NUTRITION AND HEALTH ********************************

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NUTRITION AND HEALTH
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Objectives

• To define nutrition and related words.
• To identify nutritional requirements.
• To understand Food pyramid.
• To list types of nutrients and relation to
  health.
• To define malnutrition and its classification.
• To list main malnutrition problems.
• To describe Obesity.

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• Nutrition is defined as the science of food and
  its relationship to health. Or,
• The process of making use of food.
• It is concerned primarily with the part played by
  nutrients in body growth, development and
  maintenance .

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• Dietetics is the practical application of the
  principles of nutrition it includes the planning
  of meals for the well and the sick.
• Good nutrition means maintaining a nutritional
  status that enables us to grow well and enjoy
  good health.

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• Nutrients are substances (specific dietary
  constituents) that are crucial for human life,
  growth well-being.
• Macronutrients (carbohydrates, lipids, proteins
  water) are needed for energy and cell
  multiplication repair.
• Micronutrients are trace elements vitamins,
  which are essential for metabolic processes.

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CLASSIFICATION OF FOODS

• Classification by origin
• - Foods of animal origin
• - Foods of vegetable origin
• Classification by chemical composition
• - Proteins
• Fats
• Carbohydrates
• Vitamins
• Minerals

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CLASSIFICATION BY PREDOMINANT FUNCTION

• Body building foods
• -meat, milk, poultry, fish, eggs, pulses etc
• Energy giving foods
• -cereals, sugars, fats, oils etc.
• Protective foods
• -vegetables, fruits, milk, etc

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• Community Nutrition
• Identification of nutritional needs of
  population groups and available resources.
• Nutritional Epidemiology
• It is the investigation of the relationship
  between diet and disease.

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• Nutritional requirements
• Recommended Dietary Allowances (RDA)
• The level of nutrients considered to be adequate
  to meet the nutritional needs of all healthy
  persons.
• Knowledge of RDA is necessary to
• Assess the nutritional adequacy of diets for
  growth of infants, children and adolescents.
• Maintain health in adults of both sexes and
• during pregnancy and lactation.

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The adequate diet Food Pyramids

• Food Group System
• Classifies food according to similarity in
• nutrient content.
• Foods placed in each group have a high nutrient
  density.

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Daily Food guide with Nutrient Pattern and
Recommended Quantity.
Comments Quantity Key Nutrients Group
Low-fat milk products have generally all the same nutrient content, however they are lower in calories and vitamin A. 3 cups for children 4 cups for teenagers 2 cups for adults Calcium, Protein Phosphorus, riboflavin Milk and Cheese
Legumes and nuts has a lower biological value than meat. They can be combined with animal or grain products to increase protein quality. Cholesterol and vitamin B12 are found only in animal sources. 2 servings Serving size 2-3 ounces 1 ounce of meat 1 egg or ½ cup cooked beans 1 ounce 30 gm Protein, Iron Niacin, Thiamin Red meat -gt Zinc Egg yolk and liver -gt Vitamin A Dry beans and Nuts -gt Magnesium Meats, poultry, fish, beans
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Include one good vitamin C source daily, include deep yellow or dark green vegetable frequently, include unpeeled fruits and vegetables for fiber. 4 servings Serving size ½ Cup vegetable or fruit 1 Medium fruit Vitamin A Vitamin C Carbohydrate (fiber) Vegetable and fruits
During processing, some essential nutrients are lost. Less refined products are recommended 4 servings Serving size 1 slice bread ½ cup rice Carbohydrate Thiamin Niacin Iron Bread and Cereal
Unenriched, refined bakery products are included here because they provide low levels of nutrients compared to calories Fats should not be more than 35 of the total calories with 10 from polyunsaturated fats. Sugars should not be more than 10 of the calorie intake. Fats Carbohydrate Calories Fats and sweets
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Food Pyramid

• Lessons from Food Pyramid
• Maintain a healthy weight.
• Studies show that the healthiest range for
  body weight is when the body mass index (BMI) is
  about 17 to 22.

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• Eat good fats and avoid bad fats.
• Good fats are the oils found in nuts, seeds,
  grains and fish.
• They are high in the unsaturated fats necessary
  for good health.
• Good fats should contribute 30 to 45 of the
  total fat.
• Avoid saturated fats (animal fats and tropical
  oils e.g. coconut) to minimize the risk of heart
  disease.
• Trans-saturated fats are mainly found in
  margarines and commercial baked foods.

