Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st year (First Year) Biochemistry ppt lectures Topic 56 Nutrition Notes. - biochemistry notes pdf, biochemistry mbbs 1st year notes pdf, biochemistry mbbs notes pdf, biochemistry lecture notes, paramedical biochemistry notes, medical biochemistry pdf, biochemistry lecture notes 2022 ppt, biochemistry pdf.
Synopsis
? What is Nutrition and its
importance?
? Composition of Food and its role
in human body.
? Calorific Values/Energy content
of Food constituents.
? Energy requirement by the
body
? Basal Metabolic Rate (BMR)
? Respiratory Quotient(RQ)
? Specific Dynamic Action (SDA)
? Balanced Diet and its Importance
? Nutritional Disorders
? PEM- Kwashiorkor and Marasmus
? Obesity
INTRODUCTION
What is Nutrition?
Nutrition is a wide branch of science
which deals with:
vComponents of human food and
their role in human body
vCalculations of
vEnergy content of foods
vEnergy requirement by human beings
vNutrition Explores
vHow to choose particular food/
type of diet?
vPlanning of balanced diet in
various conditions.
vNutritional Studies Involves
vRelation of Nutrients in health
and disease.
vNutritional disorders due to
under and over nutrition.
STUDY OF NUTRITION
ANSWERS FOLLOWING
QUESTIONS
? WHY TO EAT FOOD ?
? What are the Dietary Nutrients and their
Role to human body?
? What are Macro and Micronutrients?
? WHAT FORM AND AMOUNT OF
DIETARY NUTRIENTS TO BE INGESTED?
? What is a Balanced Diet?
? WHAT HAPPENS IF A FOOD EATEN IN A
BALANCED/IMBALANCED WAY ?
What Is The Main
Purpose
of Eating Food ?
?Food/Diet is a prime
requisite for human body
survival and existence.
? Main purpose of Food is to:
? Provide Energy (Fuel) for cellular activities.
? Supply basic building blocks, to build
Macrobiomolecules, for structural and
functional role in the body.
? Enable Accessory growth factors.
? Role Of Human Food
? Build The Cel and Subcel ular Structures
? Maintains all body functions
? Regulates Metabolism
? Vital for growth and development
? Therapeutic benefits
?Healing of diseases
?Prevention of diseases
? What we eat is what we build
? Remember Proper Nutrition
? Maintains normal growth, health
and reproduction.
? Rewards healthy and happy life
? Improves life span
How Should Be Our Eating?
One Should Eat
To Live
A Healthy and Happy Life
?Ingest food Nutrients with
?Appropriate quantity
?Good quality
?This is very essential for
normal healthy life.
?Ignorance and wrong
food habits are
?Responsible for most
il nesses of Human being.
? `Prevention Is Better Than Cure'
?Good and Proper diet is a
best way to prevent many
diseases.
? A sound knowledge of nutrition to a
doctor is of paramount importance.
?To maintain his/her own good
health.
?Advice for planned diets, to the
patients to maintain their good
health's.
Composition of Food
and
Their Role in Human Body
or
Nutritive Value of Nutrients
What To Eat?
And
What Not To Eat?
?Nutrients are organic
or inorganic molecules
that are crucial y
required for human
growth & wel -being.
? Food items derived from
plant or animal sources
contain nutrients.
? ~ 40 nutrients identified and present in
food items.
Chief Nutrients
Of
Food Substances
Six Classes of Nutrients
? Carbohydrates
? Lipids (Fats)
? Proteins
? Vitamins
? Minerals
? Water
Classification Of Nutrients
? There are four ways to classify the classes
of nutrients:
I. Essential or Nonessential Nutrients
I . Organic or Inorganic Nutrients
I I. Macronutrient or Micronutrients
IV. Calorific or Non calorific Nutrients
? Essential Nutrients ?
? Nutrients not biosynthesized in body or
cannot make enough of to meet the bodies
need.
? These nutrients must be obtained from foods.
?Examples:
? Vitamins
? Minerals
? Some of the amino acids and fatty acids.
? Nonessential Nutrients ?
? Nutrients readily biosynthesized by
body from other ingested nutrients
Examples:
?Cholesterol
?Non Essential Amino acids
?Non Essential Fatty acids
? Organic Nutrients - contain carbon
? Carbohydrates
? Lipids
? Proteins
? Vitamins
? Inorganic Nutrients - do not contain carbon
? Minerals
? Water
? Macronutrients-
? Required in large quantities
?Carbohydrates
?Lipids
?Proteins
?Water
? Micronutrients
? Required in small quantities.
? Minerals
? Vitamins
? Energy-yielding nutrients /Calorific
Nutrients:
?Carbohydrates
?Lipids
?Proteins
38
? Non energy yielding/Non Calorific
?Vitamins
?Minerals
Nutritional Goals
? Quality intake of food allows the body
to function at best and promotes
health.
?Quality intake should provide
adequate levels of each nutrient.
? Quantity intake of food promotes a
healthy body weight.
40
? Nutrition Influences on:
? Health
?Appearance
?Behavior
?Mood
41
The Main Food Groups
Fruit and Vegetables
Fruits and vegetables grow
on plants: underground, on
Take
the ground or in trees.
5 a day
Every day we should eat at
least 5 portions of fruit and
everyday!
vegetables. (A portion is
about a handful.)
Fruit and vegetables give us
fibre and vitamins and
minerals.
Grains and Pulses
This food group includes
wheat, corn, barley, rice,
lentils, beans etc.
What is..?
These are all from plants
Rice is the staple food in China
and form a staple part of
and much of the East. What is
the diet for people all over
it in the West (UK, USA)?
the world.
Grains and pulses give us
carbohydrates and proteins.
Nuts are another source of
protein.
Dairy Products
Dairy foods are made from milk (usually
cow's milk, but can be from other animals
like goats or sheep). Dairy foods give us
proteins and fats. They are also a good
source of calcium which is good for bones
and teeth.
These foods include:
Weird fact
?Cheese (hard, soft, cottage) Ourbrainsare80%
?Yogurt
fat.
?Food high in milk or milk products.
Meat, Fish and Eggs
The main nutrients derived from meat are
proteins, but it also gives us fats and some
minerals.
The meat and fish group includes:Foodie fact
?Chicken and all poultry
Sushi (raw fish) is now
?Fish and shellfish
Marks and Spencer's
best-selling lunchtime
?
snack.
Beef, pork and lamb
?Eggs are included in this group too.
Athletes eat lots of protein; they help to
build muscles.
