Nutrition & Growth 1

8/22/2019 Nutrition & Growth 1

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NUTRITION & GROWTH 1

Dr Lailan Safina, M.Si.Med


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NUTRITION

Al-Ghidza (Arabic): food

Important at everystage of the life span

As the indicator of healthstatus to maintain theoptimal quality of life


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Adequate Diet

is composed of various nutrients that the

body needs for:

- maintenance

- repairs

- living processes

- growth / development


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Characteristics of a healthy diet

Variety

+

Balance+

Moderation


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Variety no single food supplies all thenutrients needed

Balance a balance diet incorporatesappropriates amounts of foods from all

food groups, providing needed caloriesand nutrients

Moderation careful selection of foodsand beverages to control the intake ofexcess calories, salt, sugar,fats/cholesterol


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4 sehat 5 sempurna

Makanan 4 sehat terdiri dari:

1. Makanan pokok (staple food): karbohidrat

2. Lauk pauk: protein hewani dan nabati

3. Sayuran

4. Buah-buahan

sayuran dan buah merupakan sumber

vitamin dan mineral utama

5 sempurna: susu


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BODY MASS INDEX (Adults)

BMI = Body Weight (kg) / Height 2 (m)2

BMI (Kg/m2)

Underweight < 18,5

Normoweight 18,5 22,9Overweight 23 24,9

Obes I 25 29,9

Obes II > 30


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Malnutrition

1. Undernutrition

Severe undernutrition, particularly in infants &

young children high mortality rates

Decreases in growth

Deficits in physical and mental development

In adults: compromises health, endurance,

productivity and increases susceptibility toinfection


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2.Overnutrition

Obesity

3 leading causes of death in adults in

North America: hearth disease, Ca, stroke

Sedentary lifestyle, eating out big

portion, high fat and salt.


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Nutrient needs

Nutrients: substances that are essential for

growth and good health > 40 nutrients

Essential : it cannot be synthesized by the

organism in sufficient quantities and must be

obtained from external source Types of nutrient:

- macronutrient: nutrients needed in large

quantities (carbohydrate, protein, lipid)- micronutrient: nutrients needed in relatively

small quantities (vitamin, mineral, water)


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Nutrient needs

1. Energy

2. Carbohydrate

3. Protein4. Lipid

5. Vitamin

6. Mineral7. Water


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Influences on Nutrient needs:

- age

- gender- reproductive status

- environment

- lifestyle habits- presence of disease


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3 general functions of nutrients:

- providing energy (energetic food):

carbohydrate, protein, lipid

- forming structural components of the

body (building food): protein, mineral,

water

- regulating body functions (regulatory

food): protein, mineral, water.


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Energy

The energy obtained from food is measured inkilocalories orkilojoules

1 kcal = 4,184 kJ (4,2 kJ)

- carbohydrate : 4 kcal/g (17 kJ/g)- protein : 4 kcal/g (17 kJ/g)

- fat : 9 kcal/g (37 kJ/g)

Average calories intake:- male : 2000 kcal/day

- female : 1600 kcal/day


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Carbohydrate, protein, fat : provide energy

to perform body functions

Alcohol, which supplies 7 kcal/g, is not

considered as a nutrient because it has no

required function in the body.

Vitamin, mineral, water : do not provide

energy but performing body functions.


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Pedoman Umum Gizi

Seimbang (PUGS)

Energy needs

60-75% carbohydrate 10-15% protein

10-25% fats


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Calculation of energy in foods / diet

1 slice of toast with butter and strawberry

jam, contains: 3 g protein, 7 g fat, 26 g

carbohydrate. How much energy does it

provide?

- 3 g protein = 3x4 kcal = 12 kcal

- 7 g fat = 7x9 kcal = 63 kcal

- 26 g CHO = 26x4 kcal = 104 kcal

Total = 179 kcal or 752 kJ


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Energy Balance

If energy intake > energy expenditure

= weight gain

If energy expenditure > energy intake= weight loss


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Classification of Carbohydrate

Simple Carbohydrates

1. Monosaccharides (sugar): C6(H2O)6 dan C5(H2O)5glucose, fructose, galactose

2. Disaccharides: C12(H2O)11 sucrose, maltose,lactose

3. Sugar alcohols

4. Oligosaccharides

Complex Carbohydrates

1. Polysaccharides :

- starch (plant) cereal grains: wheat,rice, corn, oat,potatoes

- glycogen (animal/human)