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• 3. Eat whole-grain carbohydrates. Why?
• whole-grain are more nutritious than refined
  carbohydrates
• Being more slowly digested
• Place less stress on pancreatic insulin
  production.
• Sources of whole grain carbohydrates include
  whole meal bread, whole wheat, brown rice.
• Avoid white bread, baked goods and pasta made
  with white flour.

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• 4. Avoid red meat as a protein source and
  emphasize plant proteins.
• Red meat consumption is linked to a variety of
  chronic diseases increases the risk of hip
  fracture.
• Animal proteins are usually packaged with
  saturated fat.

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• 5. Eat plenty of vegetables and fruits.
• Potatoes are not included as a vegetable.
• Dark green leafy vegetables, and fruit are
  clearly beneficial.
• A diet high in fruits and vegetables lowers blood
  pressure and cholesterol and reduces the risk of
  cancer.

• 6. Take a multivitamin daily.
• This recommendation is insurance against any
  inadvertent deficiencies.

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Mediterranean Pyramid
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Energy Supplying Nutrients
Main types of Nutrients

• Protein
• Lipids
• Carbohydrates

Non-Energy Supplying Nutrients

• Vitamins
• Minerals
• Water

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PROTEINS

• Proteins are complex organic nitrogenous
  compounds.
• They also contain sulfur and in some cases
  phosphorous and iron.
• Proteins are made of monomers called amino acids.
• There are about 20 different aminoacids which are
  found in human body.
• Of this 8-9 aa are termed essential as they
  are not synthesized in human body and must be
  obtained from dietary proteins.

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Protein Needs

• Adults 0.8 gm/kg body weight per day
• Excess protein is not used to build more muscle
• If the body needs energy, the extra amino acids
  are used for energy
• If the body does not need energy, the extra amino
  acids can be converted to fat and stored.
• Sources
• Complete proteins have all essential amino acids
  (animal sources)
• Incomplete proteins lack one or more essential
  amino acids (plant sources)

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Functions of Proteins

• Body building
• Repair and maintenance of body tissues
• Maintenance of osmotic pressure
• Synthesis of bioactive substances and other vital
  molecules e.g. immunoglobulins

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Lipids

• Lipids include cholesterol and triglycerides
• Fat is necessary for health
• Functions
• Main source of energy (9Kcal/g).
• Spare protein.
• Adipose tissue holds the body organs and nerves
  in place.
• Maintain body temperature.
• Transportation of fat soluble vitamins.

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Classification

• Saturated fat
• Animal foods generally are rich sources
• Palm and coconut oil also are rich sources
• Monounsaturated fat
• Olives, peanuts, and canola oil are rich sources
• Polyunsaturated fat
• Corn, sunflower, cotton seed, and nut oils are
  rich sources
• Hydrogenated fat

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Hydrogenated fat

• Hydrogenation process hardens liquid oils into
  more solid margarine.
• It makes unsaturated fat in oil more saturated
• Also it produces an unhealthy type of fat called
  trans fatty acid
• Saturated fat and trans fatty acids may be
  harmful to health
• Baked products and fried foods are often made
  with hydrogenated fats

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Cholesterol

• Cholesterol is necessary for cell membranes and
  the production of vitamin D, bile, and certain
  hormones
• It is found only in animal foods
• High blood cholesterol levels are associated with
  increased risk of heart disease

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Fats yield fatty acids and glycerol on
hydrolysis

• Fatty acid content of different fats ( in per
  cent)
• Saturated
  Monounsaturated Polyunsaturated
• Fats fatty acids fatty
  acids fatty acids
• Coconut oil 92 6
  2
• Palm oil 46 44
  10
• Cotton seed oil 25 25
  50
• Groundnut oil 19 50
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• Sunflower oil 8 27
  65
• Corn oil 8 27
  65
• Soya bean oil 14 24
  62
• Butter 60 37
  3

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Fat requirements

• The WHO Expert committee on Prevention of
  Coronary Heart Disease has recommended only 20 to
  30 per cent of total dietary energy to be
  provided by fats. (lt30)
• At least 50 per cent of fat intake should consist
  of vegetable oils rich in essential fatty acids.