Body Composition
GROUPS OF NUTRIENTS:
?Carbohydrates
?Proteins
?Fats
?Vitamins
?Minerals
?Water
Carbohydrates
?Carbohydrates: are the Sugars
and Starch present in food.
?They are classified as either
simple or complex
Carbohydrates.
?Simple carbohydrates: are
Sugars Examples include:
vGlucose
vFructose
vLactose
?Complex Carbohydrates
are Starches-Present in
vWhole grains
vLegumes
? Simple Carbohydrates
? pop, candy, sweets, fruit
? individual Glucose or Fructose molecules
? Recent studies reported Refined sugars are Brain
damaging
? Complex Carbohydrates
? pasta, rice, breads, potatoes
? Chains of glucose molecules
53
Dietary Fiber
?Fiber is an
?Indigestible complex
Carbohydrate
?Non calorific
Substances As Dietary Fiber
? Cellulose
? Hemicellulose
? Pectins
? Gum
? Lignin
? Mucilage
? Sources Of Dietary Fibers
? Richly present in plant food
substances.
? Poorly present in refined and
commercial food products.
Types Of Dietary Fibers
? Soluble Dietary Fiber ?
? Decreases Cholesterol levels
? Found in oat bran, fruits and veggies
? Insoluble Dietary Fiber-
? Reduces risk of colon cancer
? Found in wheat bran and grains
? Recommendation of Dietary Fiber:
? 25-40 gm per day
Check
are we getting enough
dietary Fiber through your foods ?
Ways to Get More Fiber
? Eat more fruits
and vegetables
? Eat whole grain
foods
Advantages Of Dietary Fiber
? Act as roughage
? Holds water
? Forms soft and bulky feces
? Increases bowel movement
? Easy defecation
? Prevents constipation
?Dietary fiber corrects
hyperglycemia and
hypercholesterolemia
? Fiber Reduces risk of:
?Diverticular disease of colon
?Colon cancer
?Varicose veins
?Good satiety and non
calorific value of dietary
fiber
?Helps in management of
obesity.
Disadvantage Of Dietary Fiber
? It binds with trace
elements and reduces its
absorption.
? Decreases absorption of fat
soluble vitamins.
A Grain of Wheat
BRAN
- B vitamins
- minerals
ENDOSPERM
- dietary fiber
- starch
- protein
- some iron and
GERM
B vitamins
- Essential fats
- minerals
- vitamins
(B's , E and folacin)
? Germinated legumes have
partial dextrinization of
Starch.
? Which is good for digestion,
absorption and utilization.
Functions Of Carbohydrates
v Readily available source & supply
most of the bodies primary energy
needs
v Antiketogenic
v Build structure of cells
v Store calories as Glycogen
v Excess Carbs convert to Fat
v Amino acid synthesis
v Cellulose as roughage
Quantity And Quality Of
Carbohydrates To Be Ingested
? An Adult individual with
his/her routine activities
should adjust the
Carbohydrates intake.
? RDA for Carbohydrates-
400-600 gm/day
? Ingestion of Starchy food is
more preferable.
? Refined sugars have high
glycemic index so the quantity
should be reduced.
? Dietary fiber in form of
Cel uloses to be ingested.
?Dietary Proteins are
nutrients , provide essential
amino acids building blocks
for tissue proteins.
?Proteins are of structural and
Functional importance
?Maintain growth, repair and
function of the body cel s and
tissues.
? Sources of dietary Protein
? Animal (complete)
? meats, dairy
? Vegetable (incomplete)
? beans, nuts, legumes,
grains
? Types of Amino Acids
Amino acids linked together
? Nonessential (10) ? can be made by body
? Essential (8) ? must be made by body
? Semiessential (2)- Made in body to less amount
need also from diet
Nutritional Classification Of Proteins
? Dietary Proteins nutritional y
classified into two groups:
?Complete Proteins
?Incomplete Proteins
? Complete Proteins/ First Class
Proteins/High Biological y Valued
? Complete Protein contains adequate
amounts of al essential amino acids.
SOURCES INCLUDE:
Animal Origin Proteins
?Fish
?Meat
?Poultry Meat and Eggs,
?Milk, Cheese and yogurt
?Soya Bean products
? Incomplete Proteins
? Incomplete Proteins lack one or more
essential amino acids (limiting amino acid).
SOURCES INCLUDE:
? Beans
? Pulses ( Limit in Met)
? Nuts
? Whole grains (Limit in Lys and Thr)
Dietary Protein Requirements
? RDA average = 0.8-1.0 g/kg body weight/Day
? RDA Athlete = 1.2-1.6 g/kg/day
?High levels of Dietary
Protein intake
above 2 g/kg/day
can be harmful
to the body
Biological Value Of Proteins
?Dietary Proteins differ in
their quality i.e
?Efficiency of digestibility
and absorption capacity.
? An effectiveness of dietary
Protein is in
? Providing amount of
essential amino acids for
tissue Protein biosynthesis.
Evaluating Protein Quality
? Biologic Value (BV) of Protein:
?Amount of ingested Nitrogen
retained in the body
compared with Nitrogen
absorbed.
Biological Value = Nitrogen Retained x 100
Nitrogen Absorbed
Biological Value of Protein is
Percentage of Nitrogen absorbed
and retained in the body.
? Thus BV of Protein
indicates effectiveness
of utilization of dietary
Proteins
? Proteins with high biological
value(B.V) are also termed as:
? Superior Proteins
?Complete proteins
?First class Proteins
?All animal origin
Proteins rich in all
essential amino acids are
of high B.V.
? Dietary Proteins with high
biological value support
good tissue biosynthesis
and retain the Proteins in
body for their functional use.
?Complete Proteins with
high biological value
maintain
Positive/Nitrogen
equilibrium
? Plant proteins are of low
B.V since deficient in one
or two essential amino
acids.
? Net Protein Utilization (NPU):
?Percentage of Nitrogen
consumed that is retained by
the body.
Mutual Supplementation
Of
Dietary Proteins
Improves Biological Value
Of Proteins
? Eating Pulses and Grains gives all
essential Amino acids required for
the tissue Protein biosynthesis.
? Dal and Roti
?Rice and Dal
? Idli and Sambhar
?Rajma Chanwal
?Chhole Chanwal
Source Of
B.V
Limiting Amino
Protein
acid
Egg
94
Nil
Milk
84
Sulfur containing
amino acids
Fish
85
Tryptophan
Meat
75
Sulfur containing
amino acids
Soya Beans
65
Sulfur containing
amino acids
Source Of
B.V
Limiting Amino
Protein
acid
Rice
68
Lysine and
Threonine
Wheat
58
Lysine and
Threonine
Pulses
58
Sulfur containing
amino acids
? Biological value of protein affects
nitrogen balance.
