BCH323

Introduction to
Human Nutrition
A. Babandi, PhD
Learning Objectives
• Understand the importance of good nutrition.
• Identify food sources of nutrients.
• Describe the roles of nutrients in the body.
• Understand the causes and consequences of
undernutrition.
• Describe strategies to combat undernutrition.

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 Introduction
 Most of the organized studies of nutrition have been confined to the
20th century.
 Although there was evidence of long-standing curiosity about nutrition.
 Hippocrates, the father of medicine(400 BC) considered food as one
universal nutrient.
 Antonie Lauret Lavoisier(18th century, a French chemist) is known as
father of nutrition.
 In Islam there are many verses of the Quran and Hadeeths in food and
nutrition.
 Some of these fact has just been proved by the modern science and
some not.
 Intro……..contd
 Human nutrition is a complex, multifaceted scientific
domain indicating how substances in foods provide
essential nourishment for the maintenance of life.

 Nutrition has played a significant role in our life, even from

before our birth.

 Many people are concerned only with food that relives their
hunger or satisfies their appetite .

 But in many times, these foods don't supply their bodies

with all the component of good nutrition.
Relationship between nutrition and health
 Food and Diet:
Foods are products derived from plants or animals .
that can be taken into the body to yield energy and nutrients for maintenance
of life ,for growth and repair tissues.
Food is that nourishes the body.
Food is a prerequisite of nutrition.

Diet: Diet is the foods and beverages a person eats and drinks.

Nutrients:
Chemical substances obtained from foods used in the body to provide energy,
structure materials, regulating agents to support growth, maintenance, repair
of body's tissues and may also reduce the risks of some diseases.
 The study of nutrients cover:
1.The chemical and physical structure and characteristics of the nutrient
2. The food sources of the nutrient, including food composition, the way in which foods
are grown, harvested, stored, processed and prepared, and the effects of these on
nutrient composition and nutritional value
3. The digestion, absorption, circulatory transport, and cellular uptake of the nutrient, as
well as regulation of all these processes
4. The metabolism of the nutrient, its functions, storage, and excretion
5. Physiological needs (demands or requirements) for the nutrient in health and disease,
and during special circumstances (pregnancy, lactation, sport events), as well as
individual variability
6. Interactions with other nutrients, non-nutrients(phytochemicals), antinutrients, and
drugs
7. The consequences of underconsumption and over-consumption of nutrients
8. The therapeutic uses of the nutrient
9. Factors influencing food and nutrition security and food safety.
 Food composition

Food

Nutrients
Other
1-Macronutrients compounds
2-Micronutrients -fibers
-phytochemicals
-pigments
-additives
-alcohols
-and others
Nutrients
Macronutrients
• Are the nutrients which the body needed in large amount such as
carbohydrate, protein and fats.
• Carbohydrates, protein and fats are the main source of energy for
human body.
• Are the energy yielding nutrients.
 Micronutrients
• Are nutrients needed in lesser amounts such as: Vitamins &
minerals.
Essential Nutrients - Macronutrients
Macronutrient Energy Provision in
average adult diet

• Carbohydrates 50%
sugars and complex carbohydrates

• Fats 35%
saturated and unsaturated fats

• Protein 15%
provide essential and non-essential amino acids

• Alcohol (non-essential) 0%-5%

Essential Nutrients - Micronutrients

• Minerals:
Bulk Ca, Mg, Na, K, Cl, P
Trace Fe, Zn, Cu, Mn, I, Se,? others

• Vitamins:
fat-soluble A,D,E, and K
water-soluble B group and C

• Essential Fatty Acids:

n-3 series Linoleic acid and derivatives
n-6 series Linolenic acid and derivatives
 Chemical composition of the
nutrients
Nutrients

Inorganic Organic
(water &Mineral) (CHO, lipids , protein and
vitamins)

Organic nutrients: substance that contain carbon

atom.
Inorganic: substances that do not contain carbon
Essential nutrients:

