Nutrition Basics

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Nutrition Basics

• Food defined culturally
• A persons diet is the result of
• Genetics - taste ability (PTC test)
• Personal life experiences
• Culture
• Nutrients biological requirement

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Nutrition Basics

• Nutrients biological requirement
• Carbohydrates
• Protein - amino acids
• Lipids - oils and fats
• Vitamins
• Minerals
• Water

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Nutrition Basics

• Role of Food/ nutrients
• Food - supplies nutrients carbohydrate, protein,
  vitamin, mineral, fat/oils
• Food/nutrients important for growth,
  development, reproduction etc
• Food/nutrition plays a major role in human
  adaptation because
• it is an independent stressor
• modifier of other stressors (disease)

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Nutrition Basics

• Nutrients function to
• Sustain life
• Promote growth
• Replace loss
• Provide energy
• growth, maintenance, work, respiration,
  reproduction

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Energy Intake Energy Expenditure

• Food freq. quest.
• 24-hr recall
• Food records
• Food weighing
• Direct observation

• Gas exchange calorimetry
• Heart rate monitoring
• Estimated from activity
• Motion sensors
• Activity diary
• Direct observation
• Doubly labeled water (D218O)

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Nutritional Status

• Clinical exam
• Skin
• Nails
• Hair
• Eyes
• Mouth
• Thyroid

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Macronutrients

• Protein
• Carbohydrate
• Lipids (fats oils)

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Protein

• structural materials
• enzymes hormones
• source of amino acids used to make protein in
  the body
• contributes to immune function
• can provide some energy can make glucose from
  amino acids
• 20 aa used in human protein
• 9 are essential (they must be obtained from
  food). Complete protein contain all essential a a

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Carbohydrates

• Historically nutritionists have classified
  carbohydrates as either simple or complex,
  however, the exact delineation of these
  categories is ambiguous.
• Today, simple carbohydrate typically refers to
  monosaccharides and disaccharides complex
  carbohydrate means polysacchrides (and
  oligosaccharides).

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Carbohydrates major functions

• Providing energy and regulation of blood glucose
• Sparing the use of proteins for energy
• Breakdown of fatty acids and preventing ketosis
• correct working of our brain, heart and nervous,
  digestive and immune systems.
• Fiber, which is also a form of carbohydrate, is
  essential for the elimination of waste materials
  and toxins

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Lipds Fats Oils

• Production of fatty acids for the production of
  phospholipids in structure of cell membranes.
• Cholesterol is also made from fatty acids and is
  used for prod of sex and adrenal hormones.
• Lubrication, especially in joints and around
  muscles.
• Temperature regulation through the insulation
  they provide. They are also important for the
  transport of certain vitamins (fat-soluble
  vitamins).

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Types of Malnutrition

• 1. Undernutrition
• Kwashiorkor
• Marasmus
• Micronutrient deficiencies
• 2. Over-nutrition

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Vitamins

• Catalysts for metabolic processes
• Required in small quantities
• Absorption mechanisms
• fat soluble (A, D, E, K)
• water soluble (C, B complex)
• Storage capacity
• greatest for fat soluble vitamins, with potential
  for overdosage
• Food sources

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Vitamin A Deficinecy

• Night blindness,(earliest manifestation)
• rhodopsin reduced in rods
• reduced ability to see in dim light
• Early eye lesions
• conjunctival xerosis
• conjunctiva becomes dry, thickened, wrinkled,
  pigmented, loses shiny luster
• Bitots spots
• bilateral, triangular, raised whitish plaques
• plaques appear as fine foam with bubbles

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Epidemiology-Vitamin A Deficiency

• Distribution
• Poor, rice-eating populations world wide
• W. Africa-spared red palm oil, those eating
  small, (entire), fish spared as vit A
  concentrates in liver
• Affluent societies alcoholics, malabsorbtion
• Prevalence
• 251 million children lt5 years with mild to
  moderate deficiency
• 2-3 million children with xerophthalmia
• gt50 become blind or have serious visual damage
• significant mortality from infection, decreased
  immunity and decreased epithelial integrity

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SCURVY

• Scurvy is the term to describe ascorbic acid or
  vitamin C deficiency in the diet, manifest by
• weakness,
• anemia,
• spongy swollen gums,
• James Lind a British naval surgeon born 1739, is
  credited with having empirically evaluated the
  effect of diet on scurvy,
• (the first reported controlled clinical trial!).
  

