Fundamentals of Nutrition 2017

Fundamentals of Nutrition

MAR-ANN B. BRINGAS, MD Assistant Professor

Department of Biochemistry and Nutrition FEU-NRMF Institute of Medicine

Nutrition Principles

Wellness

Manage changing nutrition needs over

the life cycle

Fist Year: Structure/ function

courses

Prevention/ Primary Care

Risk factor management with

dietary modifications

Second year: Scientific Basis of

Medicine

Therapeutics

Primary or adjunct therapy with specific goals

Clinical clerkships

What is Clinical Nutrition

Clinical nutrition is the study of the relationship between food and a healthy body.

It is the science of nutrients and how they are digested, absorbed, transported, metabolized, stored, and eliminated by the body.

It is interested in how the environment affects the quality and safety of foods, and what influence these factors have on health and disease.

Nutrition Definition

NUTRITION is the composition and quantity of food intake and the utilization of the food by the living organism.

Essential nutrient

Inessential Nutrient

The Meaning of…

Nutrition Health

Food Nutrients

Essential nutrient

NUTRITION THREE AREAS

ESSENTIAL NUTRIENTS Proteins Isoleucine

Leucine Lysine Phenylalanine

Threonine Tryptophan Methionine Valine

Fat-soluble vitamins

A/D/E/K

Water-soluble vitamins

Thiamine Niacin Ascorbic acid Riboflavin

Pyridoxine Cobalamin Folic acid

Fats Linoleic acid

Arachidonic acid Linolenic acid

Minerals Calcium Iron Potassium Magnesium Chlorine Phosphorus Sodium

Iodine Sulfur Manganese Copper Cobalt Zinc molybdenum

NUTRITIONAL STATUS / NUTRITURE

• The condition of the body as a result of ingestion and utilization of food.

• Nutritional status is dependent on the:

intake of dietary

nutrients

relative need for nutrients

body’s ability to utilize them

NUTRITIONAL STATUS ASSESSMENT

•Anthropometry A

•Biochemical Data B

•Clinical History C

•Dietary Intake survey D

ANTHROPOMETRY

Physical measurement of weight, height, and body

compartments of fat and lean tissue

Growth Body composition

Energy expenditure

ANTHROPOMETRY

http://www.slideshare.net/soharashed/assessment-of-nutritional-status

ANTHROPOMETRY Adults

Height measurement Stand erect and barefooted

on a STADIOMETER with a movable headpiece.

The head piece is leveled with skull vault & the height is recorded to the nearest 0.5 cm.


ANTHROPOMETRY Infants


INDICES OF GROWTH

Weight for age Weight for

height

Height for age

Weight/height ratios

Quetelet’s index

weight in kg

height in m2

ANTHROPOMETRY

Height - chronic nutrition

Weight - measure of growth

Gomez classification

Waterlow classification

Body Mass Index (BMI)

Gomez Classification

The child's weight is compared to that of a normal child (50th percentile) of the same age. It is useful for population screening and public health evaluations. • Formula:

Actual body weight X 100

Ideal body weight

• Interpretation:

Status Weight for age

Normal 90 – 100%

Malnutrition

First degree 75-89%

Second degree 60-74%

Third degree <60%

Overweight 101-120%

Obese >120%

Waterlow Classification

Chronic malnutrition results in stunting. Malnutrition also affects the child's body proportions eventually resulting in body wastage. • Formula:

Actual body weight X 100 = Wasting

Weight for height

Actual height X 100 = Stunting

Height for age

Standard Stunting Wasting

Normal >95% >90 %

Mild 87.5-95% 80 – 90%

Moderate 80-87.4% 70-79%

Severe <80% <70%

BODY MASS INDEX FOR FILIPINOS

Body Mass Index = Weight [kilograms]/Height [meters]2 OR = Weight [pounds]x703/ height [inches]2

BODY MASS INDEX

International standard for assessing body size in adults is the BMI = weight (kg)/ Height (m2)

BMI-ASSOCIATED RISKS

Waist circumference

• Predicts mortality better than any other anthropometric measurement

No risk of illness due to overweight

Avoid weight gain or drop on weight

Should drop weight Seek for help from health care professionals

Men < 94 cm 94-101 > 102

Women < 80 cm 80-87 > 88

Waist circumference (cm)

BIOCHEMICAL DATA

• Assessment or measurement of the level of nutrient in the body

PROTEIN

plasma amino acid

level serum albumin

level hair root

morphology

NUTRIENTS

Serum retinol Serum iodine

Calcium Vit D levels

LIPIDS

serum cholesterol serum triglycerides

lipoprotein

CLINICAL HISTORY AND PHYSICAL EXAMINATION

• Complete medical history

• Complete physical examination

• Signs/symptoms of nutritional deficiency

CLINICAL NUTRITIONAL ASSESSMENT

Detailed nutritional history that includes: Clinical Dietary Socioeconomic Family issues

Areas of interest include: • present and past illnesses • family illness history • food allergies or intolerance • medications • nutritional supplements • over-the-counter meds • alcohol use • work environment • education level.

