An overview of the different theories in Nutrition

Ms C Mbili
Obesity

• Childhood??
• Obesity Epidemic!
• 2001: 6 mil 2014: 20 mil
• “A run-way train…
 Diabetes
•Now, according to the CDC,
more than 186,000 people
younger than age 20 have
diabetes -- both type 1 and
type 2 diabetes, formerly called
adult-onset diabetes

•What are we doing wrong?

energy intake = energy output
 Intake vs Output

• If energy intake < energy output, endogenous stores are utilized

(catabolism of glycogen, fats & proteins)
Energy Output
• Unit of measurement = kJoule/kcal
• 1 kcal = 4.182 kJ

• Heat produced =
◦ directly measured in calorimeter
◦ indirectly measured via VO2 : 1 litre O2 = 20 kJ
• When losses in faeces & urine are taken into account, 70% of protein,
95% of fat, 98% of CH0 is available as usable energy
 Direct Calorimetry
• Airtight, thermally insulated living
chamber
• Heat produced & radiated by person =
removed by a stream of cold water
flowing at a constant rate though
• Tubes coiled near the ceiling of the
chamber
• Humidified air is continually supplied
& circulated while the expired CO2 is
removed by chemical absorbents
• O2 is added to the air before it enters
the calorimeter to maintain a normal
O2 supply
Indirect Calorimetry

• Studies with bomb calorimeter:

blend of CHO, protein, fat
burned in 1 litre of oxygen yields
20 kJ of energy
• Bomb calorimeter:
• a metal vessel surrounded by
water inside an insulated
chamber. The food is ignited
using an electric spark
Energy input: Six nutrient classes
• Carbohydrates
• Fats
• Proteins
• Vitamins
• Minerals and trace elements
• Water: most important : Why?
Kilojoule production of fuel/energy producing
macronutrients differs
• Relationship of carbon : hydrogen : oxygen differs
• lower the relative percentage oxygen to hydrogen, more kilojoules it
supplies
• e.g. Stearin: H110C57O6 (saturated fat found in beef, poultry and
cocoa butter) Glucose: C6H12O6
• All CHO’s…2:1 ratio as in H2O
Nutrient Atwater factor (energy yield)
1g Protein 16.7 kJ 4kcal

1g CHO 16.7 kJ 4kcal

1g Fat 37.8 kJ 9kcal

1g Alcohol 29 kJ 7kcal

Passmore & Eastwood, 1986

Kilojoule content
• A lady doing 2 hours of walking per day requires an additional 3000 KJ
per day
• How could she obtain this?
Kilojoule content
Using CHO only, she would need 3000/16.7
i.e. 180 grams of CHO
On a mixed diet of CHO and fats, 1500/16.7 i.e. 89.8 g CHO;
1500/37.8 = 39.8 g FAT
Calculating % contribution of Macronutrients

• 120 g CHO in 25year old lady’s diet with a total energy intake of 9205
kJ

• What is her % CHO intake?

Calculating % contribution of Macronutrients

120g yields 120X16.7 kJ = 2004 kJ

%= (2004/9205) X 100
= 21.8%
 Calculating % contribution of Macronutrients

• Total energy intake of 9205 kJ

• 55% CHO = 0.55x9205/16.7 = 303g

• 15% protein = 0.15x 9205/16.7 =82.6 g

• 30% fat = 0.3x9205/37.8 = 73.0 g

Traditional Food Guide Pyramid: Balance, variety
and moderation (A balanced, prudent diet!)

Released by US Department of Agriculture in 1992

The ADSA Recommended percentage kilojoule
intake from macronutrients for a sedentary
individual

• 50-60% CHO

• 25-30% Fats

• 15-20% Proteins
 The Traditional Food Pyramid
BUT

• The base of the traditional food pyramid was the USDA recommendation of
a whopping 6 to 11 servings each day from "Bread, Cereal, Rice, and Pasta
Group“…the perfect recipe for obesity and diabetes!

• Recent research involving more than 100,000 people (Willet et al., 2002 )
turned the traditional food pyramid on its side!

