Nutritional and Dietary Guidelines, Exams of Nutrition

Download Nutritional and Dietary Guidelines and more Exams Nutrition in PDF only on Docsity! CNS Exam Prep - CBNS Exam Primer - Section 3 - Nutritional and Dietary Guidelines p.103 2010 United States Dietary Guidelines - 1. Maintain calorie balance over time to achieve and sustain a healthy weight. 2. Focus on consuming nutrient-dense foods and beverages. BUILD A HEALTHY BASE... - Let the My Plate guide your food choices Choose a variety of grains daily, especially whole grains Choose a variety of fruits and vegetables daily Keep food safe to eat CHOOSE SENSIBLY... - - Choose a diet that is low in total and saturated fat and cholesterol - Choose beverages and foods to moderate your intake of sugars - Choose and prepare foods with less salt - If you drink alcoholic beverages, do so in moderation Dietary Reference Intakes (DRI) p 103 - The Dietary Reference Intakes (DRI) are reference values developed by the Food and Nutrition Board of the National Academy of Sciences. They provide quantitative estimates of nutrient intakes to be used for planning and assessing diets for apparently healthy people. The DRI are subdivided into -Recommended Dietary Allowances (RDA), -Adequate Intakes (AI), -Tolerable Upper Intakes (TUL) and -Estimated Average Requirements(EAR). Estimated Average Requirements (EAR) - The EAR each estimate the daily intake of a nutrient that will satisfy the requirement for that nutrient of half of the healthy individuals in a life stage and gender group. Recommended Dietary Allowances (RDA) - The RDA each estimate the daily intake of a nutrient that will satisfy the requirement for that nutrient of 97% to 98% of the healthy individuals in a life stage and gender group. If sufficient data is available, for an individual nutrient, RDA = EAR + 2 sdEAR (where sd = standard deviation). If sufficient data is not available, for an individual nutrient, RDA = 1.2 x EAR. It is recognized that the RDA do not define physiologic requirements. Adequate Intakes (AI) - The AI each estimate the daily intake of a nutrient that will satisfy the requirement for that nutrient of most of the healthy individuals in a life stage and gender group when insufficient data is available to estimate an RDA. Tolerable Upper Intakes (TUL) - The TUL each estimate the greatest daily intake of an individual nutrient that is likely to pose no risk of adverse health effects for almost all individuals in the general population. As daily intake increases beyond the TUL, the risk of adverse effects increases (usually unpredictably). U.S. Recommended Daily Allowances (USRDA) - U.S. Recommended Daily Allowances (USRDA) The U.S. Recommended Daily Allowances (USRDA) provided a standard for nutrient intake for most healthy individuals, designed for use on food labels through 1994. For each nutrient, the USRDA represented the greatest of the RDA established in 1968 for that nutrient. The USRDA have been replaced by the Daily Values (DV). The Daily Values (DV) - The Daily Values (DV) provide a set of dietary standards for nutrients for use on food labels. The DV are based upon the Daily Reference Values (DRV) and the Reference Daily Intakes (RDI). The DV each estimate the percentage of the DRV or RDI for an individual nutrient that will be provided in a specific food product assuming that a daily intake of 2,000 kcal is being consumed. The Daily Reference Values (DRV) - The Daily Reference Values (DRV) provide standards for some nutrients for use on food labeling (total fat, saturated fat, cholesterol, total carbohydrate, dietary fiber, protein, sodium and potassium). Current DRV, per day, are: • total fat: 65 g (to provide no more than 30% of total dietary calories) • saturated fat: 20 g (to provide no more than 10% of total dietary calories) • cholesterol: 300 mg • total carbohydrate: 300 g (to provide approximately 60% of total dietary calories) • dietary fiber: 25 g • protein: • adults: 50 g (to provide approximately 10% of total dietary calories) • infants under 1 year: 14 g • children 1 to 4 years: 16 g • pregnant women: 60 g • lactating women: 65 g • sodium: 2400 mg • potassium: 3500 mg The Dietary Reference Intakes (DRI) - The Dietary Reference Intakes (DRI) provide standards for some nutrients for use on food labeling (vitamin A, vitamin C, vitamin D, vitamin E, thiamin, riboflavin, niacin, biotin, pantothenic acid, folate, vitamin B6, vitamin B12, calcium, copper, iodine, iron, magnesium, phosphorus, zinc) If less than 50% of calories are from fat, fat must be reduced at least 50% or calories reduced at least 1/3 per RACC FAT - - Fat free Contains < 0.5 g of fat per serving - Saturated fat free Contains < 0.5 g of fat per serving and the content of trans-fatty acids < 1% of total fat - Low fat Contains < 3 g of fat per serving (or per 50 g of food if serving size is < 30 g or 2 tablespoons) - Low saturated fat Contains < 1 g of saturated fat per serving and the content of saturated fatty acids < 15% of total calories - Reduced fat; Less fat Contains at least 25% less total fat per serving - Reduced saturated fat; - Less saturated fat Contains at least 25% less saturated fat per serving CHOLESTEROL - - Cholesterol free Contains < 2 mg of cholesterol and < 2 g of saturated fat per serving - Low cholesterol Contains < 20 mg of cholesterol and < 2 g of saturated fat per serving (or per 50 g of food if serving size is < 30 g or 2 tablespoons) - Reduced cholesterol; Less cholesterol Contains at least 25% cholesterol per serving < 2 g of saturated fat per serving SODIUM - - Sodium free: Contains < 5 mg of sodium per serving - Low sodium: Contains < 140 mg of sodium per serving (or per 50 g of food if serving size is < 30 g or 2 tablespoons) - Very low sodium: Contains < 35 mg of sodium per serving (or per 50 g of food if serving size is < 30 g or 2 tablespoons) - Reduced sodium;Less sodium: Contains at least 25% less sodium per serving -Light" (for sodium reduced 21 CFR products): if food is "Low Calorie" and "Low Fat" and sodium is reduced by at least 50%. 21 CFR 101.56(c)(1) - "Light in Sodium": if sodium is reduced by at least 50% per RACC. 21 CFR 101.56(c)(2) - For meals and main dishes, "Light in Sodium" meets definition for "Low in Sodium" 21 CFR 101.56(d)(2) - "No Salt Added" and "Unsalted" must declare "This is Not A Sodium Free Food" on information panel if food is not "Sodium Free" 21 CFR 101.61(c)(2) -"Lightly Salted": 50% less sodium than normally added to reference food and if not "Low Sodium", so labeled on information panel 21 CFR 101.56 FIBER - -High fiber: Contains > 5 g of fiber per serving -Good source of fiber: Contains 2.5 to 4.9 g of fiber per serving -More fiber;Added fiber: Contains at least 2.5 g more fiber per serving SUGAR - -Sugar free: Contains < 0.5 g of sugar per serving -No added sugar;Without added sugar;No sugar added: No sugars added during processing or packing: Processing does not increase the sugar content above that naturally present in the ingredients - Reduced sugar Contains at least 25% less sugar per serving Products using the term "healthy" in the product name or as a claim on the product's label - -must contain, per serving, no more than 3 g of fat, 1 g of saturated fat, 350 mg of sodium or 60 mg of cholesterol. - They also must supply at least 10% of the Daily Value for at least one of vitamin A, vitamin C, calcium, iron, protein or fiber. - Raw meat, poultry and fish can be labeled "healthy" if they contain, per serving, no more than 5 g of fat, 2 g of saturated fat, and 95 mg of cholesterol. • Health Claims - - Specifically, health claims reveal benefits in terms of reduced risk of specific diseases that may be obtained from consumption of the food or food product. - Health claims are not legal if they claim to effectively treat or cure a disease or disease condition (such a claim converts the food or food product into an illegal drug subject to the laws regulating illegal drugs). - Health claims must be approved by the US Food and Drug Administration prior to their use with a specific product. Required Wording of Health Claim Calcium: Osteoporosis - Regular exercise and a healthy diet with enough calcium helps teens and young adult white and Asian women maintain good bone health and may reduce their high risk of osteoporosis later in life. Required Wording of Health Claim Sodium: Hypertension - Diets low in sodium may reduce the risk of high blood pressure, a disease associated with many factors. Required Wording of Health Claim Dietary Fat: Cancers - Development of cancer depends on many factors. A diet low in total fat may reduce the risk of some cancers. Required Wording of Health Claim Dietary Saturated Fat and Cholesterol: Coronary Heart Disease - While many factors affect heart disease, diets low in saturated fat and cholesterol may reduce the risk of this disease. Required Wording of Health Claim Fiber-Containing Grain Products, Fruits, and Vegetables: Cancers - Low fat diets rich in fiber-containing grain products, fruits, and vegetables may reduce the risk of some types of cancer, a disease associated with many factors. Required Wording of Health Claim Fruits, Vegetables and Grain Products that contain Fiber, particularly Soluble