DIETARY ASSESSMENT

National

• Food balance sheets

• Market databases

Household

• Food account method

• List-recall method

• Inventory method

• Household record method

• Telephone survey

• Use of household food-consumption data for National Food-Consumption

Individuals

• 24-hour recall

• Food records

• Weighed-food records

• Dietary history

• Food frequency questionnaire

• Observed food consumption Video and photographic methods

DIETARY INTAKE SURVEY








Recommended Energy and Nutrient Intake (RENI)

• Formerly termed RDA

• Amount of energy and essential nutrients needed to meet the minimum requirement to:

* maintain health

* provide reserves

* added amount for incomplete digestion

• Factors that influence RDA:

* Age

* Sex

* physiologic stresses

Recommended Energy and Nutrient Intake (RENI) Philippines, 2002 Edition

COMPONENTS OF ENERGY EXPENDITURE

Basal Metabolic Rate

BMR

Physical Activity PA

Specific Dynamic Action of Food

SDA

Growth

BASIC METABOLIC RATE

• Largest component of energy expenditure

• Energy used at rest

• Calories spent with NO activity

• Indicates amount of energy used to sustain life’s processes

Factors That Affect BMR

Factors That Affect BMR

FACTOR EFFECT ON BMR

Environmental temperature

Both heat and cold raises BMR

Fasting/ starvation Lowers BMR

Malnutrition Lowers BMR

Hormones (gender) Thyroid, male hormones, premenstrual hormones raise BMR

Smoking/Caffeine Increases energy expenditure

Sleep BMR lowest when sleeping

PHYSICAL ACTIVITY

• Second largest component

• More vigorous physical work would require greater energy

SPECIFIC DYNAMIC ACTION OF FOOD

• Production of heat by the body above basal level during digestion and absorption of food

• Highest for proteins (12%)

• Low for carbohydrates (6%) and fats (4%)

• SDA contribute ̴ 10% of the consumed calories

GROWTH

Additional energy to cover for the

cost of increasing body weight and height

ENERGY REQUIREMENT

• Most basic nutritional requirement taking precedence over all other nutritional needs

• Energy – the capacity to do work

• Measured in terms of calories

Calorie (C)

• Standard unit for measuring energy

• Amount of heat energy needed to raise the temperature of 1 ml of water by 1 degree centigrade.

• Kilocalorie (C)= 1000 cal

ENERGY YIELD OF FOOD SOURCES

NUTRIENT In vitro Bomb

Calorimeter Cal/g

In vivo Oxidation

Cal/g

Standard Conversion

factor Cal/g

CHO 4.10 4.00 4

CHON 5.65 5.20 4

FATS 9.45 9.00 9

ALCOHOL 7.10 7.10 7

ESTIMATING DAILY ENERGY EXPENDITURES

• Total Energy Expenditure

TEE

• Total Energy Requirement

TER

• Total Caloric Requirement

TCR

Amount of

Calories needed per day

CALCULATION OF TER: Factorial Method

IBW • Determination of ideal body weight

BMR • Calculation of BMR for 24 hrs.

cBMR • Correct the BMR for sleep

PA • Compute for physical activity

SDA • Compute for SDA

TCR • Compute for TCR = cBMR + PA + SDA

PHYSICAL ATIVITY

Bed rest 10% of corrected BMR

Sedentary 30% of corrected BMR

Light 50% of corrected BMR

Moderate 75% of corrected BMR

Heavy 100% of corrected BMR

TER CALCULATION

Case

◦Height: 5’4’’ or 160 cm

5 fett 4 inches tall = 64 inches 64 in. x 2.54 = 162.56 or 160 cm Actual Body Weight : 65kg

TER CALCULATION

A. DETERMINATION OF IBW • Use the standard weight and height tables

Tannhauser method

• [height in cm. – 100] – [(height cm - 100)10%]

• If height is 160 cm.

• [160 – 100] – [(160 – 100) 10%] = 54 kg.

Fernando/ NDAP

• Males IBW = 50 kg + 2.3 kg every inch over 5 ft.

• Females IBW = 45.5 kg + 2.3 kg every inch over 5 ft.

• Ex: 5 feet 2 inch male

• = 50 + (2x2.3 kg)

• = 54.6 kgs or 120 lbs

TER CALCULATION

B. DETERMINE BMR FOR 24 HRS

Male = 1 kcal/ kg IBW/hr x 24

Female = 0.95 kcal/kg IBW/hr x 24

Example: Male IBW = 54 kg.

1 kcal/kg x 54 kg x 24 = 1296 kcal/day

TER CALCULATION

C. CORRECT THE BMR

Subtract 10% of kcal/kg/IBW/hr of sleep from BMR

Example: Slept for 8 hrs.

