Transcript Nutrition Issues

Nutrition Issues
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Normal Dietary requirement of protein 1g/Kg/Day
for adults
Proteins provide 4 kcal (17kJ)/gram of protein
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Functions of Protein
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Tissue growth,maintenance and repair
After anabolic needs are met excess of proteins
are catabolized for energy
After the energy requirements are met the
aminoacids are used to synthesize
carbohydrates and fats
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Final Products of Protein Catabolism
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CO2 and Water
High energy molecule (ATP)
Urea
Ammonia
(Note creatinine is derived from creatine and Uric
acid is derived from purines)
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Individual functions of AA
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Taurine- synthesized from dietary cysteine or methionine
( concern in formula fed infants may develop taurine
deficiency) Human milk is rich in taurine
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Carbohydrates- classified by number of
sugar units they contain
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Mono
Di
Oligo -3-10
Polysaccharides
Major source of food energy
4 kacl/g (17 kJ/g)
Protein sparing
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Oligosaccharides
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Alpha-galactoside
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Fructo-oligosaccharides
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Found in soybeans and
legumes
Not digested
100% fermented in colonincreases SCFA, fecal
output, and prebiotic
effects
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Jerusalem artichoke,
chicory, onion
Reduced calorific value not
digested
Prebiotic
Stimulate intestinal
bifidobacteria
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Carb Disorders:
Lactose/Sucrose/Galactosemia/ DM
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Lactose Intolerance- Adult onset-Afro-AsianMediterranean ethnicity
Avoid milk/ Cheese-Yogurt better
Sucrose Intolerance-avoid table sugar, highly
sweetened foods
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Too much fiber? Caution!
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Excessive fiber in the diet can reduce mineral
absorption resulting in negative balance of iron, zinc
and other trace elements. It can interfere with
consumption of a balanced diet.
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?Artificial Sweeteners
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43lbs of sugar per year (10-12% of energy intake)Dental issues and DM
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Risks
SaccahrinBladder Cancer
Aspartame
Safety concerns
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XYLITOL
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a safe sweetener for
people with diabetes
produced by
hydrogenation of xylose
dental heath benefits in
caries prevention
may help prevention of
osteoporosis
reduce ear infections-ear
waxIncreases gut SCFA
 Increases energy by enhancing
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ATP production
Increases utilization of fat
Replenishes glycogen
Anabolic — keeps biosynthetic
pathways open
Anticatabolic —helps maintain
lean muscle mass
Antioxidant —generates NADPH,
keeping glutathione in an active
state
Increases endurance
Reduces free radical and oxidative
damage
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Number of carbon atoms
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Classified as
Short chain (C4-6)
Medium chain (5-12)
Long chain (12 or more)
“Saturated “ fatty acids- palmitic and stearic acids
Mono-unsaturated fatty acid- oleic acid
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Poly unsaturated fatty acids
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Linoleic acid - essential
Linolenoic acid - essential
Arachidonic acid
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Fat Facts
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Cholesterol only in animal cells
Ergosterol in plant cells
Waxes are in plants and fruits but not in land animal
species
Most concentrated source of energy!
9 kcal/g (37kJ/g)
Makes food palatable/ gives aroma
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Fat Facts
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Industrial countries diet energy source is 38%
fat. This is very high.
Evidence for an effect of dietary cholesterol on
blood cholesterol is inconclusive
Foods that have a high cholesterol content
include: liver, egg yolk, kidney, brains,
sweetbreads, shellfish and fish roe
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Fat Facts
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Peanut oil and olive oil are examples of fats which
are rich in the monounsaturated fatty acid, oleic acid.
Monounsaturated fatty acids in the diet have a
lowering effect on LDL cholesterol
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?DHA deficiency
 Associated with:
1. fetal alcohol syndrome
2. attention deficit hyperactivity disorder
3. cystic fibrosis
4. phenylketonuria
5. unipolar depression
6. aggressive hostility and
7. adrenoleukodystrophy
 A decrease in DHA in the brain may be
associated with cognitive decline during aging and
with onset of sporadic Alzheimer's disease.