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Carbohydrates

• Functions
• Carbohydrate is the main source of energy,
  providing 4 Kcals per one gram
• Carbohydrate is essential for the synthesis of
  certain non-essential amino acids.
• Necessary for normal fat metabolism.
• Necessary for integrity of nerve cells.
• Lactose allow growth of beneficial bacteria in
  the intestine.
• Important for normal elimination (excretion)
  fibers
• Recommended carbohydrate intake is 55 to 65 of
  calories, primarily from starchy foods

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Classification of Carbohydrates

• Monosaccharides glucose fractose
• Disaccharides Sucrose (G F)
• Oligosaccharides (3-10).
• Polysaccharides (11-1000)
• a-Indigestable e.g. cellulose
• b-partially digestable e.g.raffinose
• c-Digestable e.g. starch
• The inability of the body to metabolize
  carbohydrates properly DM

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Fiber

• Indigestible plant material e.g. cellulose
• Dietary fiber is mainly non-starch polysaccharide
  
• It is found in vegetables, fruits and grains.
• Soluble fiber swells or dissolves in water
• Rich sources include apples, bananas, citrus
  fruits, carrots
• Importance
• Reduces cholesterol absorption
• Slows absorption of glucose

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Fiber

• Insoluble fiber remains unchanged in water
• Rich food sources include brown rice, wheat bran,
  and whole grain products
• Importance
• High fiber diet reduces the risk of heart
  disease, diabetes type II, diverticulosis,
  hemorrhoids, constipation, and possibly
  colorectal cancer
• Refined foods lose fiber-rich parts during
  processing

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Non-Energy Supplying Nutrients

• Vitamins
• Minerals
• Water

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Vitamins

• Regulate growth,
• maintain tissues, and
• help carbohydrates, proteins, and fats release
  energy
• Provide no calories (energy)
• Needed in very small amounts

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Classes of Vitamins

• Water Soluble 8 different B vitamins and
  vitamin C
• Fat Soluble Vitamins A, D, E, and K
• Most healthy people do not need supplements
  vitamins can be obtained by eating a variety of
  foods
• Supplementation can increase the risk of
  consuming toxic high levels

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Fat soluble vitamins

• Vitamin A
• Vitamin A covers both
• a pre-formed vitamin, retinol, and
• a pro-vitamin, beta carotene, which is converted
  to retinol in the intestinal mucosa.
• Sources
• Retinol in liver, code liver oil eggs (animal
  sources)
• Beta carotene Coloured plants e.g. carrot,
  mango, apricot, pumpkin,.. (plant sources)

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VITAMIN A

• Sources
• liver
• milk
• eggs
• spinach
• carrots
• tomatoes
• butter

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Functions of Vitamin A

• It is essential for normal vision.
• It is necessary for maintaining the integrity and
  the normal functioning of glandular and
  epithelial tissue which lines intestinal,
  respiratory and urinary tracts as well as the
  skin and eyes.
• It supports growth, especially skeletal growth
• It may protect against some epithelial cancers
  such as bronchial cancers.

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Vitamin D

• The nutritionally important forms of Vitamin D in
  man are
• Calciferol (Vitamin D2) and
• Cholecalciferol (Vitamin D3)

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• Sources
• liver
• caviar
• Butter
• Eggs
• Ultraviolet rays

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Functions of vitamin D

• Intestine Promotes intestinal absorption of
  calcium and phosphorus
• Bone Stimulates normal mineralization, Enhances
  bone reabsorption, Affects collagen maturation
• Kidney Increases tubular reabsorption of
  phosphate

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Deficiency of vitamin D

• Deficiency of vitamin D leads to
• Rickets in children
• Osteomalacia in adults

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• Vitamin E
• Antioxidant- Protects RBCs from haemolysis.
• Present in wheat germ and green leafy vegetables
• Vitamin K
• Important for blood coagulation
• Present in leaves of plants natural (flora).
• Deficiency causes haemorrhagic manifestations.

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VITAMIN E

• contains in
• liver
• corn
• eggs
• vegetable oils

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Water soluble vitamins

• Thiamine (B1)
• Function essential for the utilization of
  carbohydrates.
• Present in brewer yeast, beans and legumes.
• Deficiency Beri-beri

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Deficiency of thiamine

• Beriberi may occur in three main forms
• peripheral neuritis,
• cardiac beriberi,
• infantile beriberi, signs of peripheral
  neuropathy.

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• Riboflavin (B2)
• Important for cellular metabolism, oxidation and
  reduction.
• Present in milk, liver, meat, eggs, fish and
  vegetables.
• Deficiency angular stomatitis magenta tongue.