Fiber: Coronary Heart Disease - Diets low in saturated fat and cholesterol and rich in fruits, vegetables, and grain products that contain some types of dietary fiber, particularly soluble fiber, may reduce the risk of heart disease, a disease associated with many factors. Required Wording of Health Claim Folate: Neural Tube Defects - Healthful diets with adequate folate may reduce a woman's risk of having a child with a brain or spinal cord defect. Required Wording of Health Claim Fruits and Vegetables: Cancers - Low fat diets rich in fruits and vegetables (foods that are low in fat and may contain dietary fiber, Vitamin A, or Vitamin C) may reduce the risk of some types of cancer, a disease associated with many factors. Required Wording of Health Claim Dietary Sugar, Alcohol: Dental Caries - Full claim: Frequent between-meal consumption of foods high in sugars and starches promotes tooth decay. The sugar alcohols in [name of food] do not promote tooth decay. Short claim: (for use on small packages only): Does not promote tooth decay. Required Wording of Health Claim Soluble Dietary Fiber: Coronary Heart Disease - Soluble fiber from foods such as [name of soluble fiber source and name of food Such statements must not claim any relationship between the dietary supplement and the prevention or treatment of any disease. • Structure/Function Claims Each structure/function claim must satisfy the following specific criteria: - 1. A claim may not suggest that the product has an effect on a specific disease or class of disease. Examples of allowed claims: "Helps build and strengthen joint cartilage." "Helps maintain joint health and flexibility." "Helps maintain a healthy heart." Examples of claims that are not allowed: "Reduces the pain and stiffness associated with arthritis." "Helps alleviate the pain associated with migraine headaches." "Helps alleviate the blues associated with emotional despair." 2. A claim may not refer to a characteristic sign or symptom of a disease or class of disease. Examples of claims that are not allowed: "Lowers serum cholesterol levels." "Lowers blood pressure." "Relieves painful joints." "Lowers blood sugar levels." 3. References to signs or symptoms of natural states are permissible so long as they are not uncommon and cannot cause significant harm if left untreated. Examples of allowed claims: "Alleviates symptoms associated with PMS." "Promotes sexual vigor and performance." "Helps alleviate occasional hot flashes associated with menopause." Examples of claims that are not allowed: "Helps reduce inflammation by blocking the COX-2 enzyme." "Helps alleviate BPH." "Helps alleviate joint pain." 4. A claim may not be disguised as a product name. Examples of allowed product names: "Mood Health." "Joint Flex." "Heart Health." Examples of product names that are not allowed: "Arthritis Formula." "Cho-less-terol." "Arthex." "Migraine Relief." 5. A claim may not refer to a supplement's formulation if the statement suggests that the product contains an ingredient that is or was regulated by the FDA as a drug. Examples of claims that are not allowed: "This product contains L-carnitine, formerly only available as a prescription drug." 6. Citations to an article that refers to a disease in its title is permissible i Each structure/function claim or set of claims must be accompanied by the mandatory disclaimer, - "This statement has [or 'These statements have'] not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease." Structure/function claims may be used only in the labeling of dietary supplements. Does it require preapproval by the US FDA? - Although the use of a proper structure/ function claim does not require preapproval by the US Food and Drug Administration, the manufacturer or maker of such a claim must maintain full scientific substantiation of the truthfulness and non-misleading nature of the claim. Nutrient Requirements Throughout the Life Cycle • Term Neonate and Infant, not Premature or Small-for-Age p134 - Neonate and Infant (NOT Premature or Small for Age) breast feeding remains the preferred method (although low birth weight infants may require energy supplementation) The timing of the introduction of solid feedings - The timing of the introduction of solid feedings depends on neurologic development, food allergenicity, and gastrointestinal tolerance. Solid foods generally are not recommended before 9-12 months of age. Nutrient Requirements Throughout the Life Cycle • Children - Growth patterns are best represented by growth velocity curves. The major growth phases - are infancy (0 to 2 years), - childhood (2 to 10 