Are nutrients a person must obtain from food

because the body cannot make them for itself
insufficient quantity to meet physiological
needs. Also called indispensable nutrients.
 Nutrition:
• Nutrition is the science of foods, nutrients and
other substances they contain their actions within
the body (including ingestion, digestion,
absorption, transport, metabolism and excretion).
• A broader definition includes the social, economic,
cultural, and psychological implications of food
and eating.
  Nutritional requirements and Others:

Nutritional requirements:
The amounts of nutrient which are needed for covering the human needs to be
healthy depend on sex, age and few other factors.
Nutritional status
An individual condition of health in relation to digestion and absorption of nutrients.
Nutritional care:
Application of the science of nutrition in nourishing the body regardless of health
problems or potential problems.
Adequate diet: is a diet providing all the needed nutrients in the right
total amounts.
Junk food:
Refers to foods that are harmful.
  Calories
• The energy released from carbohydrates, proteins and fats can be
measured in calories.
• A calorie is the amount of heat necessary to raise temperature of 1
gm of water by 1 C.
• 1000-calorie metric units are known as kilocalories (kcal).

Empty-kcalorie foods
a popular term used to denote foods contribute energy (from sugars,
fat or both)
but lack in protein, vitamins and minerals Example:(potato chips and
candies).
  Dietetics
the health profession responsible for the application of nutrition
science to promote human health and treat disease

 Metabolism
The sum of all chemical reactions that take place in the body which it
maintains itself produces energy for its functioning.
  Nutrition science

Nutrition science:
1-The study of nutrients and other substances in foods and the body's
handling of them.
2-Its foundation depends on several other sciences including biology,
biochemistry, and physiology.
3- Comprises the body of knowledge governing the food requirement
growth, activity, reproduction and lactation.

Nutritional Genomics: The sciences of how nutrients affect the

activities of gene and how genes affect the interaction between diet
and diseases
 Malnutrition:
Malnutrition has two types:
Undernutrition: deficient energy or nutrients.

•Symptoms of under nutrition (extremely thin, losing

muscle tissues, prone to infection and disease, skin
rashes, hair loss, bleeding gum and night blindness).

Overnutrition: excess energy or nutrient.

•Symptoms of overnutrition (heart disease, diabetes,

yellow skin, rapid heart rate and low blood pressure).
  Nitrogen balance
• The proteins in the body undergo constant turnover (degraded to
amino acids and resynthesized).

• Nitrogen balance is the difference between the amount of nitrogen

taken into the body each day and the amount of nitrogen in
compounds lost.
• if: 1- More nitrogen is ingested than excreted, a
person is said to be in positive nitrogen balance
(growing individual such as children and
pregnant).
• 2- Less nitrogen is ingested than is excreted
(negative nitrogen balance, person eating either
too little protein or protein is deficient in one or
more of the essential amino acids, new protein
cannot be synthesized and the unused amino
acids will be degraded, body function will be
impaired by the net loss of critical proteins.
• 3- In contrast, healthy adults are in nitrogen
balance and the amount of nitrogen consumed in
the diet equals its loss in urine.
 Nutritive value

The amounts of nutrient which the food consist

of, determined by using:
 Food analysis.
 Food analysis tables.
Energy from food
• The amount of energy a food provide depends on how
much CHO, fat, and protein contains.
• When completely broken down in the body,
1 gm CHO 4 kcal of energy
1 gm protein 4 kcal of energy
1 gm of fat  9 kcal of energy
therefore fat has the greater energy density than either
CHO or protein.
• Alcohol is not considered a nutrient because it
interferes with health but it yields energy
1 gm of alcohol 7 kcal of energy
Functions of food
nutrients

1-Provide energy sources

2-Build tissues
3-Regulate metabolic process
1-Provide energy sources
• The major carbohydrates in the human diet
are starch, sucrose, fructose and glucose.