?Low B.V proteins leads to negative
nitrogen balance.
?Increased loss of NPN substance
Urea in urine.
Functions Of Dietary
Proteins
? Supply amino acids for growth &
repair of body tissues
? Biosynthesize all tissue Proteins
?Hemoglobin
?Nucleoproteins
?Glycoprotein
?Lipoproteins
?Enzymes
?Hormones
?Antibodies
?ETC Components
?Collagen (bones)
?Keratin (nails & hair)
? Protein serve as a source of
energy :
?When there is shortage of
Lipids & Carbohydrates in the
body.
? Proteins has role in
osmoregulation ,transport and
acid-base balance
? Dietary lipids predominantly
contains Triacylglycerol (TAG).
? TAG to human body serves as a
secondary source of energy on
long term basis.
?TAG stored as reserve food
in adiposecytes
?Provides energy in
between meals , fasting
and starvation condition.
? The other forms of dietary
lipids viz Phospholipids and
Cholesterol has structural
and functional role in the
body.
?Fats/Oils are type of
neutral lipids,
insoluble in water.
?Fatty acids are the
building blocks of
various tissue Lipids .
Types of Fatty Acids
? Saturated Fatty Acids
? Animal sources
? Solid at room temperature
? High intake is associated with an increased risk of heart disease
? Unsaturated Fatty Acids (MUFAS and PUFAS)
? Vegetable sources
? Liquid at room temperature
? Associated with a reduced risk of heart disease
? Trans Fatty Acids
? Hydrogenation to alter "state" of fat example Vanaspati Dalda
? Increase shelf-life & market availability
? Repeated heating of Oils
Composition of Oils (%)
Type
Sat
Poly Mono
safflower
09
75
16
sunflower
10
66
24
corn
13
59
28
soybean
14
58
28
sesame
14
42
44
peanut 17
32
51
palm
49
09
42
olive
14
08
78
canola
07
35
58
? Those Fatty acids are
considered as good
? Who on entry in body get
easily metabolized and
give good effect to body.
? Those Fatty acids are considered as
bad
? Which are more stable and get less
metabolized and remain for long
time in the body.
? As the fatty acids remain for long
time it increases the risk of
Atherosclerosis.
Quality and Quantity Of Dietary Lipids
? Quantity of Dietary Lipids 60 gm/day
? Quality of Dietary Lipids:
? TAG with mixture of Fatty acids linked
? Fatty acids in ratio of MUFA:PUFA:SFA 1:1:1
? Zero Trans Fatty acids
? Equal proportion of Antioxidants To protect In
vivo PUFA's
? Adequate Carbohydrate Diet-No too much
excess of Glucose to transform into Fatty acids
and Cholesterol
? Fatty food is associated
?With fat soluble vitamins A,
D, E, and K
?Sources of Linoleic acid-
essential fatty acid that is
needed for growth and
healthy skin.
Recommendations for
Fat Consumption
? Dietary Fat Recommendations
? Less than 30% of calories in diet
from dietary Lipids.
? Less than 1/3 of dietary fat
should be saturated.
? Ways to Decrease Intake of Fat
?Minimize "fast" foods and Snacks
?Minimize processed foods
?Use better cuts of Red meat
?Use low fat alternatives
?Pork Fat
?Choose foods with "Natural Lipids"
Food s Should be rich In
Essential Fatty Acids (EFAs)
? Linoleic acid (LA)
? Linolenic (LNA) or Alpha
Linolenic acid or (ALA)
? Arachidonic Acid
Omega-3 and Omega-6 Fatty acids
?Linolenic Acid (18:3n
-3) belongs to the
omega-3 family of
fatty acids
?Linoleic Acid
(18:2n-6) belongs
to the omega-6
family
Role Of Essential Fatty Acids
(EFAs)
? LA can be converted to both Arachidonic and Linolenic
acids
?Essential FA are necessary for growth, skin &
hair integrity.
?Regulation of Cholesterol metabolism.
?Lipotropic activity
?Decreased platelet adhesiveness and
reproduction.
? Rich Dietary Sources of
Linoleic Acid :
?Soya oil
?Sunflower oil
?Safflower oil
?Sesame seeds
?Corn oil
?Most nuts
? Dietary Sources Of Linolenic
Acid :
? Flax seeds(abundantly )
?Walnuts(Small quantities)
?Cold pressed Canola oil
?Wheat germ
?Dark green leafy vegetables
? Diets with <1-2% EFAs
will affect growth rate,
cause dry scaly rash
and poor wound
healing
? The right ratio of LA to ALA in the
diet
? About 3:1 or 2:1, is important
? An imbalance in the ratio
? May lead to a variety of mental
disorders,
? including hyperactivity,
depression, brain allergies, and
schizophrenia
? Docosa Hexenoic Acid (DHA-C22)
? Is high in the phospholipids of brain gray matter .
? DHA is rich in Algae and Fishes
? It is the main component of CNS importance for its
function
? Depletion of DHA in the brain can result in learning
deficits/Cognitive Function.
?DHA appears to
be important for
visual and
neurological
development
? EPA and DHA
supplementation during
pregnancy
? Has evidenced beneficial
effects on long-term
cognitive development in
children
Functions Of Lipids
v A concentrated & reserve secondary source of
energy
v Physical protection for vessels, nerves, organs
v Insulate against changes in temperature
v Structure of body tissues, cell membranes &
nuclei
v Carry the fat-soluble vitamins (A, D, E, K)
v Give appetite appeal
v Aid satiety (delay emptying time of the
stomach)
v Spare Protein
v Supply Linoleic acid, the other essential fatty
acids.
? High intake of animal origin
food is linked to increased
blood Cholesterol .
? Excess Cholesterol can lead to
an increased risk of
Atherosclerosis and heart
disease.
Vitamins
? Organic substances that are
vital for human body.
? Vitamins are accessory
growth factors to human
body.
? Vitamins are classified into two groups:
? Water-soluble Vitamins:
? Vitamins dissolve in water and pass easily into
the blood during digestion.
? The body does not store these so they need to
be replenished regularly.
? Includes vitamins C, and Vitamin B Complex
members B1 ,B2, B3,B5, B6, Folic acid, and B12.
? Excesses of water soluble
vitamins will be excreted in the
urine.
? However, B-6 and Niacin can be
toxic when ingested in
unusually large amounts.
? Fat-soluble vitamins
? These include vitamins A, D, E, and
K.
? These Vitamins are absorbed,
stored, and transported through
dietary fat.