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Role of fish and fish oilshigh in EPA (eicosa pentanoic acid)
and DHA (docosa hexanoic acid)
Beneficial in-hypertension, hyperlipidemia,
thrombosis, coronary heart disease and
immunological disorders
Lowers Triglycerides
Omega-3 fatty acids tend to increase bleeding time by
inhibiting platelet aggregation
Eating 4 to 6 ounces (120-170 g) of fish several times a
week is helpful
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The fat soluble vitamins
include:
vitamin A (retinol)
vitamin D (calciferol)
vitamin E (tocopherol) and
vitamin K (menadione)
stored in appreciable
amounts in body tissues and,
do not have to be supplied
daily
Habitual intake of excessive
amounts of fat soluble
vitamins is
toxic.
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The water soluble vitamins
include:
vitamin B1 (thiamin), vitamin B2
(riboflavin), vitamin B3 (niacin),
biotin,
vitamin B6 (pyridoxine), pantothenic
acid,
folate,
vitamin B12 (cobalamin) and
vitamin C (ascorbic acid).
not stored to any great
extent and therefore need to be
included in the diet every day
Some Toxicity reported in very high
doses
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Vitamin A
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 Food Sources- (IU/100g)
Stored as preformed Butter-3058
retinol
 Cheese-1059
 Carrot, raw-28129
Plant sources Apricots- 2619
carotenoids (Beta-  Liver Beef -36106
carotene,alpha-carotene,
 Lamb -25998
lutein, and lycopene are
 Chicken-16375
found in human plasma)
 Halibut- 179
 Sardines-224
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Vitamin A TOXICITY
Excessive ingestion of carotenoids,-not toxic to man
results in carotenemia and yellow discoloration of the skin
Chronic toxicity-
anorexia, nausea, vomiting, abdominal pain, dry skin,
rashes, headaches, loss of hair, abnormal skin
pigmentation, increased fragility and pain in the long
bones, menstrual irregularities and enlargement of the
liver and spleen
Safe dose not to exceed –
10,000 IU for children or
25,000 IU for adults
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vit A cancer benefits
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maintains epithelial tissues
tumor surveillance by the immune system is
dependent on adequate levels of vitamin A
gene expression may be directly influenced by
vitamin A and retinoids.
Beta carotene is an antioxidant
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Vitamin D
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Essential for calcium
homeostasis (a hormone and
prehormone)
 precursor or provitamin D
(ergosterol (plants)* and
7-dehydrocholesterol** (in the skin)
with ultraviolet light exposure
required
 *converts to D2 (ergocalciferol)
 **converts to D3 (liver)
(prehormone) (cholecalciferol)
 1.25-dihydroxy D3 (hormone)
(kidney) which then acts upon
its target tissues (intestine, bone
and kidney) to regulate calcium
and phosphorus absorption and
metabolism
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Food Sources- (IU/100g)
Egg 52
Cheese 12
Cow’s milk 40 (100ml)
Sardines 272
Salmon 624
Livers- 50-65
Codliver oil 16,700
Breast milk is low in vitamin D
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vit D TOXICITY
 Habitual intake of excessive vitamin D
is toxic.
 The symptoms include nausea,
anorexia, polyuria, pruritis and
calcification of
soft tissues such as the kidney and heart.
 In infants can result in bossing of the
skull, mental retardation and death.
 Mild vitamin D toxicity is manifested in
elevated serum calcium levels.
 Recommended daily intake:
(400 IU) cholecalciferol.
