NUTRITION

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NUTRITION

• Heather Wrenn, RN, BSN
• Fall 2006

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WEBSITES

• http//www.nutrition.gov
• http//www.healthypeople.gov
• http//www.health.gov/dietaryguidelines
• http//www.mypyramid.gov
• http//www.eatright.org
• http//dietary-supplements.info.nih.gov

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NUTRITION Basic Terms

• Nutrient
• Substances that the human body utilizes from
  foods that are consumed water, proteins, carbs,
  fats, minerals, vitamins
• Calorie (kilocalorie 1000 cal)
• Energy measurement of nutrients that foods
  provide
• Metabolism
• Sum of all various biochemical physiologic
  processes by which the body grows maintains
  itself (anabolism) breaks down reshapes
  tissue (catabolism), transforming energy to do
  its work.

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NUTRITION Basic Terms

• Macronutrient
• Essential nutrients that provide energy
  carbohydrates, fats, proteins
• Micronutrient
• Essential nutrients that the body needs in small
  amounts serve to regulate control functions of
  the body vitamins and minerals

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CARBOHYDRATESOverview

• Major fuel source starches sugars
• quick energy foods
• Widely available
• Easily grown in plants as grains, vegetables,
  fruits
• Should provide 45-65 kilocalories
• Relatively inexpensive
• May be stored easily without spoilage

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CARBOHYDRATESFunctions

• Providing energy
• 1gm 4kcal
• Glycogen reserves
• Liver muscle store reserves
• Protein sparing action
• Normal fat metabolism
• Providing fiber

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CARBOHYDRATESFood Sources

• Cereal grains
• Rice, wheat (bread, pasta, cereal),rye, oats
• Vegetables
• Potatoes, carrots, beets, turnips, peas, lima
  beans, corn, green leafy veggies
• Fruits
• Sugars
• Table sugar, syrup, honey, desserts

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CARBOHYDRATES Classification

• Monosaccharide simple sugar
• Glucose (dextrose)
• Found naturally in only a few foods such as corn
  syrup
• Main body supply comes from starch digestion
• All other types of sugars converted to glucose
• Hyperglycemia elevated blood glucose levels
• Hypoglycemia blood glucose levels below normal
• Fructose
• Sweetest of simple sugars found in fruits
  other substances such as honey (do not give honey
  to children under 1 year of age b/c of risk of
  botulism), soft drinks
• Can cause GI distress if present in too large an
  amount
• Galactose
• Not found free in foods produced from digestion
  of lactose (milk sugar)

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CARBOHYDRATES Classification

• Disaccharide double sugars
• Sucrose glucose fructose
• table sugar
• Lactose glucose galactose
• Milk sugar sugar component of milk during
  lactation
• Helps body absorb calcium phosphorous
• Lactose intolerant gas, cramping, bloating,
  diarrhea
• Maltose glucose glucose
• Malt sugar, malt beverages
• Results from starch breakdown
• Converts to glucose

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CARBOHYDRATES Classification

• Polysaccharide complex CHO
• Starch
• Most important source of dietary CHO worldwide
• Improved taste when cooked also thicken when
  cooked
• Break down slowly supply energy over long
  period of time
• Grains (cereal, pasta, crackers, etc) Legumes
  (beans, peas) potatoes, rice, corn, other
  vegetables
• Glycogen
• Stored in small amounts in liver muscle tissues
• Liver stores help sustain normal blood glucose
  levels during fasting periods such as sleep hours
• Muscle stores provide immediate fuel for muscle
  action

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CARBOHYDRATES Fiber

• Cellulose
• Chief constituent of plants humans cannot digest
• Important bulk to diet
• Stems leaves of vegetables, seed grain
  coverings, skins, hulls
• Noncellulose polysaccharides
• Absorb water slow gastric emptying time
• Aid in binding cholesterol controlling
  absorption
• Provide bulk
• Plant seeds, seaweed
• Lignin
• Only noncarbohydrate type of dietary fiber
• Aid in binding cholesterol controlling
  absorption
• Insoluble woody part of plants