? Body stores these vitamins in fatty
tissue, liver, and kidneys.
? Excess buildup in tissues can be
toxic.Fat Soluble Vitamins
? Consist of Vitamins A, D, E, and K
? Absorbed at the small intestine in the
presence of bile (and fatty
substances).
? Overdoses can be toxic (A and D)
Vitamin Supplementation?
? Not necessary if diet is healthy
? Multivitamins are safe (100% RDA)
? Not all vitamins are "pure"
? Can be toxic at high doses
Vitamin A Role in vision, growth and Fish Liver
differentiation of germinal
Sweet
epithelial cells,
potatoes,
anticancer
Carrots
Vitamin B
Form Coenzymes, help
Green leafy
enzymes in metabolic
vegetables,
reactions
Fruits, yeast
Vitamin C
Collagen synthesis,
Citrus fruit,
Steroidogenesis, Iron
tomatoes
metabolism, Healing skin,
preventing colds
Vitamin D
Calcium metabolism,
Milk
Strengthen bones
Sunlight
Vitamin E
Potent Antioxidant,
Vegetable
Helps strengthen cells
Oils, nuts
? Most of the vitamins except very few are
not biosynthesized in human body.
? Vitamins are associated with various plant
and animal origin foods of nature.
? Ingestion of foods rich in vitamins is
mandatory for a good health.
? Vitamins helps to maintain growth ,health
and reproduction.
? They do not generate calories/Non calorific
? Most Vitamin B complex members serve as
Coenzymes for Enzyme action.
? Vitamins help to regulate many vital
body processes that include:
? Digestion
? Absorption
? Metabolism
? Bone Ossification
? Vision
? Antioxidant role
?
Minerals
Minerals
? Inorganic elements found in
food that are essential for life
processes
? About 25 are essential Minerals
?Minerals are classified
as:
?Macro minerals
?Trace minerals
? Macro Minerals: Sodium,
Potassium, Chloride, Calcium,
Phosphorus, Magnesium, Sulfur
? Trace Elements: Iron, Zinc,
Selenium, Molybdenum, Iodine,
Copper, Manganese, Fluoride,
Chromium
Macro Minerals
?Calcium
?Is needed for bone
and teeth rigidity
?Helps in blood
clotting,
?Muscle contraction &
normal nerve
functions.
?Phosphorous
?Helps build strong
bones & teeth
?Forms various
Phosphorylated
compounds.
? Sodium, Chloride,
Potassium
? Serve as body Electrolytes
? Work together to regulate
the fluids in the body
? Help regulate the nervous
system, muscle functions
& nutrient absorption in
the cells
? Magnesium
? Helps regulate body
temperature,
? Muscle contractions & the
nervous system
? Helps cells metabolize
Carbohydrates, Fats, and
Proteins
? Sulfur
? Helps in detoxification
reactions (PAPS)
? Is present in the amino acids
in proteins
? A component of constituents
of mucopolysaccharides &
essential compounds
Microminerals
? Iron combines with Protein
to form Hemoglobin
? Iodine is needed by Thyroid
gland to produce Thyroxine
? Copper is necessary in the
formation of Hemoglobin
? Fluorine helps reduce
incidence of tooth decay
? Zinc plays an important role
in the formation of protein,
? Thus, assists in wound
healing, blood formation and
general growth &
maintenance of all tissues
? Cobalt is a component of
vitamin B12
? Manganese is necessary for
normal development of bones
and connective tissues
? Chromium maintains normal
glucose uptake into cells &
helps insulin bind to cells
? Selenium along with vitamin
E protects cells from
destruction.
? Glutathione Peroxidase
contains Selenium.
? Molybdenum is a component
of Xanthine oxidase and
Aldehyde oxidase
? Functions Of Minerals
? Body cannot manufacture Minerals
but are needed for forming healthy
bones and teeth .
? Regulate many vital body processes.
? Aids in muscle function
? Help transmit messages in nervous
system
Mineral Guidelines
? Dietary supplementation of
Calcium is beneficial for post-
menopausal women
? Salt should be limited in the
diet of hypertensives.
Calcium
? Important for preventing osteoporosis
? RDA = 800-1000 mg/day
? Found in dairy products and vegetables
High protein diets leach calcium from
bones and promote osteoporosis
Iron
? Important component of
hemoglobin
? Iron deficiency is known as
anemia
(Symptoms: shortness of breath, fatigue)
Antioxidants
? Antioxidants are chemical substances
which fight with free radicals.
? Antioxidants prevents Peroxidation of
biomolecules.
? Antioxidants protect the biomolecules of
human body.
? Promote healthy status to human body.
Dietary Sources Of Antioxidants
? Pigmented Fruits and Vegetables
? Broccoli
? Cantaloupe
? Carrot
? Bananas
? Mango
? Pumpkin
? Red Pepper
? Spinach
? Strawberries
? Sweet potato
Fresh Fruit and Vegetables
? These contain Fibre ,Minerals, Vitamins
and Antioxidants.
?Water makes up
around 65% of
the body weight.
Remember
?It's important to
drink at least 8 cups
of water a day to
maintain health.
Role Of Body Water
? Water is essential to keep the body
healthy.
? It helps to cook , swal ow and digest
food.
? It keeps the body hydrated.
? Water Helps to Maintain
Many bodily functions.
? Chief component of blood plasma
which serves as a transport media.
? Bodies solvent helps in metabolic
reactions(Hydrolase and Hydratase).
? Lubricates joints and mucous
membranes.
? Serve as Shock absorber in eyes,
spinal cord, and amniotic sac
(during pregnancy).
? Absorb , transport and eliminate
nutrients and metabolic wastes.
? Perspiration/sweating helps to
maintain normal body
temperature.
Remember
?Man can live for many
days without food,
?But cannot live few
days without water.
Calorific Values Of Food
OR
Energy Content Of Food
Calorimetry
?Calorimetry is a term
used to measure energy
content of food and its
nutrients.
? Calorific value of food is defined
as :
? An amount of energy released
by the combustion of 1 gram of
nutrient.
(Carbohydrate/Lipid/Protein)
Determination
Of
Calorific Values of Food
?Bomb Calorimeter is used
to determine Calorific
values of food nutrients.
Bomb Calorimeter
? It is a closed metal ic Oxygen
chamber with electrical y heated
platinum wires.
? When food is placed inside it and
operated
? It combust the Nutrients and
determines the calorific value of
foods.
? Nowadays there are highly
automated efficient
combustion Calorimetric
systems available
? To compute the energy
contents of food and body.