years), and - puberty (10 to 12 years). Recommended allowances and nutritional guidelines should reflect the nutritional requirements necessary to support adequate growth during each of these phases. However, more than 20% of the children in the U.S. go to bed hungry every night, while over a third are obese. Nutrient Requirements Throughout the Life Cycle • Adolescents - Adolescence is characterized by a complex pattern of rapid growth and sexual maturation, readily assessed by Tanner's stages of sexual maturity. Although this is a time of constant physiologic flux and nonlinear growth and development, dietary standards continue to be based on needs averaged over several years. During the growth spurt, current recommended allowances and daily values for calcium, zinc, magnesium, and other minerals may be inadequate. • Shift away from family as source of food and toward eating with peers, who influence food choices. Teens are susceptible to dietary fads that may involve exclusion of entire food groups. • Meal patterns become erratic and meals may be skipped. Snacking is common, usually contributing excessive amounts of fat, sugar, protein and sodium. • Pursuit of physical fitness leads to vulnerability to unproven nutritional strategies to improve performance, weight cycling or other questionable or unsafe practices. Changing patterns of physical activity alter requirements for energy and energy-related nutrients. • Most females become concerned with their weight and body image, and many adopt frequent and even obsessive weight loss practices and body reshaping techniques. Such efforts may be associated with reduced calcium consumption, use of appetite suppressants or exogenous thyroid hormones, cathartics, laxatives, tobacco use, unsupervised exercise programs, and selection of diets providing inadequate amounts of iron, zinc, vitamin B6, magnesium and vitamin A. • Lack of success in coping with developmental problems may lead to lifethreatening eating disorders (anorexia nervosa, bulimia, etc.), whose reversal requires comprehensive counseling and psychological support in addition to nutritional intervention. Nutrient Requirements Throughout the Life Cycle • Adults - • Adults Acute and chronic nutrient deficiencies in adults result from imbalances between the body's requirements for nutrients and the amounts ingested. The signs and symptoms of classical nutrient deficiencies are well characterized. A deficiency of a single nutrient in the absence of deficiencies of others is uncommon. Risk factors for nutrient deficiencies in adults include - inadequate or unbalanced food intake, -food fadism, - the use of medications or other drugs, including alcohol, - co-morbid malabsorptive or other disease states creating secondary nutrient deficiencies, enteral or parenteral nutrition support, renal dialysis, behavioral disorders affecting food intake, and - protein-energy malnutrition. Nutrient Requirements Throughout the Life Cycle • Pregnancy - Pregnancy steadily increases energy and protein requirements until they reach a maximum during the third trimester. On average, the total "energy cost" of pregnancy is between 80,000 and 110,000 kcal, averaging 300 to 400 kcal/day during the typical 250 days of "awareness of pregnant status." Similarly, on average, the total "protein cost" of pregnancy is about 1500 g, averaging 6 g/day during the typical 250 days of "awareness of pregnant status." Some vitamin and mineral requirements also increase. - Bakery products must be produced under kosher conditions. Fruits, vegetables and cereals are permitted without restriction. • Traditional and Ethnic Dietary Practices p 137 Muslin - Muslim dietary advice is to not eat to capacity and always share food. - Meat animals must be slaughtered according to ritual letting of blood and while speaking the name of God ("halal"). - Improperly slaughtered meat is forbidden ("haram"). Pork and alcohol in any form are prohibited. • Traditional and Ethnic Dietary Practices Vegetarian - - Lacto-ovo vegetarian diets allow consumption of dairy products and eggs but not meat, poultry, fish or seafood. - Lacto-vegetarian diets also exclude eggs, while - ovo-vegetarian diets exclude dairy products but allow eggs. - A strict vegan diet will exclude all meat, poultry, fish, seafood, dairy products, eggs, foods with added animal products and foods that involve animal processing. - A macrobiotic diet allows seafood and limits consumption of nuts, seeds and fruit. - A "fruitarian" diet emphasizes fruits and "botanically grown" vegetables (tomatoes, eggplant, avocado, zucchini) while allowing nuts and