2. Polysaccharide non-starch : cellulose, fiber


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Sources of carbohydrate

Simple carbohydrate Table sugar

Cakes

Biscuits-plain

Jam

Chocolate

Candy Gums / sweets

Honey

Soft drinks

Tinned fruits

Complex carbohydrate Pasta Macaroni

Spaghetti

Brown rice

Potatoes

Other root vegetables Wholemeal breads

Wholegrain cereal

All bran

Cassava

Corn Peas

Beans

lentils


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CHO Function

1. Source of energy

CHO contribute the largest proportion to daily caloricenergy consumption: 50-75%

The minimal amount of carbohydrate required, eitherfrom endogenous or exogenous sources, is determinedby the brains requirement for glucose.

The brain is the only carbohydrate-dependent organ,normally requires glucose exclusively for its energyneed

2. Energy Reserve

- liver glycogen- muscle glycogen

3. Sweetness


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Daya kemanisan gula dan pemanis buatan

Jenis gula/ pemanis Daya kemanisan

(sukrosa=1,0)

Sumber/penggunaan Konsumsi yang

dianggap aman

Gula

Fruktosa

Sukrosa

Glukosa

MaltosaLaktosa

1,7

1,0

0,7

0,40,2

Buah, madu, minuman ringan

Gula pasir, gula merah, permen

Sirup jagung

Biji berkecambahSusu dan produknya

Gula alkohol

Manitol

Sorbitol

xylitol

0,7

0,6

0,9

Permen khusus untuk diet

Permen khusus untuk diet

Permen karet tanpa gula

Pemanis buatanSakarin

Siklamat

aspartam

500

80

200

Minuman ringan diet

Minuman ringan diet, permen

karet tanpa gula, pemanis khusus

diet, makanan/minuman jajanan

Permen karet tanpa gula,

minuman diet, pemanis diet

50-300 mg/kg BB

11 mg/kg BB

40 mg/kg Bb


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4. Prevent glukoneogenesis

CHO is needed to protect protein from

being used as energy source5. Anti Ketogenic

- In the event of insufficient supply of glucose,

the brain utilizes ketoacids for part of its energy

requirements- In response, the liver increases production of

ketoacids. This occurs after the glycogen store

of the starving person is depleted.

- FAO/WHO : the amount of CHO requiredto avoid ketosis is 50 g/day in adults

6. Increase fecal bulk


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variety component sample Physiologies effect

Not digest

Non CHO Lignin Wheat bran bulk feses, effect estrogen-like

CHO cellulosa

Hemicellulosa

Wheat products

Brown Rice

bulk feses

increase intestinal transit time

Digest

CHO Pektin, gum,mucilago,

some of

hemiselulosa

Apel, banana, orange,carrot, barley, oats,

red bean

Decreased gastric emptying;Decreased glucose absorption;

decreased blood cholesterol

Fiber

Fiber product energy 0,5-3 kcal/g


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Physiologic effect of dietary fiber

Stimulating chewing, saliva flow, gastric juicesecretion

Fills the stomach and provides a sense of satiety

Increase fecal bulk Normalizes intestinal transit time

Become a substrate for colonic fermentation

Delay gastric emptying

Slows the rate of digestion and absorption

Lower serum cholesterol


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Glicemic Index

A numerical index that ranks CHO based

on their rate of glycemic response (i.e their

conversion to glucose within the human

body)

Scale 0 100, with higher values given to

foods that cause the most rapid rise in

blood sugar

A reference point: pure glucose (GI = 100)

Gl i I d


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Glycemic Indexes

Reference: glucose=100Low < 55 - High > 70

Pasta

Red rice 55

Rice 56-72

Spaghetti 41

Fruit

Boiling carrot 49

Sweet corn 55

Bake potatoes 85

Boiling potatoes 62

Sugar

Madu 73 Sucrose 65

Fructose 23

Lactose 46

Fruit

Apple 38

Banana 55

Lemon 25

orange 44

Soft drink Apple juice 40

Orange juice 46

Coca cola 63

Snack

Potato chips 54 Wafer vanila 77

Chocolate 49

Jelly 80


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Composition

C (50-55%), H (6-7,3%), O (19-24%),N (13-19%), S(0-4%)P, Fe dan Co

Dietary protein is usually measured notas protein but as nitrogen

6,25 gr protein content 1 gram ofnitrogen

Total Protein = 6,25 x total N in food


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CLASSIFICATION OF AMINO ACID