Kilocalories
? Kilocalorie/Calorie is a Unit
for measuring heat energy, of
food and energy requirement
for the body.
? When you hear "Calorie," it is
real y a kilocalorie
173
Definition of Kilocalorie
? 1 kilocalorie is amount of
heat required to raise the
temperature of 1 gram of
water with 1 degree Celsius.
Calorific Contents of Nutrients
? Macronutrients ( Calorific)
?Carbohydrates = 4 Cal/g
?Proteins = 4 Cal/g
( 5.3 Cal/g in Bomb Calorimeter)
?Fats = 9 Cal/g
?Carbohydrates and
Fats are completely
oxidized in the body
to CO2 and H2O.
? Proteins are not completely
oxidized in the body.
? Nitrogenous excretory product
Urea stil contain oxidizable
carbon and hydrogen in it.
? Micronutrients (Non Calorific)
?Vitamins = 0 Cal/g
?Minerals = 0 Cal/g
?Water = 0 Cal/g
Calorific value of Foods
? Food contain mixture of nutrients.
? Calorific value of foods depends
upon the amount of nutrients
present in it.
Calculation of Calorific Value
of
Food Stuffs
? Food energy is the amount of
energy liberated by food
nutrients.
? Through digestion absorption
and assimilation of food
nutrients.
Energy is provided by the following
Carbohydrates:
60% (45-65%) of the diet
1gm provides 4 kcal
Fats:
35% (25-45%) of the diet
1gm short-chain provides 5.3 kcal
1gm medium-chain provides 8.3 kcal
1gm long-chain provides 9 kcal
Proteins:
11% (9-15%) of the diet
1gm provides 4 kcal
Calculation Of Energy Content
Of Foods
100 gram of Wheat flour contains
? 69.6 gm Carbohydrates
? 12.0 gm Proteins
? 1.5 gm Fat
? Calories of 100 gm Wheat flour=
(69.6x4)+(12x4)+(9x1.5)=340 Calories
? Energy Content of foods is computed
as:
? Multiplying the amounts of calorific
nutrients in 100 gm of food with their
physiological calorific values.
? Final y adding up the values.
Energy Requirements by
Human body
? Human body daily requires sufficient
amount of energy to expend on
various body activities.
? This energy need is provided by
combustion/oxidation of food
nutrients of calorific values.
?Usual y Carbohydrates and Fats
?In emergencies Proteins.
Energy Requirement By
Human Body Differs
In Different
Phases Of Life
?Approximately 80-120
kcal/kg body weight for
the 1st year of life.
?Approximate 2500
Kcal/day for an Adult
individual
An Amount of Energy Needed by a body is
Based on:
1. Basal Metabolism (BMR)
2. Physical Activities
3. Specific Dynamic Action of foods(SDA)/
Thermic effect
RQ for mixed diet is .82
from 40% CHO & 60%
fat.
? Non-protein RQ is
between 0.7 and 1.0.
? Thermal equivalents
of oxygen for different
non-protein mixtures.
BMR > Activity > Dietary Thermogenesis
Basal Metabolic Rate
(BMR)
What Is
? Basal Metabolic Rate (BMR) ?
?BMR is the minimum
amount of energy required
by the body to maintain life
in basal condition.
? Basal condition of body is :
1) Post absorptive phase
2) Awake condition
3) Thermo neutral
environment
4) Complete physical and
mental rest
?BMR is the minimum
resting energy
expenditures by an
awake alert person.
? The energy required in basal condition is
consumed for the involuntary actions of
body viz
?Pumping of Heart
?Blood Circulation
?Respiration process by Lungs
?Muscular Twitching and reflexes
?Intestinal Peristalsis
?Metabolic Reactions
?Renal Functions
Determination Of BMR
Preparation Of Patient
For BMR Estimation
? In early morning subject should be
in:
?Post absorptive phase (12 hr Fast)
?Physical y and mental y relaxed
?Lying position, awake condition
?Room Temperature should be
around 21-25 degree centigrade
?Normal humidity
? Direct Method For BMR
Determination Using :
?Benedict Roth Apparatus
?Dubois Apparatus
? Benedict-Roth Apparatus
? Calculates the amount of
Oxygen consumed under the
specific basal conditions.
? Oxygen consumption for 2-6
minutes and measure the value
from graph.
? Indirect Method of BMR
Determination:
?Analysis of expired air
?Determining of O2 consumption and
CO2 output.
? The total heat production is
determined and is then
? Calculated per sq.m of body surface per
hour
BMR= Total heat production in Cal/hr
Body surface area in Sq.m
Normal Values Of BMR
? Males= 35-40 kcal/ sq.m /hr
? Females= 30-35 kcal/ sq.m /hr
? Indirect Calorimetry:
? Calculates Respiratory Quotient
? Oxygen Consumption
? Carbon Dioxide Production
? Spirometer or Respirometer
apparatus is used to measure
the amount of Oxygen
consumed and Carbon dioxide
produced.
? This helps in calculating the
energy expended.
Respiratory Quotient
? Respiratory Quotient (RQ) is ratio
of volume of carbon dioxide
produced to volume of Oxygen
consumed by an individual in a
given interval of time.
Respiratory Quotient (RQ)
Volume of CO2 Produced
RQ = Volume of O2 Consumed
At the CELL
Each substrate has its own RQ value.
(Carbohydrates (1.0) vs Fatty acids (0.7))
? Respiratory Quotient (RQ)
?Amt CO2 produced/O2 consumed
?Varies for different Calorific Nutrients
? Amount of CO2 formed does not always
equal amount of O2 consumed
RQ for CHO and FAT
Carbohydrate (Glucose):
C6H12O6 + 6O2 6CO2 + 6H2O + Energy
RQ = 6CO2 / 6O2 = 1.00
Fat (Palmitic Acid):
C16H32O2 + 23O2 16CO2 + 16H2O + Energy
RQ = 16CO2 / 23O2 = 0.70
?R.Q of Protein is 0.8
?R.Q of Mixed diet is 0.85
? R.Q in Heavy work exceeds more than 1.
?During heavy exercise the tissue
metabolism is increased.
?CO2 out put is increased by
enhanced pulmonary
ventilation
?Oxygen consumption is not
proportionately increased.
? Thus R.Q is an indicator of metabolic
status.
? R.Q of food stuffs depend upon:
? Type of food Nutrients
?Their varying proportions
?RQ value can be used to
find the amount energy
produced per litre of
Oxygen consumed
? Conditions increasing R.Q
? Violent Exercise
? Fever
? Acidosis
? Conditions Decreasing R.Q
? Starvation
? Diabetes mellitus
? Alkalosis
Significance Of R.Q
? R.Q value helps in:
?Estimation of Basal Metabolic Rate
?Type of food oxidized
?Diagnosis of various pathological
conditions such as Acidosis ,
Diabetes mel itus ,fever etc.