0.1 x 54 kg x 8 hrs = 43.2 kcal

1296 kcal – 43.2 kcal = 1252.8 kcal

TER CALCULATION

D. COMPUTE FOR PHYSICAL ACTIVITY

Example: Moderate Physical Activity

75% of corrected BMR

0.75 x 1252.8 = 939.6 kcal

Bed rest 10% of corrected BMR

Sedentary 30% of corrected BMR

Light 50% of corrected BMR

Moderate 75% of corrected BMR

Heavy 100% of corrected BMR

TER CALCULATION

E. COMPUTE FOR SDA

10% of the sum of cBMR and PA

Example: 10% (cBMR + PA)

0.1 (1252.8 + 939.6) = 219.24 kcal/day

TER CALCULATION

F. COMPUTE FOR TOTAL ENERGY REQUIREMENT

TER = cBMR + PA + SDA

TER = 1252.8 + 939.6 + 219.24

TER = 2411.64 kcal/day

CALCULATION OF NUTRIENT DISTRIBUTION BASED ON TER:

Nutrient Percentage

Carbohydrate 55-70%

Protein 10-15%

Fat 20-30%

Given TER 2400kcal/day

NUTRIENT % COMPUTATION GRAMS equivalent

CHO 60% 2400 kcal/d x .6 = 1447 kcal 1447/4 = 360

Protein 10% 2400 kcal/d x .10 = 241 kcal 241/4 = 60

Fat 30% 2400 kcal/d x .30 = 724 kcal 724/9 = 80

Diet Rx: TER 2400 kcal, 362g CHO, 60g Protein, 80g Fats


TEE/TER/TCR

TCR = BMR x Activity Factor x Injury Factor (1.0)

Resting or Basal Metabolic Rate (BMR) Harris-Benedict Equation

ENERGY FOR BMR

• Men = 66+ ( 13.7 x weight kg ) + ( 5 x height Cm ) - ( 6.8 x age in years )

• Women = 655.1 + ( 9.6 x weight kg ) + ( 1.8 x ht cm) - ( 4.7 x age in years)

HARRIS –BENEDICT EQUATION

• Men: 1 kcal/kg/hour x 24 hours

• Women: 0.9 kcal/kg/hour x 24 hours

SHORT METHOD

ACTIVITY FACTOR LEVEL OF

INTENSITY

TYPE OF ACTIVITY ACTIVITY FACTOR TEE(Kcal/Kg/Day)

Very light Seated and standing activities. Painting trades, driving, laboratory work, typing, sewing, ironing, cooking, playing cards, musical instrument

1.3 (men) 1.3(women)

31 30

Light Intensive exercise for at least 20 minutes 1 to 3 times/ week. Bicycling, jogging, basketball, swimming, skating, etc. If you do not exercise regularly, but you maintain a busy life style that requires you to walk frequently for long periods, you meet the requirements of this level

1.6 (men) 1.5 (women)

38 35

Moderate Walking 3.5-4mph. Intensive exercise for at least 30 to 60 minutes 3 to 4 times per week. Any of the activities listed above will qualify Intensive exercise for at least 3-4x/week

1.7 (men) 1.6 (women)

41 37

Heavy Intensive exercise for 60 minutes or greater 5 to 7 days per week Labor-intensive occupations include construction work (brick laying, carpentry, general labor, etc.). Farming, landscape worker or similar occupations.

2.1 (men) 1.9 (women)

50 44

Exceptional Training in professional or world-class athletic events 2.4 (men) 2.2 (women)

58 51

STRESS FACTOR/INJURY FACTOR

Starvation 0.8-1.0

Normal/ Non-Stressed 1.0-1.3

S/P surgery without complications 1.25-1.35

Moderate Stress from chronic illness

1.35-1.5

Severe stress (acute illness, severe infection, trauma etc)

1.5

STEPS IN CALCULATING DIETS USING The HARRIS -BENEDICT Equation

A Filipino laborer, 36 years of age, 5 feet 4 inch tall, engaged in moderate physical activity.

Height: 162cm Ideal Body weight: 54 kgs

Nutrient distribution of TER:

• Carbohydrates = 60%

• Protein = 10 %

• Fats = 30 %

BMR

• Men’s BMR = 66+ (13.7 x weight kg) + (5 x ht cm) - (6.8 x age in years)

• BMR = 66+ (13.7 x 54 kg) + (5 x 162 cm) – (6.8 x 36 yo)

• BMR = 66+ 740 + 810– 244.8

• BMR = 1371 kcal = 1400 kcal

Harris-Benedict Equation

• Men: 1 kcal/kg/hour x 24 hours

• BMR = 54 x 24 = 1296 kcal = 1300 kcal

Short Method

TOTAL CALORIC REQUIREMENT

TCR = BMR x Activity Factor x Injury Factor (1.0)

TCR = 1400 x 1.7 x 1 = 2380 kcal or 2400 kcal (round to nearest 50)

TCR = 30-58 kcal/kg/day (refer to table)

= 41 x 54 = 2200 kcal

ACTIVITY FACTOR LEVEL OF

INTENSITY

TYPE OF ACTIVITY ACTIVITY FACTOR TEE(Kcal/Kg/Day)

Very light Seated and standing activities. Painting trades, driving, laboratory work, typing, sewing, ironing, cooking, playing cards, musical instrument

1.3 (men) 1.3(women)

31 30

Light Intensive exercise for at least 20 minutes 1 to 3 times/ week. Bicycling, jogging, basketball, swimming, skating, etc. If you do not exercise regularly, but you maintain a busy life style that requires you to walk frequently for long periods, you meet the requirements of this level

1.6 (men) 1.5 (women)

38 35

Moderate Walking 3.5-4mph. Intensive exercise for at least 30 to 60 minutes 3 to 4 times per week. Any of the activities listed above will qualify Intensive exercise for at least 3-4x/week

1.7 (men) 1.6 (women)

41 37

Heavy Intensive exercise for 60 minutes or greater 5 to 7 days per week Labor-intensive occupations include construction work (brick laying, carpentry, general labor, etc.). Farming, landscape worker or similar occupations.