ESSENTIAL AAhistidine, leucine, isoleucine, valine,

tryptophan, phenilalanine, methionine,

threonine, lysine

CONDITIONALLY AA

proline, serin, tirosin, cystein, taurin, glycin

NON ESSENTIALE AA

glutamate, alanin, aspartat, dan glutamin


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Classification AA based on Structure

Alifatic :Glysine, Serine, Treonine,Alanine, Valine, Leusine, Isoleusine

Aromatic: Phenilalanine, Tyrosine

Content sulfur : cystein, Cystin,Methionin

Heterosiclic: Tryphtofan, Proline,Hidroksi Prolin, 3 Hidroksi proline


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The importance of protein & amino

acids

Catalyzes virtually all chemical reactions in thebody

Regulate gene expression

Comprise the major structural elements of allcells

Regulate the immune system

Form the major constituent of muscle

Individual AA also serve as neurotransmitters,hormones and modulators of variousphysiological processes


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Nutritional quality of food proteins

Depends on 2 factors:

The content of essential amino acids

The digestibility of the protein

Complete protein contain all essential AA in a

good proportion needed for growth

animal protein

Incomplete protein contain no/not all essential AA

vegetable protein, except soybean


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Net Protein Utilization (NPU)

A measure of quality protein based on the

percentage of ingested nitrogen that is

retained in the body

NPU =

N in food (N urin + feces)

N in food


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Bahan Makanan NPU

Telur

Susu sapi

Daging sapi

Beras tumbuk

Kacang tanahBeras giling

Gandum utuh

Jagung

Kacang kedelai

Biji-bijian

94

82

67

59

5557

49

36

61

53


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Nitrogen Balance

Nitrogen Balance = N consumed N loss

(urine, feces, sweat, hair/skin loss)

Nitrogen Balance if N consumed = N lost

no growth, adult people

Nitrogen Balance Positif if N consumed > N loss

infant, children, teenager, pregnant, lactating

Nitrogen Balance Negative if N loss > N consumed disease, post-op


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Protein sources

1. Animal protein:

Egg and product

Meat

Poultry

Fish

Milk and dan product

2. Vegetable protein:

Beans: soybean and products (tahu, tempe, kecap)

Nuts

Whole grains


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DIGESTION OF PROTEIN

Gaster :hidrocloride acid and pepsin

degradation protein peptide

Small intestinum: chimotripsin and

peptidase pancreas breakdown

polipeptide amino acid , for

absorption


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General signs of protein deficiency

Underweight

Stunting

Poor musculature

Edema Fragile hair

Skin lesions

Biochemical changes including low serumalbumin

Hormonal imbalances


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LIPID

25-35% of total energy

9 kcal/gram of energy

Dietary fat is stored in adipose cells locatedin depots on human frame

Survive w/o food for weeksmonths

insufficient fat starvation--malnutrition


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Adipocytes


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Classes of lipids

Triacylglycerols (triglycerides)

Glycolipids

Phospholipids

Sphingolipids

Sterol esters


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Triacylglycerols (triglycerides/TG)

- fats and oils in foods are made of TGs

(98%+)

- each molecule of TG contains 3 FA +

glycerol- TGs serve as reserve of energy stored in

adipose (fat) tissue in animals and in

seeds of plants


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Glycolipids

- FAs combined with sugars

- Associated with cell surfaces

Phospholipids

- FAs combined with glycerol & phosphorus

- Important structural component in cells

- Supply FA precursors for the synthesis of

eicosanoids which are potent controllers of

many physiological processes


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Sphingolipids

- FAs combined with long-chain amines

- Important components of brain tissues &

CNS

Sterol esters

- Sterols combined with FAs

- Structural role in cell membranes- Precursors of steroid hormones & vit D


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Fatty Acid

FA = straight chains hydrocarbons possessing acarboxyl (COOH) group at one end and methyl(CH3) at the other end

The length of chains:

- Short-chain FA: 6C or less

- Middle-chain FA: 8C 12C

- Long-chain FA: 14C 18C

- Very long-chain FA: 20C or more
http://upload.wikimedia.org/wikipedia/commons/b/b3/Stearic_acid.svg