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Vitamin D Deficiency

• Rickets childhood
• Dental changes in childhood rickets
• delayed dental eruption
• small, pointed teeth
• susceptible to early caries
• Complications
• growth retardation
• pulmonary infection
• high childhood mortality
• Osteomalacia adults

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Prevention-Vitamin D Deficiency

• Sunlight- education re swaddling

• Vitamin D supplementation

• prophylactic supplementation of the
  institutionalized

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Summary- Vit D deficiency

• Rickets- childhood
• Osteomalacia- adults

• Primary skeletal changes due to bone softening
• Lack of cutaneous synthesis or intake and
  utilization of Vit D required for calcium
  absorbtion

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Pellagra Diagnosis

• Clinical- Four Ds
• dermatitis, diarrhea, dementia, death
• Laboratory
• urine N-methyl-nicotinamide

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PELLAGRA

• Clinical Presentation
• Dermatitis
• confluent over sun exposed areas
• collar of Casal, dermatosis around neck
• Progression
• erythema, desquamation, hyperpigmentation,
  atrophy
• Seasonality
• worst after sun exposure

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PELLAGRA MANIFESTATIONS

• Gastrointestinal
• stomatitis, glossitis, gastritis, enteritis,
  malabsorbtion (edematous, painful mucosa,
  desquamation, glossy- scarlet tongue)
• Neuropsychiatric (late stage)
• confusion, irritability
• depression, delusions, suicidal ideation
• there were asylums in the southern US for victims
  of central nervous system pellagra/ niacin
  deficiency

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Mineral Deficiencies

• Iron- anemia
• Iodine- goiter
• Fluoride-caries
• Trace elements

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Iron Metabolism

• Etiology
• insufficient dietary iron (most common)
• absorbtion/binding may be affected
• anemia from blood loss
• hookworm and other parasites in developing world
• Prevalence
• 50 of developing world may have iron deficiency
  
• 56 - 70 of pregnant women in developing world
• compared to 18 of pregnant women in developed
  world
• associated with 50 of maternal deaths, retards
  fetal growth
• 60 of children lt 5 yrs in developing world

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ANEMIA

• Definition
• Anemia is defined as a decrease in the
  concentration of circulating red blood cells or
  in the hemoglobin concentration and a concomitant
  impaired capacity to transport oxygen.
• WHO Diagnosis
• Hemoglobin below 12gm/dl in non pregnant females,
  11gm/dl for pregnant women, 11gm/dl in pre
  school children.
• Etiology
• insufficient dietary iron (most common)
• absorbtion /binding may be affected
• anemia from blood loss
• hookworm and other parasites in developing world

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High Iron Bioavailability

• Blood products
• Beef, pork, chicken, fish
• Liver, spleen, kidney
• Oysters, clams, mussels
• Spinach, alfalfa shoots

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Good Iron Content

• Whole grains
• Bean, peas, soybeans, chickpeas
• Seeds (pumpkin, sesame, sunflower)
• Blackstrap molasses
• Peanuts, betel nuts, dates, raisins
• Egg yolk
• Crickets, termites, grasshoppers

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Iron Deficiency

• Insufficient intake
• poor and vegan diet
• malabsorbtion
• Blood loss
• pregnancies
• parasites hookworms, schistosomes, malaria

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Clinical Manifestations

• Mild anemia
• diffuse, non-specific symptoms, pallor
• Moderate anemia
• glossitis, anorexia, heartburn, constipation,
  fatigue
• Pica, bizarre food cravings, (ingeation of clay,
  or ice
• Severe anemia
• congestive heart failure, (high output)
• maternal morbidity/mortality
• susceptibility to infection

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Iodine Deficiency Goiter
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Iodine Deficiency

• Requirement- sources
• 150 micrograms/day in adolescent and adults
• seafood, soil, milk products
• iodized salt, 60 of worlds salt is iodized, but
  not targeted to those at risk
• Prevalence
• 1 billion at risk
• 655 million with goiter
• 11 million with cretinism
• high mountainous areas away from sea

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Goiter Treatment Prevention

• Iodine intake
• iodized salt
• iodized oil

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Endemic Cretinism

• Severe iodine deficiency
• S.America, Asia, South Pacific

• Related to maternal hypothyroidism
• Neurologic developmental damage
• Mental retardation, deaf-mutism,
• Short stature, thick skin,protuberant thick
  tongue, shuffling gait

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Trace elements-fluoride

• Fluoride
• mineral nutrient for teeth skeleton
• Deficiency
• dental caries

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Common Nutrition-Related Problems

• Arteriosclerotic heart disease
• Hypertension
• Diabetes
• Morbid obesity

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Important Nutritional Problems

• Protein-energy malnutrition
• Nutritional anemias
• Vitamin A deficiency (xerophthalmia)
• Iodine deficiency disorders