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VITAMIN B6

• Pyridoxine (vitamin B6) plays an important role
  in the metabolism of amino acids, fats and
  carbohydrate.
• The requirement of adults vary directly with
  protein intake.

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VITAMIN B12

• Vitamin B12 is a complex organo-metallic compound
  with a cobalt atom (Cyanocobalamine)
• Vitamin B 12 cooperates with folate in the
  synthesis of DNA.
• Vitamin B 12 has a separate biochemical role,
  unrelated to folate, in synthesis of fatty acids
  in myelin.

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Vitamin B12 deficiency

• Vitamin B12 deficiency is associated with
  megaloblastic anaemia (pernicous anaemia),
  demyelinating neurological lesions in the spinal
  cord and infertility (in animal species).
• Dietary deficiency of B12 may affect subjects who
  are strict vegetarians and eat no animal product.

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• Nicotinic acid
• Important for nervous system and epithelium.
• Present in yeast, liver, peanut, meat and
  intestinal flora.
• Deficiency
• Pellagra
• Dermatitis
• Dementia
• Diarrhoea

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VITAMINS OF GROUP B

• Sources
• liver
• kidneys
• legumes
• curds
• cheese
• fish
• bread

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VITAMIN C

• Vitamin C (ascorbic acid) is a water-soluble
  vitamin.
• It is the most sensitive of all vitamins to heat.
  
• Vitamin C has an important role to play in tissue
  oxidation
• It is needed for the formation of collagen of
  connective tissue, which accounts for 25 per
  cent of total body protein.
• Present in vegetables and fruits.

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VITAMIN C

• contains in
• pepper
• fresh cabbage
• berries
• strawberry
• citrus
• green peas
• green onions

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Deficiency of vitamin C

• Deficiency of vitamin C results in scurvy.
• Signs of scurvy are
• Swollen and bleeding gums,
• Subcutaneous bruising,
• Bleeding into the skin or joints,
• Delayed wound healing,
• Anaemia and weakness.

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Minerals

• Minerals are certain elements that may
• regulate chemical reactions in the body
• be part of organic molecules
• Iron in hemoglobin
• Calcium in bone and teeth
• Small amounts are needed for health

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Calcium

• Most plentiful mineral in the body
• Needed for strong bones and teeth
• Involved in regulating blood pressure, clotting
  blood, and muscular movements
• Bones store calcium
• Osteoporosis
• Bones lose mineral density and strength
• Aging people, especially menopausal women, are at
  risk

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Calcium

• contains in
• milk,
• cottage cheese,
• cheese,
• yoghurt,
• parsley.

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Iron

• Most of the bodys iron is in hemoglobin, which
  is in red blood cells
• The iron in hemoglobin picks up oxygen in the
  lungs and transports it to cells
• Iron deficiency is one of the most common
  nutritional disorders worldwide

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Iron

• Sources
• liver
• red meat,
• apples,
• dried fruit
• molasses.

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Water

• Variety of functions
• helps transport of materials in the body, and
• involved in many chemical reactions.
• Beverages and most foods, especially fruits and
  vegetables, supply water
• Diuretics such as alcohol and caffeine increase
  losses of water from body

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Water

• To be properly hydrated, a person needs at least
  8 cups of water daily
• Dehydration can be deadly
• Sports drinks replenish minerals and water that
  are lost during heavy exercise

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• Malnutrition
• Definition
• Malnutrition is a pathological state resulting
  from a relative or absolute deficiency or excess
  of one or more essential nutrients.

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• The major forms of malnutrition are
• Under-nutrition
• It is a pathological state resulting when
  nutrient intake does not regularly meet the
  nutrient needs for cell activities and body
  maintenance. It includes
• Macronutrient deficiency e.g., protein-energy
  malnutrition (marasmus kwashiorkor).
• Micronutrient deficiency e.g. iron deficiency
  anaemia, vitamin A deficiency, Iodine
  deficiency.etc.

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The major malnutrition problems in the world
are1. Proteinenergy malnutrition (PEM)2. Iron
deficiency anaemia3. Iodine deficiency disorders
(IDD)4. Vitamin A deficiency (VAD)
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Iron deficiency

• Over 2 billion people suffer from some form of
  iron deficiency
• Anaemia linked to iron and/or folic acid
  deficiency is among the worlds major nutritional
  disorders
• Africa South Asia have the highest overall
  incidence of anaemia, followed by Latin America
  East Asia
• Parasitic infestation contributes to high percent
  of cases in developing countries.