seeds. - "Raw foods" and "natural hygiene" vegetarians attempt to consume only uncooked fruits and vegetables. • Traditional and Ethnic Dietary Practices Vegetarians may need more protein - - the digestibility of the proteins in vegetarian diets containing no animal protein is lower. An approximate 15% to 25% increase in the recommended daily protein intake (to approximately 1.0 g/kg body weight) should account for the lower digestibility of the proteins in strict vegetarian (vegan) diets. - Vegetarians adhering to strict vegan diets and exercising heavily may require additional protein (up to 1.6 g/kg daily). - Because dairy products provide high quality, highly digestible sources of protein, lacto-ovo vegetarians should be encouraged to consume 2 to 3 servings of low-fat dairy products daily. - Because legume vegetables, seeds and nuts are good food sources of proteins with complementary amino acids patterns, vegetarians should be encouraged to consume 1 to 2 servings daily of each of these foods - grains provide proteins with amino acid patterns complementary to those of legume vegetables, and vegetarians should be encouraged to consume at least 6 servings of grains daily. - - In order to consume the recommended 6 servings of carbohydrate-rich foods daily, vegetarians should select whole grains, pasta, and legume vegetables (which are associated with minimal glycemic and insulin responses). Furthermore, the cereal fiber of whole grains and the digestion-resistant starches in pasta and legume vegetables provide fermentable substrates for the production of butyrate [Butyrate is a major short-chain fatty acid produced during gut flora-mediated fermentation of dietary fibers.], the primary fuel of human colonocytes. To minimize their exposure to the deleterious effects of dietary fats, vegetarians should consume low-fat dairy products and canola, soybean and olive oils. Vegetarians should be encouraged to consume - a variety of fruits, vegetables, grains, nuts and seeds (and dairy products if permitted) in order to satisfy vitamin and mineral requirements. Dairy products are excellent sources of calcium, vitamin B12 and riboflavin. Good food sources of calcium for vegetarians include nuts, leafy green vegetables, calcium-rich tofu, fortified soy milk fortified orange juice, and calcium supplements. A vitamin D supplement also may be necessary. Vegetarian diets do not enhance the absorption of dietary iron or zinc; therefore adequate intake of whole grains, nuts, fruits and legume vegetables is required. Green leafy vegetables, whole grains and legume vegetables provide riboflavin, while fortified soy milkor vitamin B12 supplements supply vitamin B12. • Food Allergies - dairy milk, cheese, soy products, eggs, strawberries, melons, bananas, avocados, oranges, plums, pineapples, tomatoes, peanuts, nuts, fish, shrimp, crab, lobster, caffeine, beer, wine, chocolate, sauerkraut, corn and wheat (gluten). Exercise-induced food allergy occurs only if consumption of the offending food is followed by exercise. Symptoms of food allergies - Common symptoms of food allergies include itching, erythema [abnormal redness of the skin or mucous membranes due to capillary congestion (as in inflammation)], angioedema [Angioedema is an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes. ... Often it is associated with hives, which are swelling within the upper skin.], urticaria [a rash of round, red welts on the skin that itch intensely, sometimes with dangerous swelling, caused by an allergic reaction, typically to specific foods], eczema [ a common skin condition marked by itchy and inflamed patches of skin. It's also known as atopic dermatitis], tearing, redness of the eyes, sneezing, nasal obstruction, swelling of the throat, shortness of breath, cough, nausea, vomiting, abdominal cramps, bloating, diarrhea, hypotension, anaphylactic shock, arthritis, migraine, glue ear [Glue ear is a condition where the middle ear fills with glue-like fluid instead of air. This causes dulled hearing. In most cases it clears without any treatment.] and irritable bowel syndrome. • Body Weight Control - Alteration in body weight can occur unintentionally or as a result of moderate or intensive voluntary efforts. Unintentional weight change usually is slow and occurs as an unintentional consequence of lifestyle or in response to a disease condition. Rapid change inmbody weight usually reflects intent to quickly alter weight and body shape. Rapid change often requires supraphysiologic nutritional excesses or deficits and typically results in short-to long-term nutritional imbalances. These