2.1 (men) 1.9 (women)

50 44

Exceptional Training in professional or world-class athletic events 2.4 (men) 2.2 (women)

58 51

TCR

Factorial Method

2412 kcal

Harris Benedict Method

2400 kcal

Short Method

2200 kcal

Use 2400 kcal

CALCULATION OF TER

Use corrected body weight in Obese patients

• Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet. Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.

Ideal Body Weight

• CBW= IBW + [(ABW– IBW) x 25%]

CORRECTED BODY WEIGHT (if % IBW is => 125%)

Example: Corrected Body Weight

• Height: 5’4”

• Actual Body Weight 65kg

Given

• IBW = 50 + (2.3x4) = 59.2 59 kgs

IBW = 50 kg + 2.3 kg for each inch over 5 feet.

• = 65 kg/59kg x 100%

• = 110%

• NO NEED TO USE CORRECTED BODY WEIGHT

%IBW= ABW/IBW x 100%


• Height: 5’4”

• Actual Body Weight 80 kg

Given

• IBW = 50 + (2.3x4) = 59.2 59 kgs

IBW = 50 kg + 2.3 kg for each inch over 5 feet.

• = 65 kg/59kg x 100%

• = 135%

• USE CORRECTED BODY WEIGHT

%IBW= ABW/IBW x 100%


• CBW= IBW + [(ABW– IBW) x 25%]

CORRECTED BODY WEIGHT

• = 59kg + (21 x 25%)

• = 59kg + 5.25kg

• = 64.25 kg

CBW= 59kg + (80kg-59kg) x 25%

USE 64 kg in computing TER instead of 59 kg


Nutrient Percentage

Carbohydrate 55-70%

Protein 10-15%

Fat 20-30%

Given TER 2400kcal/day

NUTRIENT % COMPUTATION GRAMS equivalent

CHO 60% 2400 kcal/d x .6 = 1440 kcal 1440/4 = 360

Protein 10% 2400 kcal/d x .10 = 240kcal 240/4 = 60

Fat 30% 2400 kcal/d x .30 = 720kcal 720/9 = 80

Diet Rx: TER 2400 kcal, 360g CHO, 60g Protein, 80g Fats


DIET PRESCRIPTION

Rx Kcal 2400 kcal

CHO 360 g , CHON 80 g, Fats 60 g

Grams of each day may be rounded off

60% 15% 30%

FOOD EXCHANGE LIST

List I. Vegetable Exchange

List II. Fruit Exchange

List III. Milk Exchange

List IV. Rice Exchange

List V. Meat Exchange

List VI. Fat Exchange

List VII. Sugar Exchange

FOOD EXCHANGE LIST

• Green leafy and non-leafy vegetables.

• Two exchanges of vegetable A is equal to One exchange of vegetable B

LIST I. Vegetable

• This includes fresh fruits, canned, dried, and fruit juices specified as concentrated or diluted and sweetened or unsweetened

LIST II. Fruit Exchanges

FOOD EXCHANGE LIST

• Varieties of milk appear in the milk exchanges.

• Milk is classified into whole and non-fat types specified as concentrated or diluted.

• The nutrient value of ½ glass evaporated milk as whole milk is given as well as the equivalent of other types of milk.

LIST III. Milk Exchanges

• Varieties of bread, bakery products, rice and corn products

• Considering patients who are on low fat diet, bakery products with high fat content are to be restricted or should be considered in the fat exchange.

LIST IV. Rice Exchanges

FOOD EXCHANGE LIST

• 3 categories based on the amounts of fat:

• Low fat meat exchange = 8 g protein , 2 g fat

• Medium fat meat exchange = 8 g protein , 7 g fat.

• High fat meat exchange = 8 g protein , 10 g fat.

• Each category differs by almost 35 kcal.

LIST V. Meat Exchanges

• Saturated or polyunsaturated fatty acids.

LIST VI. Fat Exchanges

• Soft drinks, fruit concentrates and alcohols are included to provide additional information and to aid in the dietary computation.

