Nutrition
DR PIYUSH TAILOR
Assiociate Professor
Dept of Biochemistry
Govt. Medical College
Surat
Nutrient – a substance that promotes normal
growth, maintenance, and repair
Macro-nutrients – carbohydrates, lipids, and
proteins
Micro-nutrients – vitamins and minerals (and
technically speaking, water)
It prevent human being from chronic
disease.
Essential nutrients obtained from the diet.
Ethanol is not an essential component of the diet but may provide a
significant contribution to the daily caloric intake of some individuals.
Dietary Reference Intakes (DRIs)
Nutrients required to prevent deficiencies
and maintain optimal health and growth.
1. Estimated Average Requirement
2. Recommended Daily Allowance
3. Adequate Intake
4. Tolerable Upper Intake Level
Estimated Average Requirement
Requirement of one half of the healthy
individuals
To specific age and gender group.
It is useful in estimating the actual
requirements in groups and
individuals.
Recommended Daily Allowance
Requirements of nearly all (97–98%) the
individuals and gender group.
to provide a margin of safety for most
individuals.
The EAR serves as the foundation for
setting the RDA.
RDA = EAR + 2SDEAR
Adequate Intake
It is set when scientific evidence is not
available for EAR or RDA.
Based on estimates of nutrient intake
by a group (or groups) of apparently
healthy people
Example,
AI for infants,
“Human milk is source of food for the
first four to six months”
Tolerable Upper Intake Level
Highest average daily nutrient intake level to
almost all individuals in the general
population.
As intake increases above the UL, the
potential risk of adverse effects.
Useful because of
Availability of fortified foods
increased use of dietary supplements.
Comparison of the components
of the Dietary Reference Intakes
Energy Requirement
Energy Requirement in a healthy adult
accordingly
Age
Gender
Level of physical activity.
Differences in the genetics.
Body composition
Metabolism
Behavior of individuals
Energy Requirement
in kcal/kg/day
Sedentary adults = 30
Moderately active adults = 35
Very active adults = 40
1 kcal(cal) = 4.128 Joules.
Average energy available from
the major food components
How energy is used in the body
Total energy
expenditure in a
20-year-old woman,
5 feet, 4 inches tall,
weighing 50 kg
engaged in light
activity.
Resting(Basal) metabolic rate (BMR)
Energy expended by an individual in a resting,
50 – 70 % of total energy
Energy required for physiological functions
Respiration
Blood flow
Ion transport
Maintenance of cellular integrity.
BMR in an adult,
1,800 kcal for men (70 kg)
1300 kcal for women (50 kg).
Factor Affecting BMR
Age
Gender = Male > Female
Physical activity
Climate
Body temperature
Hormone level
Thyroid hormone , Androgen
Pregnancy
Thermic effect of food
Heat production ,during the digestion and
absorption of food, by the body increases as much
as 30% above the resting level
Thermic effect of food
Diet-induced Thermogenesis.
Over a 24–hour period, it has 5–10% of the total
energy expenditure
Physical activity
Muscular activity provides the greatest
variation in energy expenditure.
Energy consumed depends on the
duration and intensity of the exercise.
Sedentary person = 30–50% more calory
than resting caloric requirement
highly active individual require 100% or
more calories above the BMR
Acceptable Macronutrient
Distribution Ranges
AMDR for adults
Carbohydrate = 45–65%
Fat = 20–35%
Protein = 10–35%
Significant
of
Plasma lipids & Dietary fat
Are fat, fatty acid and other lipid
harmful only?
OR
is all this having any positive
significant?
LDL & HDL
High LDL cholesterol increases risk for IHD.
High HDL cholesterol decrease risk for IHD.
Chances of Complications due to Dyslipidemia
increase with following risk factor
Smoking
Obesity
Sedentary lifestyle
Hypertension
Diabetes mellitus
Beneficial effect of lowering
Plasma Cholesterol
Dietary or drug treatment of
hypercholesterolemia
Effective in
decreasing LDL
increasing HDL
reducing the risk for CAD
Reduction of plasma cholesterol through
Diet control = 10–20%.
“Statin” drugs = 30–40%.
Red --- death due abnormal diet habit.
Blue --- death due to excessive alcohol ingestion
Saturated Fat
Strongly associated with
High levels of total cholesterol
LDL cholesterol
Increased risk of CHD.
The main sources
Dairy and meat products
Coconut and palm oils
Most experts strongly advise limiting intake of
saturated fats.
Monosaturated Fat
Dietary Source - vegetables and fish.
Monounsaturated FA
Lower total cholesterol
Lower LDL cholesterol.
Maintain or increase HDL cholesterol.
Diets rich in olive oil.
Polyunsaturated Fat
Mainly two type
n-6 fatty acid
n-3 fatty acid
.