• The study found that people whose diets contained fewer carbohydrates —
foods like bread and cereals — and a bigger proportion of "healthy" fats,
such as olive oil, than recommended by the pyramid were 20% to 40% less
likely to develop chronic disease than those whose diets more closely
matched the USDA guidelines
 Food Pyramid
• The Food Pyramid is “flawed," says study author Walter
Willet, MD, a professor of nutrition at the Harvard
University School of Public Health.
• "It says all fats are bad, all complex carbohydrates are
good, all protein sources offer the same nutrition, and dairy
products should be eaten in high amounts
 Suggested pyramid
• Dr. Willet suggested a pyramid in which daily exercise gets the most
emphasis, followed by plenty of good fats like plant oils, and plenty
of fiber-filled whole grains.
• Next is vegetables and fruits.
• Then comes protein in the form of nuts and legumes, and fish,
poultry and eggs.
• Next is dairy or calcium supplements.
• Unhealthier items like red meat, butter, sweets, potatoes, white
rice, white bread and pasta should be eaten only sparingly.
 Recommendations:
• Four times as much fish and poultry as red meat
• Five servings of vegetables daily
• Four servings of fruits daily
• One daily serving of nuts or vegetable protein like soy
• More polyunsaturated fats (mostly found in vegetable sources) than
saturated fats ( mostly found in animal sources)
• 15g of fiber from grain sources like cereals or whole wheat bread,
each day.
 Recommendations

• What's really important is to emphasize healthy fats, healthy

carbohydrates and deemphasize unhealthy fats and unhealthy
carbohydrates

• The traditional pyramid completely fails to do that

1 ounce = 28,3495g
1 cup = 340g
 Healthy Diet
• Balance between food & physical activity:
✓ Be physically active for at least 30 min/day most days of the week

• Meats & beans

✓ Choose low-fat or lean meats & poultry (baked, boiled or grilled);
vary your protein routine-choose more fish, beans, peas, nuts & seeds
(10%)

• Oils, sugars & salt

• Know the limits of fats, sugars and salt; make the most of the fat
sources in fish, nuts & vegetable oils( 2%)
 Healthy Diet
• Fruits
✓ Eat plenty of fruit (15%)

• Milk & calcium-rich foods

✓ Go low-fat or fat-free when you choose milk, yogurt & other milk
products (23%)

• Vegetables
✓ Eat more dark green veggies ( 23%)
✓ Grains : make half your grains whole (27%)
 Food Based Dietary Guidelines of South African
Dietetic Society
• Enjoy a variety of food
• Be active
• Make starchy food the basis of most meals
• Eat plenty of vegetables and fruits
• Eat dry beans, peas, lentils and soya often
• Meat , fish, chicken, milk and eggs can be eaten every day
• Eat fats sparingly
• Use salts sparingly
• Drink lots of clean, safe water
• If you drink alcohol, drink sensibly

SOUTH AFRICAN GUIDELINES FOR HEALTHY EATING

Department of Health, Directorate: Nutrition, Pretoria, June 2004
Supported by: Association for dietetics in South Africa, Nutrition Society of South Africa
Importance of Healthy Diet
• It is widely acknowledged that the intake of
fresh fruits and vegetables diminishes the
prevalence of several cancers and
cardiovascular diseases.

• Antioxidant microconstituents present in

these foods, play a key role in the protection
mechanisms by scavenging free radicals.

• Since intervention studies have suggested that

the intake of single anti-oxidants given at high
doses in high-risk subjects could have negative
consequences, it has been recommended that
the consumption of fruits and vegetables rich
in a complex, synergistic mixture of natural
 Enhancement of anti- oxidant
• Anti-oxidants be increased as much as possible (Tyssandier et al., 2002).
• Oxidant formation in the vasculature contributes to vascular disease and
dysfunction associated with obesity
• Exercise-dependent production of oxidants may stimulate adaptive
responses with increases in circulating levels of:

✓ Glutathione peroxidase
✓Catalase
✓ Superoxide dismutase

• These add to anti- oxidant nutrients to protect against the development of

such diseases.
Enhancement of anti- oxidant
• Vitamin C
• Vitamin E
• Beta carotene
• Selenium
• Lutein
• Lycopene
 Enhancement of anti- oxidant

• Health practitioners should firstly advocate a balanced

diet…using individual self-prescribed supplements cannot
provide an equal protective effect.