Avoid intakes above
(3200 IU) cholecalciferol
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Benefitscan reduce the risk of
osteoporosis
may be important in
regulating blood
pressure and improving
some forms of
hypertension
anticarcinogenic effect
in colon carcinogenesis
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vitamin E
 Alpha-tocopherol- function
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not fully known
May function as an
antioxidant by reducing the
free radicals
(other enzymes involved :
glutathione peroxidase, catalase and
superoxide dismutase)
 Food sources- oils Wheat germ 192.4
 Soybean 18.2
 Nuts Almonds 5.6
 Filbert 23.9
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vit E TOXICITY
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Rare
A vitamin K inhibitor
and can prolong
clotting time
 Can cause bruising
bleeding
 No proven benefits
 Safe dose 400 units
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Food SourcesSpinach/ Turnips/
Broccoli 1.9-1.7
Butter 1.6
Chicken 1.3
Fish- Halibut 1.1
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vitamin K
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green leafy vegetables such 
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as cabbage and spinach
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half of the human supply of
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vitamin K is derived from
bacterial synthesis in the
intestine, absorbed from the
lower intestine and colon
 sources of vitamin K are
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Food Sources (mg/100g)
Broccoli 270
Spinach 400
Lettuce 122
Cabbage 145
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Water Soluble vitamins:
The B group (B-complex) Thiamine (B1)
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 A coenzyme
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 thiamin pyrophosphate 
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(TPP) is involved in
energy metabolism
Milling of grains removes
those portions which are
the richest in thiamin
(the endosperm, the
aleurone layer and the
bran).
Food Sources
Wheat germ 1.86
Bran flakes 1.3
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?Get more vitamin B1
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Cooking removes thiamine
Conserved when consumed without excessive
cooking (enriched bread, breakfast cereals).
Parboiling of rice facilitates retention of some of
the thiamin
Main site of thiamin absorption is the jejunum
Absorption is decreased by folate deficiency and
alcoholism
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Thiamine deficiency (Beriberi)
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Thiamin deficiency affects the cardiovascular,
muscular, nervous and gastrointestinal systems.
 The earliest manifestation of thiamin
deprivation includes anorexia, fatigue, depression,
irritability, poor memory, inability to concentrate and
vague abdominal and cardiac complaints.
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Alcoholics and Lack of Thiamine
Polyneuropathy (factors other than thiamin
deficiency may also be involved)
Wernicke’s disease (signs
opthalmoplegia,nystagmus and ataxia)
 Korsakoff’s psychosis (signs are memory defect
and confabulation) and
Amblyopsia (dim vision).
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Water Soluble vitamins:
The B group (B-complex) Riboflavin (B2)
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Significant losses of
riboflavin can occur by
exposure to light
Coenzyme activity in
Krebs cycle
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Food SourcesBeef liver 2.8
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Riboflavin deficiency
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cheilosis, angular stomatitis, glossitis, seborrheic
dermatitis and ocular manifestations:
photophobia, itching, burning and circumcorneal
capillary engorgement.
The seborrheic dermatitis is usually found in the
nasolabial region, near the inner and outer canthi
of the eyes, behind the ears and on the posterior
surface of the scrotum
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Water Soluble vitamins:
The B group (B-complex) B3 (Niacin)
 Food Sources Niacin functions in  Chicken 9.2
energy metabolism  Roast lamb 4.6
in the amide form as Salmon 6.5
 Veal 9.9
part of the
 Peanuts roasted 13.5
coenzymesglycolysis, the Krebs  Whole wheat flour 6.4
cycle
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Niacin deficiency: Pellagra
4 D’s-dermatitis, diarrhea, dementia and death
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Usually
associated with
diets based
chiefly on corn and
proteins
containing
inadequate
amounts of
tryptophan.
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Niacin Megadoses
(3-6 g/day) Toxicity
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Niacin lowers cholesterol
Niacinamide does not lower cholesterol
Toxicity:
Short term-vasodilation, burning or stinging sensations in
the face and hands, nausea, vomiting, and diarrhea.
In the longer term- varying degrees of hyperpigmentation of
the skin, abnormal glucose tolerance, hyperuricemia, peptic
ulcers, hepatomegaly, and jaundice
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BIOTIN
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required for carbohydrate
and fat metabolismcoenzyme in
gluconeogenesis and Krebs
cycle
 biotin deficiency: namely
decreased protein synthesis
and
hypercholesterolemia
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Food Sources:
Liver, Chicken 170
Banana 2.6
Oatmeal 21
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Biotin Deficiency Features
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Scaly dermatitis, grayish pallor, extreme lassitude,
anorexia, nausea, anemia, depression, muscle pain,
parethesia, hypercholesterolemia and
electrocardiogram changes
Seen with bizarre food habits, i.e. consumption of large
quantities of raw egg whites and little else. Seborrheic
dermatitis in infants under six months may be
responsive to biotin administration.