consequences can be avoided by use of a moderate controlled regimen under the careful supervision of a professional nutritionist. • Physical Activity - The energy requirements of physical activity reflect the duration and intensity of the activity. -In most cases, the speed at which linear motion occurs is dependent on energy availability but does not affect energy utilization; - an approximately equal number of calories are expended whether the same distance is walked or run (about 100 kcal/mile by an adult weighing 50 kg; about 150 kcal/mile by an adult weighing 100 kg). - Protein requirements are increased only during times of true gain in actual muscle mass (by about 200 mg to 250 mg per g of new muscle mass), not during "body shaping" (attempts to trim body fat depots in specified anatomic locations) or weight loss regimens. • Competitive Athletics - The search for ergonomic nutrients (performance enhancing nutrients) and nutritional regimens continues, even though none have as yet fulfilled expectations. Define Epidemiology p 146 - Epidemiology is the study of populations and the existing characteristics of those populations. It is used to identify aspects of the population that merit further and more detailed examination. However, epidemiologic data is appropriate for testing only very broad and population- level hypotheses because such data always is confounded by a number of uncontrollable factors, including environmental conditions, regional food preferences, local social and economic factors, soil conditions, food distribution, and the availability of health care (especially in areas where preventive health care is poorly available). Name the types of research designs in epidemology - • cross-sectional surveys: contemporaneous determination of disease status (prevalence) and dietary exposure • ecological studies: examination of correlations between disease status and dietary exposures of several populations or of one population observed at several times • cohort studies: prospective or retrospective observation over time of the occurrence of disease (incidence) in subgroups within a population that have been formed based on degree of exposure to the putative risk factor • case-control studies: contemporaneous (using active controls) or retrospective (using historical controls) examination of any relationship between disease status and dietary exposure of individuals matched or paired on the basis of common characteristics other than disease status and dietary exposure (such as sex, age, nondietary lifestyle factors, etc.) Etiologic Relationships between Diet and Chronic Disease • Increases in polyunsaturated fatty acid intake are associated with increased requirements for vitamin E. • Excess dietary leucine may antagonize the functions of vitamin B6 and impair the conversion of tryptophan to nicotinic acid. • Toxic levels of cadmium interfere with the absorption of iron. Drug/Nutrient Interactions - Known defects in nutrient absorption or utilization induced by medications include: • anesthetic (nitrous oxide): accelerates metabolic clearance of vitamin B12 • angiotensin-converting enzyme (ACE) inhibitors (benazepril HCl, captopril, enalapril, fosinopril, lisinopril, moexipril HCl, quinapril HCl, ramipril): chelate iron and inhibit its absorption, inhibit potassium excretion and increase urinary zinc excretion • antacids containing magnesium: increase intestinal pH and decrease folate and riboflavin absorption • antacids (H2 antagonists: cimetidine, famotidine, nizatidine, ranitidine): inhibit the absorption of calcium, iron, zinc, folate, vitamin B12 and vitamin D • anthracyclines (daunorubicin, doxorubicin, epirubicin, idarubicin, valrubicin): inhibit endogenous synthesis of coenzyme Q10 (ubiquinone) • antibiotics: lethal to intestinal microbes and impair the abilities to ferment dietary fiber, produce vitamin K and resorb water along the colon • anticoagulant (heparin): interferes with activation of vitamin D and with osteoblast function • anticonvulsants (carbamazepine, phenobarbitol, phenytoin, primidone, valproic acid): - accelerate vitamin D inactivation by liver and excretion in bile, - decreasing calcium absorption, - increase hepatic accumulation of vitamin A, - accelerate metabolic clearance of vitamin C and vitamin K and - inhibit absorption of biotin, folate and vitamin B12 • antidepressants (tricyclic): inhibit the actions of enzymes requiring coenzyme Q10 Drug/Nutrient Interactions - antidepressants (monoamine oxidase inhibitors: clorgiline, furazolidone, isocarboxazid, moclobemide, phenelzine, selegiline, tranylcypromine, toloxatone): increase