• It is for, example, not known which of the 400 carotenoids which

exist in fresh fruit and vegetables and in which combination,
provide maximum protective effect.

• Carotenoid complexes are known to interfere with the

progression phase of the cancer triggered cell and
restore communication channels and gap junctions
A take – home message…

• Health practitioners should always reinforce messages of a nutritious

diet, even when they are providing clients with nutrient pills for
prevention or treatment of nutrient-related issues.
 Vitamin Intake

• Mild vitamin deficiencies are very common among elders, and

particularly so among the frail and institutionalized elderly

• Infections anaemia, cognitive impairment and poor wound

healing are among the associated manifestations of mild
vitamin deficiencies in the elderly

• While single vitamin deficiencies do occur, usually multiple vitamin

deficiencies are seen with general malnutrition. Severe vitamin
deficiency can lead to irreversible organ damage.
Paradigm shift in the Assessment of
Requirements

From:
Sole avoidance of deficiency state as determined by clinical
manifestation and status
To: Maximising health and improving quality of life
 Recommended Daily Allowances(RDA’S) of
National Research Council, USA
• Set of nutrient and energy standards adequate to meet known
nutritional needs of all healthy people
• To meet the lowest continuing intake level to maintain nutritional
needs and avoid nutrient deficiency
• Adjusted for age, gender & health status (pregnancy, lactation)
 Daily Reference Intakes
• EAR: Estimated average requirement
• RDA: Recommended Dietary Allowance
• AI: Adequate Intake
• UL: Tolerable upper intake level
• NOAEL: No observed adverse effects level
• LOAEL: Lowest observed adverse effects level
 EAR’s
• Nutrient intake value estimated to meet requirement of 50% of a life-
style or gender group

• Basis for setting of the RDA; if no EAR can be set, no RDA will be set
 RDA’s
• The average daily dietary intake level that is sufficient to meet the
nutrient requirement for nearly all (97-98%) healthy individuals in a
particular life stage and gender group

• RDA= EAR + 10%

 Adequate intake (AI)

• Set instead of a RDA, if insufficient scientific evidence is available to

calculate an Estimated Average Requirement (EAR)

• The AI is based on observed or experimentally determined estimates

of nutrient intake by a group of healthy people
 Tolerable Upper Intake Level (UL)
• Highest level of daily nutrient intake that is likely to pose no risk of
adverse health effects to almost all individuals

• As chronic intake increases to above the UL, the risk of adverse effects
increases

• UL’s are based on total intake of a nutrient from food, fortified food
and food supplements
 Safe Range of Intake

• Between RDA and NOAEL (highest level at which no observed

adverse effects have been reported/highest possible level of chronic
intake)

• Once into LOAEL (lowest observed adverse effects level), risk of

inadequacy/toxicity rises again
 DRI’s
• Vitamin C: RDA: men: 90 mg; women: 75 mg; 35 mg to be added for
smokers; NOAEL: 2g/day; LOAEL(osmotic diarrhoea): 3g/day

• Beta Carotene: no UL, LOAEL or NOAEL (carodemia is reversible)

• Vitamin E: large uncertainty factor; haemorrhagic effects chosen as

critical point for LOAEL; AI=3-6 mg/day
UL: 1000 mg/day; 2000 mg/day= NOAEL

• Vitamin B1, B2, B12, K: no LOAEL/NOAEL

 Another Paradigm shift in Nutrition
• Concern about taking in too great amount of micronutrients, in
addition to deficiencies in vitamins and minerals.