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CARBOHYDRATESFiber

• Physiologic effects
• Water absorption
• Binding effect
• Dietary fiber recommendation
• Consume more whole grain products, fruits,
  vegetables, seeds, nuts
• 20-35 g/day

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CARBOHYDRATESEffects on Disease

• Diabetes
• Reduces fasting blood sugar levels
• Reduces glycosuria
• Reduces insulin requirements
• Inhibits postprandial hyperglycemia
• Obesity
• Increases satiety rate
• CAD
• Reduces cholesterol levels
• GI
• Promotes normal bowel function
• Reduces incidence of colon cancer

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CARBOHYDRATESHealth Care Considerations

• Recommend ½ daily required calories from CHO
• Deficiency wt loss, fatigue
• Excess
• after sufficient glycogen, the rest becomes
  adipose tissue
• Tooth decay

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FATSOverview

• Secondary source of energy
• 1gm 9kcal
• Should provide lt 20-35 kcal

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LIPIDS (Fats)

• Food lipids
• Fuel source for energy
• Essential nutrient supply
• Food satiety
• Body lipids (adipose tissue)
• Energy
• Thermal insulation
• Vital organ protection
• Nerve impulse transmission
• Tissue membrane structure
• Cell metabolism
• Essential precursor substances
• Carriers of fat-soluble vitamins

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FATSFood Sources

• Animal sources
• Meats, esp fatty meats such as bacon, sausage,
  luncheon meats
• Whole milk, 1 2 milk
• Cream butter cheeses egg yolks fatty fish

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BASIC LIPIDSFatty Acids

• Saturation degree of hydrogen saturation
• Saturated
• Most found in tropical oils such as coconut
  palm kernal. Also animal sources such as milk
  whole dairy products.
• Monounsaturated
• Mostly plant sources I.e. olive oil, canola oil
• Polyunsaturated
• Plant sources (except as noted above)
• Essential fatty acids
• Essential if body cannot manufacture it
• Linoleic acid only true essential fatty acid

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BASIC LIPIDSFatty Acids

• Essential fatty acids (cont.)
• Functions
• Membrane structure
• Cholesterol transport
• Serum cholesterol
• Blood clotting
• Local hormonelike effects
• (see Williams Figure 4-1)

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BASIC LIPIDSTriglycerides

• Basic structure
• Storage form of fatty acids
• Glycerol fatty acids glycerides
• Most natural lipids are triglycerides
• Nature of food lipids
• Saturated lipid meat, milk, eggs
• Unsaturated lipid plant sources

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LIPIDS

• Men 34 of total kcal
• 11 saturated
• Women 32 of total kcal
• 11 saturated
• Recommend no more than 30 of calories from total
  fat lt10 from saturated fat

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LIPIDSCholesterol

• Structure
• Lipid related compound different from
  triglycerides in structure. Travels in
  bloodstream attached to fatty acids
• Functions
• Vital substance in metabolism
• Precursor to all steroid hormones, I.e. sex
  hormones adrenal corticoids
• Essential for formation of bile acids
• Food sources
• Occurs naturally in all animal foods none in
  plants
• Egg yolks organ meats (liver, kidneys)
• Health concerns
• Atherosclerosis cholesterol-containing fatty
  plaques build up on blood vessel walls
• Recommend no more than 300 mg/day

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LIPIDSLipoproteins

• Function
• Lipids protein
• Lipid transport
• Lipids insoluble in water, so lipoproteins
  transport
• Classified according to density
  lipid/cholesterol loads
• LDL carry cholesterol to peripheral tissue
  cells
• HDL carry cholesterol to liver for breakdown
  elimination from body

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LIPIDSHealth Concerns

• Essential fatty acid deficiency can cause
  problems
• Lipids contribute to atherosclerosis
• HDL cardioprotective
• Increased LDL assoc with heart disease
• Research shows colon breast cancer r/t
  increased level of saturated fat

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PROTEINSOverview

• Primary function is tissue building
• Last source of energy
• 1gm 4kcal
• 10-35 total calories