Linoleic acid (18:2, ∆9,12), n-6 fatty acid
Linoleic acid (18:3, ∆9,12,15), n-3 fatty acid
(Essential Fatty Acid)
Lowers total cholesterol.
Lower LDL
Lower HDL .
Nuts, Soybeans, Cottonseed oil and Corn oil
Require in 5-10 % of total calories.
More than 10 % intake may lead to
deleterious products due to oxidation of
these PUFAs.
Polyunsaturated Fat
n-3 fatty acid
Dietary n-3 PUFAs
Suppress cardiac arrhythmias
Reduce Serum Triglyceride
Decrease the tendency for thrombosis
Lower blood pressure
Reduce risk of cardiovascular mortality
But , little effect on LDL or HDL cholesterol levels.
Found in plants and in fish oil.
Require 0.6 to 1.2 % of total calories.
Two fish meals per week are recommended.
Included in infant formulas
Dose responses of physiologic
effects of fish oil intake
Trans fatty acids
Unsaturated fatty acid.
Elevate serum LDL
Increase the risk of CHD.
Formed during the hydrogenation of liquid
vegetable oils.
Trans fatty acids are a major component
Many commercial baked cookies and cakes
Most deep-fried foods.
New York City, have banned the use of trans
fats in restaurants.
Dietary Cholesterol
Cholesterol is found only in animal products.
The effect of dietary cholesterol on plasma
cholesterol is less important than the amount and
types of fatty acids consumed.
The words ‘Partially hydrogenated’ on the list
of package ingredients indicate the presence
of trans fatty acids in a food.
Other dietary factors affecting CHD
Consumption of 25–50 g/day of soy protein causes
10 % decrease in LDL cholesterol in patients with
elevated plasma cholesterol.
Moderate consumption of alcohol (for example,
two drinks a day) decreases the risk of CHD and
increases concentration of HDLs.
Red wine may provide cardioprotective benefits
because it contains phenolic compounds that
inhibit lipoprotein oxidation
These antioxidants are also present in raisins and
grape juice.
Effects of dietary fats
Dietary Carbohydrates
The primary role of dietary carbohydrate is to
provide energy.
Carbohydrate consumption has significantly
increased obesity.
However, obesity has also been related to
increasingly inactive lifestyles, and to calorie-
dense foods.
Monosaccharide
Glucose and fructose are the principal
monosaccharides found in food.
Glucose is abundant in fruits, sweet corn, corn syrup
and honey.
Free fructose is found together with free glucose and
sucrose in honey and fruits.
Disaccharide
The most abundant disaccharides are sucrose, lactose and
maltose.
Sucrose = “table sugar,”
Lactose sugar found in milk.
Maltose is a product of enzymic digestion of
polysaccharides. It is also found in significant quantities in
beer and malt liquors.
Polysaccharide
Do not have a sweet taste.
Starch is found in abundance in plants.
Common sources = wheat and other grains, potatoes,
dried peas and beans, and vegetables.
Fiber
Nondigestible carbohydrates
Soluble fiber
Osmotically active
Form a viscous gel with a liquid.
Fiber intake (AI)
25 g/day for women
38 g/day for men.
Benefits of Fiber in Diet
Adds bulk to the diet .
Absorb 10–15 times its own weight in water
Drawing fluid into the lumen of the intestine
Increasing bowel motility.
Delays gastric emptying
Result in a sensation of fullness.
Results in reduced high peaks of blood glucose
level
Decreses LDL cholesterol levels
by increasing fecal bile acid excretion
interfering with bile acid reabsorption.
Decrease the risk for
Constipation ,Hemorrhoids
Actions of dietary fiber
Dietary Carbohydrate & Blood Glucose
Some carbohydrate produce a rapid rise followed by a
steep fall in blood glucose concentration,
whereas others result in a gradual rise followed by a slow
decline.
Glycemic index is defined as the area under the blood
glucose curves seen after ingestion of a meal with
carbohydrate-rich food, compared with the area under the
blood glucose curve observed after a meal consisting of
the same amount of carbohydrate in the form of glucose or
white bread.
Glycemic index of potato and white bread are similar to the
response to pure glucose, indicating that complex
carbohydrates may not differ from simple sugars in their
effect on plasma glucose level.
Food with a low glycemic index tends to create a sense of
satiety over a longer period of time, and may be helpful in
limiting caloric intake.
[Link] concentrations following ingestion
of food with low or high Glycemic index.
Requirements for Carbohydrate
Carbohydrates are not essential nutrients, because the
carbon skeletons of amino acids can be converted into
glucose.
However, the absence of dietary carbohydrate leads to
ketone body production and degradation of body protein.
The RDA for carbohydrate is set at 130 g/day for adults
and children, based on the amount of glucose used by
carbohydrate-dependent tissues, such as the brain and
erythrocytes.
Adults should consume 45–65 percent of their total
calories from carbohydrates.
Dietary Proteins
Humans have no dietary requirement for protein but the
protein in food does provide essential amino acids.