Aim: the “safe” range of intake

Areas of Public Health Priority : Nutrition
• Nutrition is one of priority areas
• 66% of Americans die of diseases linked to diet (Surgeon General’s
report on Health)
• Eating habits associated with 5 of the leading causes of death in the
US: heart disease, some cancers, stroke, diabetes, arthrosclerosis.
• Smaller households: 60% of households: 1- 2 people
• Increasing older population...
• Cultural diversity: ethnic & religious identity determines food habits…
 Areas of Public Health Priority: Nutrition
• Eating out………...33% ”once a week”
• Convenience foods… over refined, excessive in fats, salt & kilojoules
• Health & fitness trends…supplementation!
• Stress….supplementation!
• Substance Abuse
• Sedentary Lifestyles
• Changing consumer (influenced by mass media), changing economy….
Nutritional therapy = cutting edge of Heath
st
care system of 21 Century
Challenges of system of 21st Century
Adapting to meet changing lifestyles

Too Much Salt

• Despite counselling by physicians, most adults who follow a typical
western diet, consume about 9 to 12g, far too much, putting them at
risk for high blood pressure, heart disease and stroke, according to a
new study in the latest issue of the American Journal of Preventive
Medicine.
• Even though people who already having hypertension, generally
consume less sodium than others, their average daily intake is still far
higher than recommended levels.
Too Much Salt
 The Top- 10 High Salt Foods
1. Smoked, processed and cured meats
• Ham, bacon, corned beef, frankfurters, sausage, tongue, chipped beef -
high salt content Processed meats such as corned beef, viennas, also
contain nitrates and nitrites added to preserve

2. Fish
• Pickled herring, anchovies, tuna and sardines all have a high salt content
Therefore,
✓ opt for fresh or frozen fish instead of canned fish
✓choose tuna that's in water, and not in brine;
✓avoid smoked fish
 The Top- 10 High Salt Foods
3. Meat extracts and stocks
• Meat extract and stocks are salt bombs, replace with home made
stock and gravies
• Make your own chicken stock by simply boiling the chicken
bones with vegetables like carrots, leeks, onions and celery.

• More control over the amount of salt added, also taste less
artificial
• Also add plain or flavoured vinegar to flavour soups and stews
The Top- 10 High Salt Foods
4. Salted snacks
• from potato, tortilla and corn chips to pretzels, salted nuts, popcorn
and crackers
• Make a point of
✓ including nuts in your diet, but always go for the unsalted varieties
✓pop your own popcorn at home and use the minimum
✓amount of salt
✓check the labels of chips and crackers and always go for the reduced-
salt products (if the labels only indicate sodium content, multiply the
value by 2,5 to get the salt content).
The Top- 10 High Salt Foods
5. Pickles
Gherkins, pickled onions, capers and artichokes preserved in a potent
salt mixture

✓pickles are especially bad when it comes to monitoring salt intake,

because the sodium content varies so much from product to product
✓Rinse pickles to get rid of any excess salt water and always check
labels for sodium/salt content
The Top- 10 High Salt Foods
• 6. Salad Dressings
• Most commercial salad dressings have a high salt content. However,
there is great variation among different products. So, it's important
to check labels
• Also:
✓Ask for salad dressing to be served on the side when you're at a
restaurant
✓Prepare your own salad dressing at home, using a little vinegar, olive
oil and herbs
 The Top- 10 High Salt Foods
7. Sauces
Worcestershire sauce, soy sauce, tomato sauce, barbeque sauce …
beware of these products. They're usually packed with salt.

• Tomato sauce contains more salt than seawater

• Limit your use of prepared sauces
• Rather use spices, herbs and other seasonings, like horseradish
(wasabi), lemon juice and vinegar, to season food.
 The Top- 10 High Salt Foods
8. Prepackaged and frozen foods
• Includes packaged mixes for sauces, gravies, casseroles, noodle, rice
and potato dishes, oriental foods, spaghetti and pot pies
• Most processed foods are high in salt without tasting obviously salty.
• Here are a few tips to reduce salt intake:
• Get into the habit of checking the labels of readymade meals;
• Never eat more than a single serving size;
• Try to prepare your own meals at home, freezing it for
 The Top- 10 High Salt Foods
9. Canned Soup

• A 1-cup serving of commercial canned soup contains about 1000mg

of sodium almost half your daily recommended amounts
• Buy soup products that say "sodium free, low sodium, reduced
sodium, or unsalted", or simply prepare your own soups at home,
where you have control over the amount of salt you add.
 The Top- 10 High Salt Foods
10. Cheese

• Processed cheese and cheese spreads are particularly problematic.