LIST VII. Sugar Exchanges

COMPOSITION OF FOOD EXCHANGES

LIST FOOD MEASURE CHO gram

CHON gram

FAT gram

ENERGY kcal kj

I-A Vegetable A 1 cup, raw ½ cooked

- - - -

I-B Vegetable B ½ cup cooked/raw

3 1 16 67

II Fruit varies 10 40 167

III Milk Evap Whole Powdered Skim Very Low

½ cup 1 cup 4 tbsp 4 tbsp

12 12 12 12 12

8 8 8 8 8

10 10 10 5 trace

170 711 80 335

IV Rice varies 23 2 100 418

IV Meat Low fat Med fat High fat

Varies Varies Varies

8 8 8

2 7 10

50 209 95 398 122 510

VI Fat 1 tsp 5 45 188

VII Sugar 1 tsp 5 20 84

TRANSLATING A DAY’S EXCHANGES INTO A DAY’S MEAL

BREAK FAST

EXCH FOOD

Fruit 1 1 slice papaya

Milk 1 1 glass fresh cow’s milk

Sugar 1 2 teaspoons jelly preserves/spread

Rice 3 6 pcs. Pan de sal

Meat 2 2 slices cheese/ 3 tbsp corned beef

TRANSLATING A DAY’S EXCHANGES INTO A DAY’S MEAL

LUNCH EXCH. FOOD

Veg A 1 ½ cup talong

Veg B 2 1cup kalabasa

Fruit 1 1 medium slice mango ripe

Sugar 2 4 pcs. Chocolate candy with milk

Rice 3 1 ½ cup rice

Meat 2 2 medium size chicken wings

Fat 1 1 cup coconut milk (ginataang gulay)

FOR WEIGHT LOSS

Using the Harris-Benedict Equation, individuals can take a mathematical approach to weight loss. There are 3500 kilocalories in 1 lb (0.45 kg) of body fat. Using the Harris-Benedict Principle, if someone has a daily allowance of 2500 kilocalories, but he reduces his intake to 2000, then the calculations show a one pound loss every 7 days.

3500 kcal/ 7 days = 500 kcal/day

FOOD LABELS

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DAILY VALUES OF FOOD LABELS Food labels must present the “% daily Value” for these nutrients

Note: Daily Values were established for adults and children over 4 years old.

The values for energy-building nutrients are based on 2000 kcalories a day.

For fiber, the daily values was rounded up from 23.

Food Component Daily value Calculation factor Fat 65 g 30% of kcal Saturated fat 20 g 10% of kcal Cholesterol 300 mg - Carbohydrate (total) 300 g 60% of kcal Fiber 25 g 11.5 g per 1000 kcal Protein 50 g 10% of kcal Sodium 2400 mg Potassium 3500 mg Vitamin C 60 mg Vitamin A 1500 ug Calcium 1000 mg Iron 18 mg

Note: Daily Values were established for adults and children over 4 years old. The

values for energy-building nutrients are based on 2000 kcalories a day. For fiber, the

daily values was rounded up from 23.

HOW TO CALCULATE DAILY VALUES

The Daily values on food labels are designed for a 2000- kcalorie intake

Macronutrients have daily requirements of: Carbohydrates 60%, Fats 30%, Protein 10% of TCR.

2000 kcal x 0.60 kcal from CHO = 1200 kcal from CHO

2000 kcal x 0.30 kcal from fat = 600 kcal from fats

2000 kcal x 0.10 kcal from protein = 200 kcal from protein

A person who prefer to count in grams should convert using the 4-4-9 rule

1200 kcal/ 4 kcal per gram = 300 grams CHO

600 kcal/ 9 kcal per gram = 66 or 65 grams fats

200 kcal/ 4 kcal per gram = 50 grams protein

HOW TO CALCULATE THE ENERGY AVAILABLE IN FOODS:

1 slice of bread with 1 tablespoon of peanut butter on it contains 16 grams carbohydrate, 7 grams proteins, and 9 grams fat:

TOTAL 173

16 g carbo x 4 kcal/g 64

7 g protein x 4 kcal/g 28

9 g fat x 9 kcal/g 81

To determine the percentage of kcal from fat: 81 fat kcal / 173 = 0.468 ( rounded to 0.47) Then multiply by 100 to get the percentage: 0.47 x 100 = 47%

47% of this serving is from FAT

1 slice of bread with 1 tablespoon of peanut butter on it contains : 16 grams carbohydrate, 7 grams proteins, and 9 grams fat:

Calories 173 % Daily Value

Total Fat 9 g 14%

Total CHO 16 g 5%

Total CHON 7 g 14%

Calories 173 % Value

Total Fat 9 g 81 47%

Total CHO 16 g 64 37%

Total CHON 7 g 28 16%

100%

Nutrition Facts

9 g fat x 9 kcal/g = 81 kcal

16 g carbohydrate x 4 kcal/g = 64 kcal

7 g proteins x 4 kcal/g = 28 kcal

Total = 173 kcal

Based on a 2000 kcal diet:

(9g/65 g) x 100 = 13.8 14%

(16 g/300 g) x 100 5 %

(7/50 g) x 100 14%

LET’S CHECK!

Fat:

(6.5/65) 100 = 10%

Carbohydrate

(15/300) 100 = 5%

Sodium

(240/2400)100= 10%

Protein

(3/50)100 = 10%

Cholesterol

(30/300) 100 = 10%

Calorie balance is like a scale. To remain in balance and maintain your body weight, the calories consumed (from foods) must be balanced by the calories

used (in normal body functions, daily activities, and physical activity).