• Dietary carbohydrate (starches and sugars)

provided the body's primary source of fuel for
energy.

• Oxidation of carbohydrates to CO2 and H2O in

the body produces approximately 4 kcal/g.

• They also maintain the back-up store of quick

energy as glycogen (animal starch).
• Fats are lipids composed of triacylglycerols.

• A triacylglycerol molecule contains three fatty acids

esterified to one glycerol molecule.

• Dietary fats, from both animal and plant

sources, provided the body's secondary or storage form
of energy.

• It is a more concentrated, yielding 9 kcal for

each gram consumed.

• In a well-balanced diet, protein provided about 15 %

of the total kcalories.

• Each gram of protein can yield 4 kcal.

Energy Requirements
• Amounts needed to maintain health, growth, and
appropriate physical activity
• Vary according to age, gender, and activity
• Met through an age-appropriate balanced diet
• Based on
• Basal metabolism: Energy needed for basic body functions
• Metabolic response to food: Energy needed to digest, absorb,
and utilize food
• Physical activity: Work, rest, and play
• Physiology: Pregnancy, lactation, and maturation increase
energy needs

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Energy metabolism
• Energy is required for:
1. Basal metabolism ( maintaining life)
2. Voluntary exercise and activity
3. Additional need such as growth.
• Energy is derived from the oxidation of
carbohydrates, fats, and proteins in the diet. We
measure the energy value of the food or the energy
needs of the body in unit called calories or joules.
The calorie or the joule is measure of heat
• Calorie: one large calorie ( kcal) is the amount of heat
required to raise the temperature of 100 g of the
water by 1C. In nutrition the large calorie is always
used. It is 1000 times as great as the small calorie unit
used in chemistry or physics.
• Joule: the international unit of energy is joule. It is
defined as the amount of heat needed to raise the
temperature of 240 g of water by 1 C
• 1 kcal = 4.184 kilojoules
• The energy value of food is measured in the laboratory by
an instrument called a bomb calorimeter.
• Ex: carbohydrates: 4 kcal/gram, Fat: 9 kcal/gram, Protein:
4 kcal/gram.
• Thus if we know the carbohydrate, fat and protein
contents of food or diet, we can calculate the calorie
value.
• Energy needs of the body: the body used glycogen,
sugars, fatty acids, glycerol and amino acids to supply
energy.
• The breakdown of these substances required
numerous steps and is a very complex process.
• The rate of breakdown depends upon the total daily
energy requirement: the basel metabolism, the
amount of voluntary activity, the influence of food
and the need of growth.
• Basel metabolism: account for more than ½ the
energy requirement for most people. Its include the
involuntary activity of the body while at rest but
awake
• The basal metabolism can be measured as basel
metabolism rate(BMR). The following conditions are
observed:
1. The individual is a wake but laying quietly in
comfortable room.
2. He is in the post absorptive state( he has had no
food for 12-16 hours).
3. The body temperature is normal
4. He is not tense or emotionally upset.
• The BMR is then measured by indirect calorimeter,
which is the measurement of oxygen consumption
and carbon dioxide production arising from the
combustion of specific nutrients.
• It is based on the fact that the amount of energy
expended is always in direct relationship to the
amount of oxygen utilized in the combustion of
various food componants
• In clinical practice, BMR can be estimated accurately by
measuring O2 consumption of the patient for two 6 min
periods under basel condition thus:
• O2 consumption/hour= average O2 consumptionx10
• 1L of O2 = 4.825 kcal/hour
• Convert O2 consumption/hour into kcal/hour
• BMR=( Kcal/hour)/surface area = Kcal/m2/h
• Surface area =obtained from the nanogram
• Several factors affect the BMR: these include body
size, muscle tissue, growth, age, thyroid state and
climate..
• Voluntary activity: increases the energy requirement
considerably. When calculating the person's energy
needs the BMR may have to be doubled for a very
active person. Under most normal life includes mainly
light exercise ( office workers, teachers), moderate
exercise ( nurses) of heavy exercise ( manual laborers
• Useful table based on the type f activity, age and
weight are available to help one determine quickly
the needs of the individuals.
Energy Requirements
of Adults > 19 Years Old