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Consequences of iron deficiency

• Reduces work capacity, thus productivity,
  earnings
• Associated with 50 of maternal deaths
• Retards fetal growth, causes low birth weight
  (LBW) increases infant mortality
• Impairs ability to resist disease in childhood,
  reduces learning

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Improving Iron status

• Iron tablets
• Iron fortification of basic foods (bread)
• Increased consumption of iron rich foods
  factors which enhance absorption
• Control of parasitic infections

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Iodine deficiency disorders (IDD)

• In 1990 1.6 billion people worldwide at risk of
  IDD
• At least 655 million with goitre
• 43 million with some degree of mental impairment
• 11 million with cretinism
• Moderate Iodine deficiency is associated with
  average reduction of over 13 IQ points

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Prevention of IDD

• Adequate intake of Iodine can prevent all IDD
• make milder forms of goiter disappear
• improve development of older children mildly
  affected
• Severe forms of IDD such as cretinism, cannot be
  reversed But,
• can only be prevented by adequate intake of
  Iodine during pregnancy
• Now, iodizing salt is all over the world

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Vitamin A deficiency (VAD)

• May be subclinical, severe or moderate
• Clinical (xerophtalmia)
• 2.8 million children 0-4 years old
• Blindness, total or partial
• at least half a million children a year
• about half die within a few months

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Deficiency of vitamin A

• The signs of vitamin A deficiency are
• Follicular hyperkeratosis,
• Night blindness
• Conjunctival xerosis
• Bitot's spots
• Corneal xerosis
• Keratomalacia

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Improving vitamin A status

• Increased intake of vitamin A rich foods e.g.
  eggs, butter, whole milk, liver, red palm oil,
  dark green, yellow red fruits vegetables
• Fortification of basic foods with vitamin A
• Supplements e.g. 2 capsules of Vitamin A per year
  to young children

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• Over-nutrition
• It is a pathologic state resulting when
  nutritional intake exceeds the body needs, which
  leads to caloric excess over an extended period
  of time.

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Definition
Obesity is Disorder of Body Regulatory
Systems leads to Excess Body Fat

• Assessment
• Body Mass Index (BMI)
• Waist Circumference (WC)
• Waist to Hip ratio (WHR)

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Causes Associated Factors

• Genetic Complex Polygenic
• Environmental and Behavioral
• Signaling factors
• Hormonal
• Neurologic
• Psycological

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Assessment of Obesity

• The international standard for assessing body
  size in adults is the body mass index (BMI).
• BMI is computed using the following formula BMI
  Weight (kg)/ Height (m²)
• Evidence shows that high BMI (obesity level) is
  associated with type 2 diabetes high risk of
  cardiovascular morbidity mortality

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BMI (WHO - Classification)

• BMI lt 18.5 Under Weight
• BMI 18.5-24.5 Healthy weight range
• BMI 25-30 Overweight (grade 1 obesity)
• BMI gt30-40 Obese (grade 2 obesity)
• BMI gt40 Very obese (morbid or grade 3
  obesity)

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Waist circumference

• Waist circumference predicts mortality better
  than any other anthropometric measurement.
• It has been proposed that waist measurement alone
  can be used to assess obesity, and two levels of
  risk have been identified
• MALES FEMALE
• LEVEL 1 gt 94cm gt 80cm
• LEVEL2 gt 102cm gt 88cm

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Waist circumference

• Level 1 is the maximum acceptable waist
  circumference irrespective of the adult age and
  there should be no further weight gain.
• Level 2 denotes obesity and requires weight
  management to reduce the risk of type 2 diabetes
  CVS complications.

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Waist Hip Ratio (WHR)

• Visceral obesity (apple shaped)
• Peripheral obesity (Pear shaped)

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• WHR
• gt 0.8 F
• gt 1.0 M

• WHR
• lt 0.8 F
• lt 1.0 M

Visceral Vs Peripheral
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Interpretation of WHR

• High risk
• Females WHR gt0.80 or gt80
• Males WHR gt0.95 or gt95
• It indicates central (upper body) or visceral
  obesity and is considered high risk for diabetes
  CVS disorders.
• A WHR below these cut-off levels is considered
  low risk (peripheral obesity).