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Saturated Level of FA

Saturated FA: single bonds between C atoms

Unsaturated FA: double bonds between C atoms- monounsaturated FA

- polyunsaturated FA

Generally, at room temperature

- saturated FAs are hard

- unsaturated FAs are oils


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The greater the degree of unsaturation inFA the more vulnerable it is to lipid

peroxidation

protected by antioxidants


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Unsaturated FAs:

- lowering LDL cholesterol- reducing the coagulability of blood

platelets

- reducing the risk of heart disease


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Types and sources of dietary fats

Saturated Monounsaturated Polyunsaturated

Coconut oil Olive oil Corn oil

Palm kernel oil Canola oil Soybean oil

Beef / pork fat Peanut oil Sunflower oil

Chicken skin Safflower oil

Cocoa butter Fish oil

Milk fat & products


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Essential FA

FA that cannot be constructed within anorganism (humans), therefore must be obtainfrom the diet

Two families of EFA:

- linoleic acid (18:2 -6)- linolenic acid (18:3 -3)

Derivatives of EFA which is important:

- arachidonic acid (20:4 -6)

- eicosapentaenoic acid/EPA (20:5 -3)- docosahexaenoic acid/DHA (22:6 -3)


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EFAs are needed especially for foetal

growth and infant synthesis of structuralcomponent in cells.

Almost 50% of brains component lipid

50% : polyunsaturated FA

Breast milk polyunsaturated FA >>

(arachidonic acid & DHA)


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EFAs are precursor for eicosanoid group:

prostaglandin, prostacyclin, tromboxane,

leukotrien

blood pressure, heart beat, immunity,

nervous system, muscle contractility,

wound healing

Formation of Arachidonate


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Formation of Arachidonatein Mammals

Linoleic acid

CO2H

14 11 8 5

Arachidonic acid (20:45, 8, 11, 14)(Eicosa-5,-8,11,14-tetraenoic acid)

As CoA ester:

1) Elongation2) Desaturation x 2

Prostaglandins

CO2H


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Omega-3 Fatty Acids

CO2H

CO2H

-3 double bond Eicosapentaenoic acid (20:55, 8, 11, 14, 17)

Docahexaenoic acid (22:64, 7, 10, 13, 16, 19)

Found in fish oils, esp. cold water fish

Important in:Growth regulationModulation of inflammationPlatelet activationLipoprotein metabolism


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Manifestation of essential fatty acid deficiency

Flaky, itchy skin

Diarrhea

Infections

Growth retardation

Poor wound healing

anemia

Trans Fatt Acids


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Trans Fatty Acids

Found in animal and plant foods

Originally unsaturated the good ones which arechanged to bad ones (saturated fat) throughchemical changes including hydrogenation ofoils

Recent research suggests that trans FAs canincrease the risk for heart disease

The American Heart Association: limitation theamount of trans FAs & saturated FAs to lessthan 10% of total calories consumed daily

F d f t f t


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Food sources of trans fat

Trans FAs are formed when vegetable oils arepartially hydrogenated to make them solid atroom temperature

Trans FAs are found in commercially bakedcookies and cakes, salty snack foods such aschips, some margarines and commercially friedfoods

Meats and dairy products (from naturallyoccuring chemical changes in the animals bodyas it digests food)

Ch l t l


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Cholesterol

Cholesterol in food comes from animal sources

only

Cholesterol is also produced in our bodies

Limit our dietary intake to no more than 300

mg/day Sources:

- meat, poultry, shell fish, egg yolks

- whole milk & dairy products: butter, cheese,ice cream

Functions of Lipids


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Functions of Lipids

Concentrated energy (diet and storage)

Provides essential FAs

Insulation for body

Padding around organs Transport fat-soluble vitamins: A,D,E,K

Contribute to satiety

Flavor and mouth feel of foods Present in cell membranes

Ri k f f t i t k b it


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Risk of excess fat intake: obesity

OBESITY

Some cancers atherosclerosis Stroke & heart

attack

Gallbladder disease diabetes

hypertension

Health claims on food labels


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Health claims on food labels

Fat free : less than 0,5 g/serving and less than 0,5 g

trans FAs Low fat : 3 g or less of total fat

Reduced or Less Fat : at least 25% less than the original

product

Saturated Fat Free : less than 0,5 g/serving and lessthan 0,5 g trans FAs

Low Saturated Fat : 1 gr or less/serving and not more

than 15% calories from saturated FAs

Cholesterol Free : less than 2 mg/serving

Cholesterol Low : 20 mg/serving


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Nutrition & Growth 1