• Basal metabolic rate (BMR) = Number of kilocalories

(kcal) needed each day
• Energy needs = BMR x activity factor
• Additional energy needed by pregnant and lactating
women

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Energy Requirements
of Children and Adolescents < 18
• Calculated based on age, physical activity, and energy
needs for growth
• Increase after age 10 to support changing body
composition and growth
• Kcals required per day (FAO, WHO, UNU 2004)
• Boys 1−18 years old: 948−3,410
• Girls 1−18 years old: 865−2,503

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Energy Requirements
of Infants 0−12 Months Old

• Mainly for growth

• Vary by age and gender
• All energy and nutrient needs met by breastmilk for
the first 6 months of life

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How to calculate the energy available from 1 slice of bread with 1slice
of bread with 1 tablespoon of peanut butter on it contains 16 grams
carbohydrate, 7 grams protein and 9 grams fat?
2-Build tissues
• Proteins are composed of amino acids that are joined to form
linear chains.

• The digestive process breaks down proteins to their constituent to

amino acids, which enter the blood.

• The primary function of protein is tissue building and repairing

body tissues.

• Dietary protein provides amino acids, amino acids are the building
unit necessary for construction and repairing body tissues.
• Muscle protein is essential for body movement.

• Other proteins serve as enzymes.

• Other nutrients such as minerals and vitamins used in tissue

building and maintaining tissue.
• Minerals are also found in the fluids of the body and
influence their properties.

• There are 13 different vitamins, one vitamin enables

the eyes to see in dim light,
protect the lungs from air pollution
make the sex hormones,
stop the bleeding,
helps repair the skin,
replace old blood cells and lining of the digestive
tract.
Protein Requirements

• Needed daily to replenish continuous depletion

• May vary by age, health status, physiological
status, and occupation
• Higher for pregnant and lactating women
• Fluctuate in children based on weight, age, and
gender

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Undernutrition
• The manifestation of inadequate nutrition
• Common in sub-Saharan Africa
• 1/3 of all children < 5 years old underweight
• 38% of children with low height for age
• Many causes
• Inadequate access to food/nutrients
• Improper care of mothers and children
• Limited health services
• Unhealthy environment

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Conditions Associated
with Under- and Overnutrition
• Vitamin deficiency disorders
• Scurvy (deficiency of vitamin C)
• Rickets (deficiency of vitamin D)
• Mental, adrenal disorders (deficiency of B vitamins)
• Mineral deficiency
• Osteoporosis (deficiency of calcium)
• Diet-related non-communicable diseases
• Diabetes
• Coronary heart disease
• Obesity
• High blood pressure
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Causes of Undernutrition

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 3-Regulate metabolic
process
• Many vitamins and minerals function as coenzymes
factors in cell metabolism.
• Other nutrients (water and fibers),
water provides the environment in which nearly
all the body's activities.
Also, in many metabolic reactions and supplies the
medium for transporting vital materials to cells and
waste products away from them.
• Dietary fibers help regulate the passage of food
material through the gastrointestinal tract and
influences absorption of various nutrients.
Composition of human body

6% 2%

14%
water (61%)
Protein (17%)
Fats(13.8)
Minerals(6.1%)
17% 61% Carbohydrates(1.5)
Nutrition assessment of
individual

Evaluation of person's nutrition

1- Historical information (socioeconomic status, drug
use, diet and person's family history).
2-A=Anthropometric data (height and weight).
3- B= biochemical data (Laboratory tests).
4-C=clinical assessment(Physical examinations)
5-D=Dietary assessment
Nutritional Status
Determined by Anthropometry
• Underweight: Low weight for age compared to
reference standard, a composite measure of
stunting and wasting
• Stunting: Low height for age compared to
reference standard, an indicator of chronic or past
growth failure
• Wasting: Low weight for height, an indicator of
short-term nutritional stress