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Pantothenic acid deficiency
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Abdominal pain and soreness, nausea, personality
changes, insomnia, impaired adrenal function,
weakness and cramps in the legs, paresthesia of the
hands and feet and impaired antibody production.
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Water Soluble vitamins:
The B group (B-complex) B6 (Pyridoxine)
 Food Sourcespyridoxal phosphate (PLP)  Brown rice 0.14
 coenzyme in transamination, Wheat flour 0.34
decarboxylation and
 Beef liver 0.94
transulfuration reactions of  Banana 0.58
 active coenzyme form of
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amino acids.
involved in the synthesis of
the neurotransmitters
serotonin and norepinephrine
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B6 Deficiency
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Seborrheic dermatitis, cheilosis, glossitis, stomatitis,
altered tryptophan metabolism, depression and
confusion
B6 deficiency in alcoholics may be as high as 20-30 %
Up to one-fifth of oral contraceptive users show
biochemical evidence of vitamin B6 deficiency
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B6Toxicity
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Oral doses of 1-150 mg/day of vitamin B6 have
been used therapeutically without ill effect
A transient dependency has been induced in
adults given a supplement of 200 mg
Cause ataxia and severe sensory-nervous system
dysfunction
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B6 Health benefits
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Reduces the symptoms of carpal tunnel
syndrome and premenstrual syndrome in some
women
May decrease the frequency and severity of
asthma attacks.
Useful in homocystinuria and high circulating
homocysteine levels, as well as in diabetic
neuropathy and in normal immune function
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Vitamin C (Ascorbic Acid)
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Absorption of vitamin C
occurs in the jejunum and
ileum
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Relatively high
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concentrations of vitamin
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C are found in the retina
and other eye tissues, the
adrenal and pituitary
glands, brain, pancreas,
kidney, liver and spleen.
Food SourcesKiwi fruit 96
Oranges 53/ Juice 34.4
Broccoli 93
Parsley 133
Red sweet peppers 190
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Deficiency of vitamin C
 weak, spongy and bleeding
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gums
loose teeth, resorbed
dentine, swollen tender
joints, hemorrhage
rough skin, muscular aches
and pains and irritability
impaired iron absorption,
impaired folic acid,
serotonin and adrenaline
metabolism and
psychological changes
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Vitamin C Megadose Toxicity
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Gastrointestinal
disturbances
Uricosuria
Excessive absorption of iron
Impaired bactericidal
activity of the leukocyte
Interferes with urine
glucose testing
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? Benefits:
Cardiovascular health
Blood pressure
Platelets function
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Dietary Goals
1. Enjoy a variety of foods/maintain a balanced diet
2. Maintain ideal weight by reducing excessive energy
consumption and increasing physical activity
3. Reduce fat intake to no more than 30% of total energy
with no more than 10% of total energy as saturated fat.
4. Moderate consumption of alcohol
5. Limit intake of sugar
6. Avoid too much salt, and
7. Increase intake of whole grain cereals, fresh fruit and
vegetables
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?Breast Milk
 Exclusive breast feeding up to 6 months and longer!
 Complementary foods may be introduced from about
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6 months of age.
Exclusively breast fed infants follow a slower but
normal growth pattern than bottle fed infants at
around 4 to 6 months of age and may therefore
require a separate growth curve.
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Breast vs. Bottle (formula) feeds
 not present
 contains digestive enzymes such as  does not encourage lactobacilli
amylase and lipase
 contains immunologic
substances such as IgA, lactoferrin,
lysozymes, macrophages and other
antibodies that confer passive
immunity
 lactobacillus factor present in breast
milk
 less susceptible to respiratory,
enteric and ear infections.
colonization- predisposes to
respiratory, enteric and ear
infections
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Breast milk-Long term Benefits!
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breastfed infants may have reduced risk of-
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diabetes mellitus,
certain types of cancer and
raised serum cholesterol later in life
TRIPLE BENEFITS of Breast feeding-
1.Breast milk is readily available, relatively
safe and enhances intestinal development
2.Breastfeeding is satisfying for both the
mother and child.