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CARBOHYDRATES

• Major source of energy

• Cheapest source of energy

• Provide quick and sustained body fuel

CARBOHYDRATES

DIETARY FIBER

CARBOHYDRATES Functions:

• Fuel for energy

• Protein sparer

• Allows for normal fat metabolism

• Maintains functional integrity of the CNS

• Facilitates excretion of toxins

• Precursor of nucleic acid, connective tissue matrix, galactoside to nerve tissue

• Aids in normal elimination of waste materials

• Promote growth of coliform bacteria

CARBOHYDRATES Sources:

• Starches

• Root crops

• Fruits

• Sugar and candies

• Vegetables

• Liver glycogen

RENI FOR CHO: 55-70% of TCR

FATS Types

• Lipids

• Provides high caloric value

• Classification:

– Simple

– Compound lipids

– Derived lipids

FATS Types

FATS Types

• Visible fat

• Hidden fat

• Cholesterol - vital substance in human cell metabolism

Functions:

Vital substance in human metabolism

Precursor of steroid hormones

Precursor of vitamin D

Essential in forming bile acids

Brain and nervous tissue component

Cell membrane component

FATS ESSENTIAL FATTY ACIDS

• Linoleic Acid

• Alpha - Linolenic Acid

• Arachidonic Acid

FATS Types

Radical chain reaction mechanism of lipid peroxidation From Wikipedia, the free encyclopedia

http://upload.wikimedia.org/wikipedia/commons/9/9e/Lipid_peroxidation.svg

FATS Types

SFA PUFA MUFA

Most animal products Milk and dairy prod. Cocoa butter Coconut Oil Palm Kernel oil

Vegetable seed oils (sunflower oil, safflower oil, corn oil and soybean oil) Nut oil Cold water ocean fish

Olive Oil Canola Oil Peanut Oil

COMPOSITION OF COMMONLY ENCOUNTERED DIETARY LIPIDS

FROM ANIMALS

• Rich in saturated fatty acids

• Butter and Lard

FROM PLANTS

• Rich in saturated fatty acids

• Coconut and Palm oil

FROM PLANTS

• Rich in monounsaturated fatty acids

• Olive oil and Canola oil

• Rich in polyunsaturated fatty acids

• Soybean oil and Corn oil

GROWTH



• Insoluble in water

• Cannot be made by the body

• Soluble in solvents with low polarity

• Low melting point

• Liquid at room temperature

• Double bonds are oxidizable (DANGER)


• Humans evolved on a diet with equal amounts of omega-6 and omega-3 FA

• Present diet : omega 6:omega 3 is 20-25:1

• Desirable ratio : 5-10:1


Greenland Inuit gutting a seal in the early 1900s. Their diet consisted largely of fish, whale, seal, and walrus, resulting in a high intake of omega 3 fatty acids. Copyright Arctic Institute


Cold water fishes: tuna ,cod, sardines, mackerel,

salmon, herring


FATS MECHANISM OF ACTION OF EFA

PG 2 series PG3 series

Vasoconstriction Vasodilatation

Potent platelet aggregator Inhibit platelet aggregator

Increases LDL Decreases LDL

Decreases HDL Increases HDL

Antiarrhythmic Antithrombotic

Anti-atherosclerotic Anti-inflammatory

Lowers blood pressure Improves endothelial function

Lowers triglyceride concentrations

FATS Functions

• Source of energy

• Protein sparer

• Serve as shock absorber

• Strengthens biological membrane structure

• Body insulator

• Dietary vehicle

• Supplies taste and flavor to food

FATS Source

• STORAGE OF FATS

– White fats

– Brown Fats

• SOURCES OF FATS

– animals (butter, lard, meat, eggs, milk)

– plants (vegetable oils)

RENI FOR FATS: 20-30% of TCR

PROTEIN

• First substance recognized as a vital part of living tissue

• Nitrogen-containing compounds which yield amino acids upon hydrolysis

• Classification:

– Indispendible AA

– Dispensible AA

– Conditionally dispensible

PROTEIN

PROTEIN

• Repair of worn-out body tissue proteins

• Muscle building

• Maintenance of growth

• Source of heat and energy

• Maintains normal osmotic relations among body fluids

• As enzymes and hormones

• As acid-base regulators

• As transporters

PROTEIN Sources

Animal Plant

PROTEIN Quality

• Determined by the extent of indispensable amino acids needed by the body to maintain equilibrium

Complete Incomplete

PROTEIN Quality

AMINO ACID SCORE

• Analyze protein as to its essential amino acid content in relation to a reference protein

PROTEIN EFFICACY RATIO

• Analyze proteins in terms of promoting growth and weight gain for every gram of protein

BIOLOGIC VALUE (BV)

• Proteins with complete essential amino acids will maintain nitrogen balance but those with incomplete essential amino acids will promote negative nitrogen balance

NET PROTEINUTILIZATION

(NPU)

• Product of BV and Degree of food protein digestibility

AA score

= mg IDAA/g test protein

--------------------------- x 100 mg IDAA/g reference protein

PER

= growth in grams

-------------------------

Protein intake in grams

BV

amount of protein retained

-------------------------------- x 100

amount of protein ingested

NPU

N intake – N output

---------------------------

N intake

PROTEIN Quality

NITROGEN BALANCE

CONDITION MEASUREMENT SIGNIFICANCE

Positive N intake > N excretion Growth

Equilibrium N intake = N excretion Maintenance and repair

Maintenance N intake < N excretion Wasting

FOOD PROTEIN SUPPLEMENTATION

• Combination of complete and incomplete protein in sufficient quantity and quality

• Examples:

– Cereal and milk

– Macaroni and cheese

– Rice, beans, and fish sauce

– Wheat and beans

WHAT FOODS SHOULD WE EAT?