• On a gram-to-gram basis, blue cheese and feta cheese have a much
higher salt content than mozzarella and cottage cheese.
• Avoid processed cheeses and cheese spreads, always check labels,
and be on the lookout for cheeses that make "low-sodium" claims.
 Sea Salts VS table salts
• Gram for gram sea salts contain as much sodium as table salt, their
larger crystals and unique flavours, derived from various sources, may
result in your using less salt over
• Commercial refined salt is not only stripped of all its minerals, besides
sodium and chloride, but is also chemically cleaned, bleached and
heated at unnecessary high temperatures.
• It is treated with anti-caking agents which prevent salt from mixing
with water in the salt container. These agents also prevent dissolving
within our system leading to build up and then deposit in organs and
tissue, causing severe health problems.
 Table salts cont….

• The iodine that is added into salt is usually synthetic which is difficult
for your body to process properly. Shockingly under U.S. law, up to 2%
of table salt can be additives.
 Himalayian Salt

• Packs a hearty 80+ minerals and elements- Himalayan salts are

mineral packed crystals which formed naturally within the earth made
up of 85.62% sodium chloride and 14.38% other trace minerals
including: sulphate, magnesium, calcium, potassium, bicarbonate,
bromide, borate, strontium, and fluoride (in descending order of
quantity)…just as Mother Earth intended
 Additives
• Is an unrefined, unprocessed "raw" salt that is hand-mined from
abundant salt caves that were formed 250 million years ago as ocean
salt settled in certain geologic pockets around the earth.
Preservatives : Sulphur dioxide & sodium benzoate

• Sulphur dioxide may be labelled as sodium metabisulphite, potassium

metabisulphite, sodium or potassium bisulphite or sulphite

• Tight chests in individuals who have asthma and scratchy feeling at

the back of their throats
• Skin rashes may also occur
 Preservatives
Foods that may contain sulphur dioxide include (shortened list):
• Some fruit juices
• concentrated soft drinks
• dried fruit
• boerewors
• dried wors
• Wine, beer
• some sauces
• Pickles
• hamburger patties
 Preservatives
Foods that may contain sodium benzoate include:

• Fruit juices
• Soft drinks
• Foods with fruits
 Colourants
• May be natural or synthetic

• Foods that may contain colourants include: Fruit juices, soft drinks, sweets,
desserts, toppings, syrups, cooking oils, sauces and pickles.

• Reactions, although not common, can occur with both types.

• Best known : Tartrazine. An azo dye, so patients who react to this

colourant, should avoid all of the azo dyes.

• not many individuals are in fact affected. Not all asthmatics need to avoid
tartrazine.
• Whether tartrazine or other colourants can result in hyperactivity in
children is still controversial.
 Flavour Enhancers
• Most commonly used is Monosodium Glutamate (MSG)
• found in oriental food, packet soups, sauces, soya sauce
• synthetic manipulation & processing of glutamate produces a form that is not found in nature-
exotoxin

Has been associated with:

✓ burning sensations of the mouth, head & neck
✓ weakness of the arms or legs, headaches &upset stomach ± 15 min after the MSG is consumed
✓ tight chests in asthmatics: immediately or 6 -12 hours later
✓ nausea
✓ sweating and a sensation of facial pressure
✓ “pins and needles" or tingling may be experienced in the limbs or face and head., but not
common

• Research evidence not conclusive

 Artificial Vs Natural Sweeteners
• Natural Sweetener : stevia –Helps balance blood sugar

• Sugar Alcohols : Loosen stool

✓Erythritol
✓Xylitol

• Artificial Sweetener: sucralose, acusulfame K, cyclamates, saccharine

= harmful to body and brain
THANK YOU