? To estimate the Calories needed
for basal metabolism/hour:
?For Men: Multiply body weight
(lbs) by 11
?For Women: Multiply body
weight (lbs) by 10
Average Calories Required for Basal Metabolism is
70 C/hr or 1680 C/day
Factors Affecting BMR
BMR is Influenced By Many Factors.
? Age
? Sex
? Body Surface Area
? Climate/Environmental Temperature
? Nutritional Status
? Hormones
? Pregnancy
? Physical Activity- Exercises
? Circadian Rhythms
? Emotional State
? Smoking and Caffeine
? Body temperature
? Diseases
? Digestive Processing
(Specific Dynamic Action)
? Aquatic Salinity (Osmoregulation)
Age
? Infants and children have much
higher BMR than adults.
? Growth increases BMR.
? Highest BMR is noted at age of 5-6 yrs
(58kcal/sq.m/hr)
? BMR is gradually decreased as age
proceeds
Gender/Sex
? BMR of men is always higher
than women.
? Men possess
? increased lean muscle mass.
? increased physical activities.
Body Surface Area
? Body surface area is related to
height and weight of an
individual.
? BMR is directly proportional to the
body surface area.
?Increased Body Surface
(lean muscle) area has
greater BMR.
?Lean muscle mass is
more metabolical y
demanding than Fatty
tissue.
? Lean tal persons with greater
muscle mass has higher BMR.
? Obese short persons with
lower lean muscle mass has
lower BMR.
? Lower body Fat percentage
higher is the BMR.
? Higher the body Fat percentage
lower is the BMR.
Climate/Environment Temperature
? BMR is decreased in summer
? BMR is increased in winters
Nutrition
?BMR is lower in
persons with
malnutrition and
starvation.
Endocrine Secretion/Hormones
? Thyroid hormone influences
directly on BMR
?BMR is increased in
hyperthyroidism
?BMR is decreased in
hypothyroidism.
?High levels of Growth
hormone and Epinephrine
also increases BMR.
Pregnancy
?BMR is raised by 5%
in pregnancy.
BMR For Physical Activity
ACTIVITY LEVEL
PERCENTAGE OF BASAL
METABOLISM CALORIES
Inactive: sitting most of the
30%
day; <2 hours moving about
slowly or standing
Moderate: sitting most of
50%
the day; walking or standing
2-4 hours, no strenuous
activity
Active: physically active for
75%
>4 hours a day; little sitting
or standing; some strenuous
activity
Thus BMR Increases With
Rate Of Physical Activity
Circadian Rhythms
? BMR is lower in sleep
? BMR is higher in awake
Emotional State
? Stress increases BMR
Smoking and Caffeine
?Smoking and ingestion
of Caffeine increases
BMR.
Body Temperature
? BMR increases with increasing
body temperature .
? An elevation of body temperature
above 370C will increase BMR by
13% per 0C.
? Thus in Fever BMR is raised.
BMR In Diseased Conditions
? BMR is increased in
? Fevers
? Leukemia
? Cardiac Failure
? Hypertension
? Metabolic disorders
? Surgery
? Infections
? Anorexia
Significance Of BMR Calculation
? BMR values help in calculating
energy requirement of an
individual body which help in
planning of diets.
? To know the effect of food and
drugs on BMR.
? BMR value checks the basal
metabolism and disease
conditions.
? BMR values help in assessing
Thyroid function.
Energy Required For
Physical Activities
? Energy requirement for an
individual per day varies from:
? Person to person
? Action to action
?Mode of life style
?Type of occupation
Energy Requiring Factors For Physical
Activities
? Age
? Sex
? Body Surface Area ?
Body weight ,size and height
? Nature of work
? Duration and intensity of work.
Workers
Calories/Day
B.M.R %
Light Workers
2200-2500
30-40%
Teachers, Doctors, Office
Workers
Moderate Workers
2500-3000
40-50%
Students, House wives
Heavy Workers
3000-3500
50-60%
Farmers ,Miners, Athlete
Very Heavy Workers
3500-4000
60-100%
Rickshaw Pullers,
Construction Workers
Activity
Energy Expenditure in
Calories/ hour
Sitting
25 Calories/hour
Standing
30 Calories/hour
Writing
30 Calories/hour
Car Driving
60 Calories/hour
Typing
75 Calories/hour
Walking Upstairs
800 Calories/hour
Every physical activity needs energy above BMR
Energy Cost of Physical Activities
Activity
Cal/KgBW/Hour
Bicycling (fast)
7,6
Bicycling (slow)
2,5
Dancing (foxtrot)
3,8
Dancing (waltz)
3,0
Dish washing
1,0
Driving
0,9
Table tennis
4,4
Marathon run
7,0
Sawying
5,7
Walking 5 km/h
2,0
Writing
0,4
Playing piano
2,0
Sewing
0,6
Specific Dynamic Action
(SDA)
Thermogenic Effect Of
Food (TEF)
SDA also termed as
Calorigenic Action Of Food.
? SDA is the extra heat
produced when food is
consumed by the body,
over and above the
calculated calorific value.
? 25 gm of dietary proteins when
consumed in the body should
produce 100 Calories of energy.
? 25 x 4= 100 Calories
? But actual heat produced is 130
Calories
? Thus 30 Calories of energy is extra.
? SDA is referred to an increased
heat production following an
intake of food.
? SDA heat is expended for
digestion and absorption of
food.
SDA or TEF
?SDA of Protein diet 30%
?SDA of Carbohydrate diet 5%
?SDA of Lipid diet 13%
Dietary Proteins
Has Highest SDA Values
? Protein rich meal eaten in hot
weather feels the body hot
and sweaty.
? Protein rich meal in cold
weather provide cozy and
comfortable feeling.
? SDA accounts for
approximately 10% of the
body's total energy need
(basal needs and energy
needs)
SDA of food is the amount of
energy required to digest mixed food
(Carbohydrate, protein, lipid, fruit &
vegetable).
Approximately 10% of BMR is
required as the SDA of food
Adult 60 Kg, requires BMR =24 Cal/kg
BMR
= 1440 Cal
SDA
= 144 Cal
Total = 1584 Cal (BMR+SDA)
Significance Of SDA
? Heat of SDA can be utilized
for maintaining body
temperature but not for
muscular activity.
