is false; the second is true.

ANS: B

Type 2 diabetes is far more common that type 1. Almost 90% to 95% of Americans with diabetes have type 2 diabetes. Type 2 diabetes results from insulin resistance, usually with a relative insulin deficiency. Unlike type 1 diabetes, onset of type 2 is gradual and can take years. Onset of type 1 is sudden; however, it may develop slowly in adults.

REF: p. 134

1. Each of the following is true of type 2 diabetes except one. Which one is the exception?

a.	Body mass index greater than 27 kg/m2 is a risk factor.
b.	Obesity and sedentary lifestyle are risk factors.
c.	Increased fat stores cause some degree of insulin resistance.
d.	Inadequate insulin is a major cause.

ANS: D

In type 2 diabetes, insulin production is often adequate or higher than normal. Regardless of adequate amounts of available insulin, the mechanism of glucose uptake by the cells (except the brain) is decreased. This results in insufficient insulin for use by the cells. With type 1 diabetes, insulin production is decreased or absent altogether.

REF: p. 134

1. The main manifestation of type 2 diabetes is:

a.	hyperglycemia.
b.	hypoglycemia.
c.	ketoacidosis.
d.	insulin resistance.

ANS: A

Hyperglycemia, or high blood glucose, is the main manifestation of type 2 diabetes. Its symptoms include thirst, frequent urination, hunger, blurry vision, fatigue, frequent infections, and dry itchy skin. The patient can also be asymptomatic. Hypoglycemia literally means “low blood sugar.” Ketoacidosis is a serious and potentially fatal condition associated with type 1 diabetes. Insulin resistance is a major cause of type 2 diabetes.