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PROTEINS

• Nature
• Chemical units amino acids which are released
  at initial digestion
• CHO nitrogen
• 22 amino acids
• Essential amino acids
• 10 are essential b/c the body cannot synthesize
  them in sufficient quantity or at all

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PROTEINS Functions

• Growth tissue building maintenance
• Immunity
• Fluid balance
• Overall energy metabolism

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PROTEINS Classes

• Complete
• Contain all essential amino acids in sufficient
  quantity ratio to meet the bodys needs.
• Animal origin eggs, milk, cheese, meat
  including poultry fish
• Incomplete
• Deficient in one or more of the essential amino
  acids.
• Plant origin grains, beans, peas, nuts, seeds

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PROTEIN REQUIREMENTS

• Excess intake in Americans
• Factors influencing requirements
• Tissue growth
• Diet
• Illness/disease
• RDA 0.8 g/kg of body weight

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PROTEINHealth Concerns

• Deficiencies can result in anemia, wt loss, edema
• Increased protein may lead to exclusion of other
  nutrients cause deficiencies
• Increased protein can place stress on kidneys
• Correlation b/t high protein heart disease,
  obesity
• Nitrogen balance

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ENERGY SOURCES

• Fuel Factors
• Carbohydrates 1gm 4 kcal
• 50-60 of total kcal
• Proteins 1gm 4 kcal
• 15-20 of total kcal
• Fats 1gm 9 kcal
• No more than 25-30 of total kcal

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SOURCES OF STORED ENERGY

• Glycogen only 12-48 hour reserve of glycogen
  exists in liver muscle is quickly depleted
• Muscle mass storage of energy as protein exists
  in limited amounts in muscle mass, but in greater
  volume than glycogen stores
• Adipose fat tissue supply varies from person to
  person

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BASAL METABOLISM

• Basal metabolism
• The sum of all the internal chemical activities
  that maintain the body at rest. BMR is a measure
  of the energy required by these activities of
  resting tissue
• Brain, liver, GI tract, heart, kidneys contribute
  about 60 of total metabolic processes

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FACTORS THAT INFLUENCE BMR

• Lean body mass
• Growth
• Fever disease
• Temperature
• Food intake
• Activity
• Hormones
• Meds

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COMPONENTS OF ENERGY EXPENDITURE

• Resting metabolic rate 70
• Thermic effect of food 10
• Physical activity - variable

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VITAMINS

• Must be a vital organic dietary substance that is
  not an energy-producing CHO, fat, or protein, and
  is usually necessary in only very small
  quantities to perform a particular metabolic
  function or to prevent an associated deficiency
  disease
• Cannot be manufactured by the body must be
  supplied in food

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VITAMINS

• Fat-soluble
• A, D, E, K
• Require fats
• Stored easily
• Water-soluble
• C B-complex family
• Poor storage require daily ingestion

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VITAMIN A

• Forms
• Retinol
• Beta-carotene
• Function
• Vision
• Epithelial tissue
• Growth
• Antioxidant capacity
• reproduction

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VITAMIN A

• Factors affecting requirement
• Amount stored in liver
• Form in which it is taken
• Illness
• GI or hepatic defects
• Food sources
• Animal sources liver, kidney, cream, butter,
  egg yolk
• Yellow green vegetables fruit sources of
  carotene

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VITAMIN D

• Forms
• D3 (cholecalciferol) most significant form
• Absorption
• Need UV rays to produce Vit D3
• Functions
• Calcium phosphorus metabolism
• Role in bone disease
• Basic cell processes
• Food sources of Vitamin D
• Few natural food sources exist
• Yeast fish liver oils
• Added to milk
• Toxicity
• Failure to thrive, calcium deposits in soft
  tissue, progressive weakness, bone bain,
  hypercalcemia

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VITAMIN E

• Stored in fat tissue
• Antioxidant prevents breakdown of substances by
  O2
• Dietary important in lactation, pregnancy,
  newborns
• Food sources
• Vegetable oils main source
• Nuts, certain vegetables, fruits