HI- 5 DIET: Fruits and vegetables

Whole Grain Cereals

More on Fish

Beans, Nuts and Legumes

Full Cream Milk &

Soft Boiled Eggs

Traffic Light of Nutrition FOOD

Pork & pork products

Crabs, shell, shrimps

Beef

Chicken

Fish

Full cream powdered milk

Soft boiled eggs

Fruits & Vegetables

Whole Grain/Cereals

Beans, nuts, legumes

PROCESSING

Frying (lipid peroxides)

Baking (acrylamides)

Broiling (benzopyrene)

Microwaving (plastic)

Raw

Boiling

Steaming

Cooking in coconut milk

Cooking in curry

MALNUTRITION

Pathologic state resulting from a relative or absolute deficiency or excess of one or more essential nutrients

Under nutrition

Specific deficiency

Over nutrition

Imbalance

MALNUTRITION

Pathologic state resulting from a relative or absolute deficiency or excess of one or more essential nutrients

Primary • Dietary inadequacy in amount

or in kind

• Iron deficiency, Iodine deficiency

Secondary • Pathologic or physiologic

condition of the body preventing adequate ingestion of food or proper metabolism of nutrients

• Fever, Infection, Metabolic disease

• Pregnancy, adolescence

MANUTRITION Etiology

Pregnancy or lactation Lack of Family Planning

Improper Weaning practices Lack of Immunization

Poverty Congenital Diseases

2 or more children under the same household

Malabsoprtion: Celiac, Lactose Intolerance, Giardiasis, Cystic Fibrosis

Poverty Metabolic

Incompetent/Ignorant mother

Infections: TB

PROTEIN ENERGY MANUTRITION

the most common, most disastrous form of malnutrition in the world.

It is characterized not only by an energy deficit due to a reduction in all macronutrients but also by a deficit in many micronutrients.

3 FORMS:

Dry (thin, desiccated)

Wet (edematous, swollen)

Combined form between dry and wet

PROTEIN ENERGY MANUTRITION

Marasmus Kwashiorkor

MARASMUS PATHOPHYSIOLOGY

Insufficient energy intake

Body draws on its own stores

Liver glycogen is exhausted within

a few hours

Triglyceride in fat depots are

broken down into free fatty acid

Fatty acids are incompletely

oxidized to ketone bodies

Rise Cortisol & GH

Low Insulin, TH and plasma protein level

Skeletal muscle for protein is used via gluconeogenesis

KWASHIORKOR

• Protein Malnutrition

• Nutritional Edema Syndrome

• Etiology:

Insufficient intake of good

quality protein

KWASHIORKOR

DIAGNOSTIC SIGN

Edema

COMMON SIGNS Hair changes

Skin depigmentation Moon face

Anemia

OCCASIONAL SIGNS Flaky paint rash Hepatomegaly

Infections

KWASHIORKOR

CHO intake CHON intake

Hypoalbuminemia

Decreased visceral protein synthesis

Fat mobilization and amino acid release from

muscle

Impaired beta lipoprotein synthesis

Dependent edema

hypoalbuminemia Fatty liver

Protein-Energy (calorie) malnutrition

Kwashiorkor

(edema with maintenance of some subcutaneous fat tissue)

Marasmus

(skin and bones appearance with little or no subcutaneous fat tissue)

Moderate energy deficit with severe protein

deficit

Severe energy and protein deficit

KWASHIORKOR vs. MARASMUS

KWASHIORKOR MARASMUS

Primary Deficiency:

PROTEIN deficiency, due to no protein in diet or inadequate absorption.

OVERALL ENERGY deficiency

Description: "A response to some kind of stress" "A slow adaptation to starvation"

Incidence: 1-3 years 0-2 years

Edema EDEMA is present -- due to lost oncotic pressure in blood vessels, in turn due to hypoalbuminemia

Absent

Hypo albuminemia

LOW ALBUMIN is the cardinal symptom. Liver shuts down albumin production to conserve on protein which is lacking.