Conditions with Decreased SDA
? Conditions where amino acid catabolism
decreased
? SDA is decreased
?Starvation
?Growth
?Pregnancy
?Convalescence period (Recovery )
Balanced Diet
OR
Prudent Diet
(Thoughtful And Careful Way Of Eating)
? Nutrition is a first need of human
beings.
? General health and wel being of a
body depends on
? Nutritional status of an individual
?If human body is considered as a
Machine
?Food is our fuel
Composition of Food Nutrients
Determines:
?Bodies composition and built
?Bodies strength to cope up with
interacting environmental
pol utants
?Bodies capacity to grow, repair and
reproduce.
What Is a Balanced Diet?
Balanced Diet
IS A Planned Diet At Various
Physiological States
Balanced Diet A Healthy Diet
? Nutritionists planned the diet considering :
? Various physiological phases of human life
? Human Nutritional requirement of the body
?Calculates the energy requirement per day
related to
?BMR and various physical activities.
?Its necessary to maintain balanced diet
since:
?What we eat today, will affect our health
in the future.
Maintain Balanced Diet By
?Eating items from al food groups
?With appropriate quantity and good quality to
provide all nutritionally essential nutrients.
?Eating properly and regularly (Timely) without
skipping the whole meals.
? It is especial y important to
take care of eating during
? Growth, Pregnancy and
lactation
?Remember a young plant, not
given proper nutrients grows up
to a poor specimen with less/no
fruits and flowers.
Features of Balanced Diet
? Balanced diet provides the
mixture of al dietary nutrients
in:
?Adequate quantity
(Restrict to RDA values)
?Good quality
? Balanced Diet Provides
?Calorific needs
?Building blocks
?Accessory Growth factors
?Balanced diet does not
al ow an individual
?To ingest any one
dietary nutrient in
excess or less amount.
?Thus Balanced diet
prevents a body
?To suffer from over or
under nutritional
disorders.
Points To Consider
While Planning For Balanced Diet
1. Physiological States
2. BMR (Considering al factors)
3. Physical activities of an individual
4. SDA
? The food included during planning of
balanced diet should be local y
available
? The food should be within economic
means of people.
? It should fit with local food habits.
? Balanced diet food items should be
easily digestible and palatable.
? The food eaten should contain al
the chief constituents which
suffice bodies health, growth and
reproduction.
? An individual should eat fol owing food
groups in recommended quantity and
quality and maintain balanced diet.
?Cereals and Pulses
?Milk
?Meat and Fish
?Vegetables and Fruits
? RDA values differ during
different physiological states
of human body
? viz growth, pregnancy,
lactation and convalescence.
Points To Remember
? During growth, pregnancy and
Lactation the dietary intake
should be increased
? To build the body and maintain
reproduction respectively.
Indian Balanced Diet
? The Nutrition Expert Group
constituted by ICMR
? Taking into account of Indian
available foods
? Has recommended the composition
of Balanced diets for Indians.
The Indian balanced diet composed of
? Cereals : Rice, Wheat,Jawar
? Pulses
? Vegetables- Roots,Tubers
? Fruits
? Milk and Milk products
? Oil
? Sugar
? Fish
? Meat
? Eggs
Recommended Daily Al owance(RDA)
? RDA of Chief Nutrients for an Adult Individual
? Prescribed by WHO
? Modified by ICMR as per Indian conditions
Nutrient
RDA in Grams
Carbohydrates
400 gm
Fats
70 gm
Proteins
60 gm
Fiber
40 gm
? Carbohydrate content of
Some common foods
Food Item
Carbohydrate Content
Cane Sugar
100 %
Rice
80%
Wheat
70-80%
Bread
50-60%
Potatoes
25%
Vitamins
RDA
Vitamin A
3000- 4000 IU
Vitamin D
200-400 IU
Vitamin E
9 mg
Vitamin K
70 ug
Vitamin C
60 mg
Folate
400 ug
Thiamine (B1)
1.2 mg
Vitamins
RDA
Biotin
30 mcg
Riboflavin (B2)
1.2 mg
Niacin (B3)
15mg
Pantothenic (B5)
5 mg
Pyridoxine (B6)
1.6 mg
Cyanocobalamin (B12)
2.4 ug
Minerals
RDA
Calcium (Ca)
1200 mg
Phosphorus (P)
700 mg
Magnesium (Mg)
370 mg
Sodium (Na)
500 mg
Chloride (Cl)
750 mg
Potassium (K)
2000 mg
Minerals
RDA
150 ug
Iodine (I)
Iron (Fe)
10 mg
Copper (Cu)
1.5 mg
Zinc (Zn)
14 mg
Selenium (Se)
60 ug
Minerals
RDA
Molybdenum (Mo)
75 ug
Manganese (Mn)
2 mg
Fluoride (F)
4 mg
Chromium (Cr)
50 ug
q Eat different forms of foods to
keep healthy
qOR
qEat varied type of diet in a day
Eat A Balanced Diet
Guidelines for
Healthy Eating
Fol ow principles in the Food Guide Pyramid
? 75% of a day's
food
? Should come
from grains,
vegetables and
fruits
? Extra servings of green
and yellow vegetables
may be beneficial
? Extra consumption of
citrus and other fruits
may be beneficial
Tips For Eating Wel
? Eat regular meals
? Do not skip breakfast
? Eat foods from al food
groups /According to the
food pyramid
? Limit processed /Junk food
?Prefer meals on starchy
foods
?Eat Egg and Fish
?Eat adequate amounts of
vitamins and minerals
?Eat lots of fruit and
vegetables
? Eat fresh and natural foods
? Cut down saturated fats , trans fats and
refined sugars.
? Try to eat less salt (no more than 5g/day)
? Restrict Alcohol
? Limit Tea and coffee
? Drink plenty of water
? Remain active and try to maintain a
healthy weight.
Regularly Recal the 8 tips
Significance Of Balanced Diet
Balanced Diet
Makes Life
Healthy And Happy
? Eating balanced diet right from the
beginning of life builds:
? The organ system of human body
with ful of strength and vital
capacity
? This prepares the body to face any
critical conditions.
?Metabolic stress
?Infections etc
?Balanced diet Significantly
? Maintains bodies normal growth , health
and reproduction.
? Prevents from the suffering of nutritional
disorders.
? Increases span of healthy and happy life.
Energy Balance and Imbalance
?Body weight is stable
when energy consumed
is equal to energy
expended.
?This is termed as
Nitrogen balance.
Energy Balance:
Input vs Output
One pound of body weight is equal to
3,500 kilocalories
?Body weight increases,
when energy consumed
is greater than energy
expended.