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VITAMIN K

• Functions
• Blood clotting precursor to prothrombin for
  clotting
• Skeletal metabolism
• Neonatology
• Malabsorption disease
• Drug therapy
• Food sources
• Green leafy veggies cabbage, spinach
• Bacterial synthesis important
• Diseases hemorrhagic

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VITAMIN C Ascorbic Acid

• Oxidizes easily
• Cook in little water
• Short cooking time
• HCL for absorption
• Builds/maintains body tissue
• Food citrus, tomato, white potato, cabbage,
  broccoli

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B1 Thiamin

• Destroyed by alkali
• Role basic coenzyme to glucose metabolism
• Food sources pork, beef, liver, grains, legumes
• Deficiency
• Beriberi neuro deficits cardiac failure
• Wernicke-Korsakoff
• Excess
• Headache, irritability, insomnia, tachycardia,
  weakness

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B2 Riboflavin

• Stable in heat destroyed by light
• Role basic coenzyme for protein metabolism
• Food sources milk, organ meats, legumes,
  veggies, whole grain products
• Deficiency
• Ariboflavinosis
• Oral lesions, eye problems
• Excess
• Yellow-orange discoloration of urine

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B3 Niacin (Nicotinic Acid)

• Tryptophan is precursor
• Role coenzyme in glucose metabolism
• Cholesterol lowering properties
• Causes peripheral vasodilation
• Food sources meat, peanuts, legumes, enriched
  grains, coffee, not corn
• Deficiency
• Pellagra
• Excess
• Increased histamine, uric acid
• Aggravate PUD

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Biotin

• Role coenzyme
• Food sources liver, kidney, meat, tomatoes, egg
  yolk
• Losses seen with heat
• Deficiency
• Rare
• Nausea, thinning hair, hair loss, depression
• Excess
• No toxic effects reported

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B5 Panthothenic acid

• Role coenzyme
• Food sources whole grain cereals legumes
• Deficiency
• Fatigue, paresthesias, weakness, leg cramps,
  restlessness, irritablility
• Excess
• Diarrhea, fluid retention

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B6 Pyridoxine

• Role coenyzme in protein, CHO, fat metabolism
• Food sources grain, seeds, pork, organ meats
• Deficiency
• Peripheral neuropathy, depression, confusion,
  headache, fatigue, scaly dermatitis
• Increased need during pregnancy and with women
  taking certain oral contraceptives
• Excess
• Can prevent ID of Vit B12 deficiency

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Folic acid

• Role coenzyme
• G D of RBCs
• Prevent neural tube defects
• Food sources green leafy vegetables, OJ, fruit,
  liver, kidney, asparagus
• Deficiency
• Neural tube defects in fetus
• Anemia
• Excess

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B12 Cobalamin

• Role functions with intrinsic factor in
  production of heme
• Deficiencies rare, mostly vegetarians
• Disease pernicious anemia
• Food sources liver, meat, milk, cheese, egg

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MINERALS

• Inorganic elements
• Assist in metabolic functions
• Needs vary
• Class on how much is required by body --- major
  gt 100 mg/d minor lt 100 mg/d
• Table 8.1
• Essential if deficiency causes an impairment of
  function supplying just the element will
  prevent or cure

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Calcium

• Mineral present in body in greatest concentration
• 99 bone teeth 1 blood
• Parathyroid hormone (PTH) causes calcium release
  from bone, absorption, phosporous excretion
• Metabolic functions
• Blood clotting nerve transmission muscle
  contraction relaxation cell membrane
  permeability enzyme activation
• Clinical problems
• Tetany, rickets, osteoporosis renal calculi

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Sodium (Na)

• Average diet far exceeds
• Diet
• therapeutic 2 gm or 3 gm
• Normal 4 gm
• Food salt, processed meats
• Kidney most responsible for regulating bodys
  sodium level

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Iron (Fe)

• Ferritin stored iron
• Hemoglobin level good indicator
• Breast milk has iron
• Cows milk must be fortified
• Food organ meats, liver
• Diseases anemia

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Iodine

• Function is to help sythesize thyroxine
• Radioactive iodine used for diagnostics
• Food seafood, iodized salt
• Disease goiter