Nine of the 20 amino acids needed for the synthesis of
body proteins are essential—that is, they cannot be
synthesized in humans.
Quality of Proteins
It is a measure of its ability to provide the essential
amino acids required for tissue maintenance.
PDCAAS = Protein Digestibility-Corrected Amino Acid
Scoring is the standard for evaluate protein quality.
PDCAAS is based on the profile of essential amino
acids and the digestibility of the protein.
The highest possible score under these guidelines is
1.00.
Relative Quality of some common
Dietary Proteins
Proteins from animal sources
Proteins from animal sources (meat, poultry, milk, and fish) have
a high quality because they contain all the essential amino acids
in proportions similar to those required for synthesis of human
tissue proteins.
Gelatin prepared from animal collagen is an exception; it has a
low biologic value as a result of deficiencies in several essential
amino acids.
Proteins from Plant sources
Proteins from wheat, corn, rice, and beans have a lower quality
than do animal proteins.
However, proteins from different plant sources may be combined
in such a way that the result is equivalent in nutritional value to
animal protein.
For example, wheat (lysine-deficient but methionine-rich) may be
combined with kidney beans (methionine-poor but lysine-rich) to
produce a complete protein of improved biologic value.
Thus, eating foods with different limiting amino acids at the same
meal (or at least during the same day) can result in a dietary
combination with a higher biologic value than either of the
component proteins
Combining two
incomplete proteins
that have
complementary A.A.
deficiencies results in
a mixture with a
higher biologic value.
Nitrogen balance
Nitrogen balance occurs when the amount of nitrogen
consumed equals that of the nitrogen excreted in the urine,
sweat, and feces. Normally, it remains balance.
Positive Nitrogen Balance
This occurs when nitrogen intake exceeds nitrogen
excretion.
It is observed during situations in which tissue growth
occurs, for example, in childhood, pregnancy, or during
recovery from an emaciating illness.
Negative Nitrogen Balance
This occurs when nitrogen loss is greater than nitrogen
intake.
It is associated with inadequate dietary protein, lack of an
essential amino acid, or during physiologic stresses, such
as trauma, burns, illness, or surgery.
Requirement for protein in humans
The greater the proportion of animal protein included in the diet, the less protein
is required.
The RDA for protein = 0.8 g/kg of body weight for adults.
Athletes = 1 g/kg protein daily.
Pregnant or lactating woman = 30 g/day.
children should consume 2 g/kg/day.
1. Consumption Excessive Protein :
No physiologic advantage to the consumption of more protein than the RDA.
Protein consumed in excess of the body's needs is deaminated,
When excess protein is eliminated from the body as urinary nitrogen,
accompanied by increased urinary calcium, increasing the risk of nephrolithiasis
and osteoporosis.
2. The Protein Sparing Effect of Carbohydrate :
The dietary protein requirement is influenced by the carbohydrate content of the
diet.
When the intake of carbohydrates is low, amino acids are deaminated to provide
carbon skeletons for the synthesis of glucose that is needed as a fuel by the
central nervous system.
If carbohydrate intake is less than 130 g/day, substantial amounts of protein are
metabolized to provide precursors for gluconeogenesis. Therefore, carbohydrate
is considered to be “protein-sparing,”
Protein-energy (calorie) malnutrition
(PEM)
Most frequently in hospital patients with chronic
illness, major trauma, severe infection, or the effects
of major surgery.
Such highly catabolic patients frequently require
intravenous (parenteral) or tube-based (enteral)
administration of nutrients.
Affected individuals show a variety of symptoms,
including a depressed immune system with a
reduced ability to resist infection.
Death from secondary infection is common.
Two extreme forms of PEM are kwashiorkor and
marasmus.
Child with kwashiorkor
A child with kwashiorkor frequently shows a deceptively
plump belly as a result of edema
Kwashiorkor
Kwashiorkor occurs when protein deprivation is relatively
greater than the reduction in total calories.
Unlike marasmus, significant protein deprivation is
associated with severe loss of visceral protein.
Kwashiorkor is frequently seen in children after weaning at
about one year of age, when their diet consists
predominantly of carbohydrates.
Typical symptoms include stunted growth, edema, skin
lesions, depigmented hair, anorexia, enlarged fatty liver,
and decreased plasma albumin concentration.
Edema results from the lack of adequate plasma proteins to
maintain the distribution of water between blood and
tissues.
Marasmus
Marasmus occurs when calorie deprivation is
relatively greater than the reduction in protein.
Marasmus usually occurs in children younger than
one year of age when the mother's breast milk is
supplemented with thin watery gruels of native
cereals, which are usually deficient in protein and
calories.
Typical symptoms include arrested growth,
extreme muscle wasting (emaciation), weakness,
and anemia.
Victims of marasmus do not show the edema or
changes in plasma proteins observed in
kwashiorkor.