appetite and carbohydrate craving; inhibit the actions of enzymes requiring vitamin B6; cause sensitivity (with vasoconstriction, tachycardia, chest pains, headache, intracranial hemorrhage, cardiac arrthythmias, cardiac failure) to dietary tyramine (found in cheese, smoked or pickled fish, chianti, banana peels, yeast, dry sausage, sauerkraut, beers and ales) Drug/Nutrient Interactions - anti-gout (colchicine): induces malabsorption of vitamin B12 and dietary sugars and inhibits intestinal mucosal cell replication • antihypertensives (hydralazine, isoniazid): inhibit the actions of enzymes requiring vitamin B6 • antihypertensives (methyldopa): inhibit absorption of iron, folate and vitamin B12 and inhibit the actions of enzymes requiring coenzyme Q10 • antihypertensives (beta-blockers: acebutolo, alprenolol, atenolol, esmolol, metoprolol, penbutolol, pindolol, propranolol): chelate dietary calcium, preventing its absorption, and inhibit the actions of enzymes requiring coenzyme Q10 • anti-inflammatory (colchicine): arrests mitosis of enterocytes, causing structural defects and enzyme deficiencies in the intestine and inhibiting the absorption of vitamin A, fatty acids, -carotene, vitamin B12, sodium and potassium Drug/Nutrient Interactions - anti-inflammatory (non-steroidal anti-inflammatory drugs: aspirins, bromfenac, celecoxib, choline salicylate, diclofenac, diflunisal, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, nabumetone, naproxen, oxaprozin, piroxicam, rofecoxib, salicylic acid, sulfasalazine, sulindac): inhibit folate absorption • antimicrobials (cycloserine, erythromycin, kanamycin, neomycin): can produce structural defects in bile ducts, decreasing bile acid transport to the intestine and inhibiting the absorption of amino acids, fatty acids, calcium, sodium, potassium, magnesium, iron, vitamin A, folate and vitamin B12 • antimicrobials (sulfasalazine): inhibits mucosal uptake of folate • antimicrobials (tetracyclines): forms chelates with divalent and trivalent cations, inhibiting their absorption • antineoplastic (cisplatin): accelerates urinary excretion of magnesium and potassium Drug/Nutrient Interactions - antineoplastic (methotrexate): arrests mitosis of enterocytes, causing structural defects and enzyme deficiencies in the intestine and inhibiting the absorption of folate, vitamin B12 and calcium • antipsychotics: inhibit the actions of enzymes requiring coenzyme Q10 • antitubercular (isoniazid, para-aminosalicylic acid; rifampin): inhibit absorption of folate and vitamin B12; block the activation of vitamin D; inhibit conversion of tryptophan to niacin; and inhibit the actions of enzymes requiring pyridoxine • contraceptives containing estrogen: inhibit absorption of vitamin A, folate and vitamin C • diuretics (potassium-sparing: amiloride, spironolactone, triamterene): inhibit urinary potassium excretion Drug/Nutrient Interactions - • diuretics (potassium depleting: thiazides, loop diuretics: bumetanide, furosemide, torsemide): increase urinary excretion of thiamin, magnesium and potassium • estrogens: accelerate calcium and magnesium deposition into bone • glucocorticoids: inhibit calcium and folate absorption and accelerate bone demineralization • HMG-CoA reductase inhibitors (atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin, simvastatin): inhibit the regulatory enzyme in the pathway of coenzyme Q10 synthesis Drug/Nutrient Interactions - • hypocholesterolemics (cholestyramine): binds bile acids, cholesterol, bile salts and nutrients, decreasing the digestion and absorption of fatty acids, fat soluble vitamins, iron, vitamin B12 and beta-carotene • hypocholesterolemics (clofibrate): interferes with the absorption of vitamin A, vitamin D, vitamin E and vitamin B12 • hypocholesterolemics (colestipol): binds and promotes excretion of bile acids, decreasing the absorption of fatty acids and fat soluble vitamins • hypoglycemics (oral hypoglycemic drugs, especially metformin and phenformin): induce malabsorption of vitamin B12 Drug/Nutrient Interactions - • laxatives (castor oil, milk of magnesia, mineral oils, phenolphthalein): decrease absorption of calcium, potassium, beta-carotene and vitamin A, vitamin D and vitamin K • potassium repletion: alters ileal pH, inhibiting absorption of vitamin B12 • proton pump inhibitors (lansoprazole, omeprazole, rabeprazole): inhibit absorption of vitamin B12, iron and zinc • reverse transcriptase inhibitor (zidovudine): inhibits absorption of zinc, copper and vitamin B12 • sedative (glutethimide): inhibits calcium and folate absorption• Therapeutic Nutrition Acne p 158 -