Absent

OVERNUTRITION

• Obesity

• Weight is 20% above IBW

• Etiology:

– Excessive intake of food compared with its utilization

– Other factors: Genetic constitution

Psychic disturbances

Lack of exercise

Metabolic

OVERNUTRITION

• Male % body fat >/= 25%

• Female % body fat >/= 30-35%

• BMI = 30 or above

• Scale weight is 20% above Healthy body weight

OVERNUTRITION

OVERNUTRITION

Central, apple, android Lower, pear, gynecoid

OVERNUTRITION

OBESITY IS RELATED TO MANY DISEASE ENTITIES

• Osteoarthritis O

• Breathlessness B

• Endocrine disorders E

• Stroke S

• Increased lipid/

• Cholesterol levels I

• Tumor/ Cancer T

• hYpertension Y

OVERNUTRITION

THE WEIGHT LOSS TRIAD

Control Energy Intake

Control Problem

behaviors

Perform regular physical

activity

BREAST FEEDING

Optimal method of feeding infants

Gold standard Most appropriate form of nutrition

for infants

Better than bottle feeding

Complete food for infants up to 6 months of life

BREAST FEEDING

MILK LET-DOWN REFLEX

Prolactin – produces milk Oxytocin – release milk

BREAST FEEDING

• Factors affecting composition of breast milk:

– Time of day

– Diet of mother

– Mother’s emotional state

– Foremilk or hindmilk

– Drugs

– smoking

BREAST MILK Colostrum

• Secretion of breast during the first 2-4 days post-partum

• Deep yellow in color

Colostrum

Nutritional factors

Energy, protein, vitamins, minerals, carbohydrates,

fats

Immune factors

IgA, IgG, IgM, IgD, IgE, lactoferrin, polypeptide,

oligosaccharides, cytokines, lactoalbumin,

lysosomes

Growth factor PDGF, EGF, IGF1, VEGF,TGF

BREAST MILK

FOREMILK HINDMILK

First milk obtained during a nursing period

Last milk obtained during a nursing period

Clear, thin bluish Thick, cream-white

BREAST MILK Storage

BREAST MILK

Typical contents of 100 ml breast milk produced on days 1-5 (colostrum) and more than 15 days (mature milk) post-partum

CONTENTS COLOSTRUM MATURE MILK

Energy (kcal) 55 67

Fat (g) 2.9 4.2

Lactose (g) 5.3 7.0

Protein (g) total 2.0 1.1

IgA 0.5 0.1

Lactoferrin 0.5 0.2

Casein 0.5 0.4

Calcium 28 30

Sodium 48 15

Vit A 151 75

Vit C 6 5

BREAST MILK Composition

NUTRIENT COMPOSITION

Carbohydrates Lactose

Fats More than 98% TAG - Oleic and palmitic acid - Linoleic acid and Linolenic acid Functions: brain development

Proteins 75% of breastmilk composition - micellar casein (beta casein) - acqueous whey (a-lactalbumin, lactoferrin, secretory IgA, and serum albumin)


ANTIMICROBIAL FACTORS secretory IgA, IgM, IgG lactoferrin lysozyme complement C3 leucocytes bifidus factor lipids and fatty acids antiviral mucins, GAGs oligosaccharides

GROWTH FACTORS epidermal (EGF) nerve (NGF) insulin-like (IGF) transforming (TGF) taurine polyamines

CYTOKINES/ANTI-INFAMMATORY tumour necrosis factor interleukins interferon-g prostaglandins a1-antichymotrypsin a1-antitrypsin platelet-activating factor: acetyl hydrolase

DIGESTIVE ENZYMES amylase bile acid-stimulating esterase bile acid-stimulating lipases lipoprotein lipase


HORMONES feedback inhibitor of lactation (FIL) insulin prolactin thyroid hormones corticosteroids, ACTH oxytocin calcitonin parathyroid hormone erythropoietin

TRANSPORTERS lactoferrin (Fe) folate binder cobalamin binder IgF binder thyroxine binder corticosteroid binder

POTENTIALLY HARMFUL SUBS viruses (e.g., HIV) aflatoxins trans-fatty acids nicotine, caffeine food allergens PCBs, DDT, dioxins radioisotopes drugs

OTHERS casomorphins d -sleep peptides nucleotides DNA, RNA


HUMAN MILK COW’S MILK

Water Same Same

Kcal/ 100 ml 71 66

Proteins (g/100 ml)

Casein Whey

1-1.5 % 35 % 65 %

3.3 % 82% 18%

Lactose (g/100 ml) 6.5-7 % 4.5 %

Fats (g/100 ml) 3.8 % 3.7 %

Mineral .15-.25 % .70-.75 %

Vitamins Adequate Vit C/D

Low vit. C/D

Digestibility More digestible Less digestible


BREAST MILK Attributes

INFANT

• Bacteriologically safe

• Always fresh and ready to go

• Contributes to maturation of GIT

• Reduces risk of food allergies

• Establishes habit of eating in moderation

• Contributes to proper development of jaws and teeth

• Decreases ear infections

• Facilitates bonding with mother

BREAST MILK Attributes

• Proper quality and quantity of nutrients

• Anti-infective properties are universally effective

• Prevents hypersensitivity or allergy

• Psychological advantages

• Contraceptive effects

• Safe, convenient, and always available

• Lack of motivation and preparation

• Aesthetic reasons

• Working mothers

• Fear of pain

• Anxiety

• Chronic diseases

• Intake of medications

BREAST MILK Unsuccessful

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Education

Fundamentals of Nutrition 2017