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Other Anthropometric
Measurements
• MUAC (mid-upper arm circumference)
• BMI (body mass index): Compares height and
weight
BMI = Weight (kg) ÷ height (m)2

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Classification of overweight
and obesity
Classification BMI Disease risk
Under weight <18.5
Normal 18.5-24.9
Over weight 25-29.5 High
Obese
Class 1 30-34.9 Very high
Class 2 35-39.9 Very high
Extreme obesity =>40 Extreme high
Class 3

Disease risk: DM 2, hypertension, CVD for men >40 inches and

women>35 inches
Medications that can cause
weight gain
Medication Possible alternative
Corticosteroids NSAIDs, acetaminophen
Anti diabetic ( sulfonylurea, insulin, Biguanides
thiazolodione)
Anticonvulsants gabapentin, Lamotrigine
carbamazepine, valopric acid
Alpha- adrenergic blocker( clonidine, doxazosin
prazosin)
Hormonal contraceptives Barrier methods
Pharmacological treatment options available in
USA

Class/ Drug Usual dose

Lipase inhibitor Alli: 60 mg 1x3 with each fat containing
Orlistate meal
Xenical: 120 mg 1x3 daily 1 hour after
each fat containing meal

Sympathomimetics
Phentermine 15-37.5 mg/day given in 1-2 divided dose,
before or 1-2 hours after breakfast
Phendimetrazine Capsule: 105 mg 1x1 daily before
breakfast
Complementary and
alternative medicine
Herb Dose Effectiveness rating Common A/E
Bitter orange 975 mg/day Insufficient Increase in Bp,
evidence tachycardia, CV
toxicity
St. john's wort Not available for Not available GI discomfort ,
obesity, range from diarrhea, insomnia
300-1200 mg/day
Chitosan 1-5 g/day Insufficient GI upset, nausea,
evidence flatulence,
constipation
Manifestations
of Protein-Energy Malnutrition (PEM)

• Marasmus: Severe growth failure

• Weight < 60% weight for age
• Frailty, thinness, wrinkled skin, drawn-in face,
possible extreme hunger
• Kwashiorkor: Severe PEM
• Weight 60−80% weight for age
• Swelling (edema), dry flaky skin, changes in skin and
hair, appetite loss, lethargy
• Marasmic kwashiorkor: Most serious form of PEM,
combining both conditions above
− Weight < 60% weight for age
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Strategies to Prevent and Control
Undernutrition
• Improve household food security.
• Improve diversity of diet.
• Improve maternal nutrition and health care.
• Improve child feeding practices.
• Ensure child health care (immunization, medical
care, growth monitoring).
• Provide nutrition rehabilitation.

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Nutritional Anemia
• Most common type of anemia
• Caused by malaria, hookworm, and inadequate
iron and vitamin intake resulting in low
hemoglobin levels
• Affects mainly children < 5 years old and pregnant
women
• Detected by measuring blood hemoglobin levels

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Effects of Anemia
• Adults
• Reduced work capacity
• Reduced mental capacity
• Reduced immune competence
• Poor pregnancy outcomes
• Increased risk of maternal death
• Infants and children
• Reduced cognitive development
• Reduced immune competence
• Reduced work capacity

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Strategies
to Prevent and Control Anemia
• Promote iron, folic acid, and B12-rich foods.
• Treat and prevent anemia-related diseases (malaria
and worms).
• Provide iron and folic acid supplements to infants
and pregnant and lactating women.
• Fortify foods.
• Promote vitamin C-rich foods with meals.
• Discourage drinking coffee or tea with meals.