3.The closeness of this coupling enhances
maternal-infant bonding
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When to start cow’s milk?
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delay the introduction of cow’s
milk to between 9 and 12 months
Reason:
 High protein content and the accompanying renal solute
load in cow’s milk;
 the risk of an allergic reaction; and the risk of a bloodlosing enteropathy in some infants that is induced by a
heat-labile factorin the protein
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Signs of food allergy in children
 Systemic: anaphylaxis (allergic shock reaction)
 Gastrointestinal: vomiting, abdominal pain,
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diarrhea,malabsorption, enteropathies;
Respiratory: rhinitis, sinusitis, secretory otis media,
cough, wheezing, pulmonary infiltration;
Cutaneous: rash, uticaria, eczema.
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Gluten Sensitivity
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Gluten sensitive enteropathy, more commonly
known as celiac disease, is a food allergy
affects children and is life-lasting
need a diet which eliminates gluten and
gluten-containing products for the patient's
lifetime.
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Obesity: ‘defined as 20% above the ideal
weight’
 Risk factor for diabetes mellitus,
 hypertension, hyperlipidemia, coronary artery disease,
 obstructive sleep apnea, and
 Cancer
 cause: nutrition transition to fat-rich diets and reduced
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physical activity
In developed countries, poverty is associated with
increased prevalence, whereas in developing countries
it is the relatively affluent class
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?Too fat
Over fatness has been defined
as a percent body fat
composition
than 20 for men and
greater than 30 for women
Obesity Grade
BMI
Class III
≥40
Class II
35-39.9
Class I
30-34.9
Overweight
25-29.9
Normal
18.5-24.9
Thinness
≤18.5
(Protein Malnutrition)
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EXERCISE!
 Activity
 Basketball
 Cycling at 9.4 mph
 Dancing (twist)
 Football
 Running 8 min/mile
 Sitting quietly
 Walking
 Vacuuming
 Ironing
Kcal/min/kg
9
6.5
10.9
8.6
13.6
1.4
5.2
3
2.1-4.2 (F:M)
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Useful tools:
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Weight Watchers International
Shape Up America (http//www.shapeup.org)
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Soluble Dietary Fibers
 Soluble fibers include pectin, resistant starches and other
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polysaccharides.
They are not digested in the small intestine increase
The transit time through the gut, delay gastric emptying, and
slow glucose absorption.
They can be degraded by colonic bacteria and
Thus lower luminal pH, stimulate proliferation of colonic
microflora (prebiotic effect) and produce short chain fatty
acids (SCFA) such as acetic, butyric and propionic acid.
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SCFA benefits?
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Provide nourishment to the colon
Fruits, vegetables and oats are the main dietary
sources of soluble fiber
50% fiber intake from grains,
30% from vegetables and beans and
20% from fruits
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Gut flora
Unique internal eco-system
GI tract houses several trillion bacteria
Bad onesClostridia, staphylococci, vibrionaceae and
Ps. Aeruginosa
Good ones- Lactobacilli and
Bifidobacteria are main colonic bacterial
species
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Prebiotics are dietary components that
promote the growth of probiotics.
Probiotics and prebiotics are the main dietary
approaches to selectively influence the growth
of beneficial bacteria.
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Probiotic
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A probiotic is a live bacteria contained in a food (e.g.
functional food such as yogurt) or a food supplement
which beneficially affects the host by improving its
intestinal microbial balance.
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Fiber First Diet
Adult
Children
Total Dietary Fiber 31g
Total Dietary Fiber 20g
Breakfast
Wheat Bran Cereal (8g)
2 cup wheat bran cereal (4g)
1 fruit (4g)
2 fruits (2g)
1 slice whole wheat toast (2g)
Lunch
2 slice whole wheat bread (4g)
2 slice whole wheat bread (4g)
1 fruit (3g)
1 fruit (3g)
Snack
½ cup fruit (2g)
Dinner
1 cup vegetable/ legume (4g)
¼ cup vegetable/ legume (1g)
1 baked potato w/skin (4g)
2 tomatoes (1g)
1 baked potato no skin (2g)
2 cup fruits (2g)
1 cup lettuce (1g)
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