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Iodine Deficiency Disorders (IDD)

• Caused by inadequate intake of iodine

• Only 1 tsp. needed over entire lifetime
• Iodine in food sources varies by geography.
• Less in highlands and mountain regions
• Leached from soil and carried to lowlands

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Manifestations of IDD
• Goiter: Enlarged neck region from overactive thyroid
gland
• Hypothyroidism: Dry skin, weight gain, puffy face,
lethargy from underactive thyroid
• Hyperthyroidism: Rapid pulse and weight loss from
overactive thyroid
• Cretinism: Mental retardation, physical development
problems, spasticity from IDD in mother during
pregnancy

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Strategies to Control IDD

• Iodize salt, dairy products, and bread where where

iodine is deficient in local foods.
• Provide iodine drops.
• Inject people with iodized oil (expensive).

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Causes of Vitamin A Deficiency
(VAD)

• Low consumption of vitamin A-rich foods.

• Dietary deficiency due to food processing
• Limited consumption of fats and oils
• Poor breastfeeding (no colostrum, insufficient
breastfeeding)
• Diseases affecting absorption (e.g., worms, chronic
diarrhea)

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Manifestations of VAD
• Xerophthalmia (eye conditions)
• Blindness (VAD is the leading cause of blindness in
children < 5 years old)
• Bitot’s spots
• Damage to the cornea
• Slowed growth and development
• Reduced reproductive health
• Increased risk of anemia

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Strategies to Control VAD
• Promote vitamin A-rich foods (fruits, vegetables, red
palm oil).
• Give infants and women low-dose iron supplements
according to WHO protocols.
• Improve food security.
• Feed children properly.
• Prevent disease and treat disease early.
• Fortify foods.

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National Nutrition Strategies,
Policies, and Guidelines
• General nutrition
• Infant feeding
• Nutrition and HIV
• Food security

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Sign of good nutrition
1. Well-developed body.
2. Ideal weight.
3. Good muscle development.
4. The skin is smooth and clear
5. The hair glossy and the eyes clear and bright.
6. Appetite, digestion and elimination are
normal.
7. Have good resistance to infection.
The relationship of nutrition
with other sciences
food
science
Medicine physiology

Nutrition
microbiology
biochemistry

biology
There are three main areas of overlapping
between nutrition and medicine:
1-dietary control of disease.
2-the relationship between diet as a possible
causative factor in disease ex: cancer, heart
diseases etc.
3-the toxicology of natural and processed
foods.
Case Study 1

• Food has been in short supply in your area. A

mother brings her 3 year-old daughter to the clinic.
She is worried because the child has a poor
appetite, skin conditions that won’t go away, and
excessive diarrhea. Her hair has gotten lighter. You
notice swelling around the child’s ankles. What
might she suffer from? What is the appropriate
course of action?

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Case Study 2
• A 28-year-old pregnant woman attending the
antenatal clinic complains of shortness of breath,
dizziness, a fast heart rate, and extreme fatigue.
When asked about the foods she has been eating,
she says she’s had little access to meat and fish since
her pregnancy. What nutrition deficiency might she
be suffering from? What action would you
recommend?

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Case Study 3
• You and another nurse are community health
workers making rounds to households to assess the
general health of children under five. You notice
that most children seem small or thin for their age
and decide to assess weight for age and height for
age using a hanging scale and height board. In the
first household, a 24-month-old boy weighs 13 kg
and is 80 cm tall. Using the growth charts in the
Appendix, assess this child.

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Nutrient intake limits
Accurate View

Danger of toxicity
Naive View
marginal

Safety
Safety

RDA RDA
Safety

Danger
marginal

Danger of deficiency
Conclusions
• Good nutrition is essential for health and well-being.
• Daily well-balanced diets should include foods
containing essential nutrients and meeting energy
requirements.
• Inadequate nutrition can lead to PEM and vitamin and
mineral deficiencies (anemia, VAD, IDD).
• Nutrition interventions include improved household
food security, food fortification, vitamin and mineral
supplementation (for women and children), and
improved child feeding.

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Thank you for listening