?Body weight decreases
when energy consumed is
less than it expenditure.
? Balanced Energy Intake: not losing or
gaining weight
? Negative Energy Balance
?Weight loss: Energy intake < Energy
expended
? Positive Energy Balance
? Weight gain: Energy intake > Energy
expended
Nutritional Disorders
MALNUTRITION
A pathological state resulting
from a relative or absolute
deficiency or excess of one or
more essential nutrients.
Forms of Malnutrition
v
Undernutrition:
Kwashiorkor, Marasmus
v
Overnutrition:
Obesity, Hypervitaminosis
v
Specific Deficiency:
Kwashiorkor, Hypovitaminoses, Mineral
Deficiencies
v
Imbalance: Electrolyte Imbalance
? Human beings suffer from Nutritional
disorders due to:
?Lack of general awareness
?Il iteracy
?Poverty
?Wrong food habits
?Disorders
? The availability of food is not uniform
due to:
?Unequal distribution of food items
?Unequal economical status of
human population
ETIOLOGY OF MALNUTRITION
Types Of Nutritional Disorders
? Under Nutritional Disorders
? Over Nutritional Disorders
Under Nutritional Disorders
Under Nutritional Disorders
? It is a type of Malnutrition.
? Less intake of food nutrients.
? Insufficient building blocks and
vital growth factors.
? Insufficient energy sources.
Protein Energy Malnutrition(PEM)/
Protein Calorie Malnutrition (PCM)
? Protein Energy Malnutrition (PEM)
? Protein and Energy deficiency go
hand in hand.
? This combination leads to protein-
energy malnutrition
?PEM is the worlds most
widespread malnutrition
problem in developing
countries.
PEM PRECIPITATING FACTORS
? LACK OF FOOD (Famine, Poverty)
? INADEQUATE BREAST FEEDING
? WRONG CONCEPTS ABOUT NUTRITION
? DIARRHOEA & MALABSORPTION
? INFECTIONS (Worms, Measles, T.B)
EPIDEMIOLOGY & ETIOLOGY
? Seen most commonly in the first year of
life due to lack of breast feeding and the
use of dilute animal milk.
? Poverty or famine and diarrhoea are the
usual precipitating factors
? Ignorance & poor maternal nutrition are
also contributory factor
Development Of PEM
? The majority of world's children
live in developing countries
? Lack of food & clean water, poor
sanitation, infection & social
unrest lead to LBW & PEM
? PEM leads to
? Increased Rates of Infant Mortality
? PEM disorders caused due to lack of
adequate Proteins and Energy in the
diet.
? According to W.H.O PEM is the most
important public health problem
prevailing in developing countries.
? PEM most common in Africa, Central
America, South America, Middle
East, SE/E Asia
? Also see in US
?Homeless
?Inner-city
?Rural poverty
? PEM most often affects
children:
?500 mil ion children are
malnourished
?>50% of deaths of <5
children (5 mil ion/year)
? Adults may also be affected with PEM
?Men at greatest risk are:
?Those living in poverty
?Elderly living alone
?Addicts
?Those with eating-disorders
?Those with long-term illness
Forms Of PEM
? Protein Energy Malnutrition (PEM)
includes
? Kwashiorkor
? Marasmus
? Marasmic Kwashiorkar
(Noted during Starvation or Wasting
extreme energy deprivation)
?Kwashiorkor
?Marasmus
? Two Facets of PEM
Kwashiorkor
?Kwashiorkor means sickness
of displaced/deposed child.
?Kwashiorkar describe the
sickness of weaning,
?That affects the first born
child, when the second
child is born.
KWASHIORKOR Historical Aspects
? The word Kwashiorkor was
introduced to the medical literature
in 1933 ,by Cecil y Wil iams, a British
Nurse.
? Kwashiorkor is the Ghanaian name
for the Evil Spirit
Biochemical Cause
? Kwashiorkar is an extreme
condition of Protein Energy
Malnutrition
? Caused due to ingestion of
Protein deficient diet.
Cause
? Age of onset- 1 to 5 years
? Child gets displaced by mothers
attention.
? Ingestion of low dietary Proteins
? No milk fed instead low protein diet
like gruel prepared from grains and
potatoes is fed.
Biochemical Alterations
? Amino acid deficiency for tissue
protein biosynthesis.
? Serum Albumin levels markedly
decreased < 2gm%
? Digestive Enzymes lowered
? Overal body Proteins are lowered
? Serum Cortisol levels decreased
Clinical Signs And Symptoms
? Enlarged abdomen
? Pitting edema of trunk, limbs and
eyelids (Low serum Albumin)
? Moon Face
? Anemia
? Growth retardation
? Loss of weight, lethargic
? PSYCHOMOTOR CHANGES
? SKIN DEPIGMENTATION
? Failure of digestion and absorption due to
lack of digestive enzymes.
? Due to indigestion of food
vLoss of appetite and anorexia
vDiarrhea
vWater and Electrolyte imbalance
? Subnormal Immunocompetence
(Low Immunity)
? Mental Changes observed-Low
Neurotransmitters
? Fatty Liver-Low/No mobilization of
Lipids
? Sparse ,soft, thin and curly hairs
? Glossitis
? Conjunctivitis
? One theory says Kwashiorkar is
a result of Liver insult with
hypoproteinemia and oedema.
? Food toxins like Aflatoxin have
been suggested as precipitating
factors for Kwashiorkar.
Kwashiorkor
(Edematous Malnutrition)
? Underweight with Edema
? Stunted growth
? Irritable, difficult to feed
? Highest mortality ?
50 to 60%
Treatment Of Kwashiorkar
? Gradual feeding with good
quality food proteins
?Milk
?Egg
?Legumes /Pulses
Marasmus
? Marasmus means neglected child
? Marasmus is a disorder of PEM
where an infant is virtual y
starving
? Due to lack of both dietary
calories and proteins.
? The term Marasmus is derived from
the Greek word, which means
wasting.
? Marasmus involves inadequate
intake of Protein and Calories and is
characterized by emaciation.
? Marasmus represents the end result
of starvation where both proteins
and calories are deficient.
Causes Of Marasmus
? Age of onset- Below 1 year
? Deficiency of both Calories and
Proteins.
? Marasmus occurs in areas where
there is severe starvation and
famine/draught conditions.
Biochemical Alterations In Marasmus
?Serum Albumin levels 2-3
gm%
?Serum Cortisol levels
increased
Clinical Signs And Symptoms
? Marked growth retardation
? Severe Muscle wasting
? Loss of sub cutaneous fat
? Extreme loss of body weight
? No Edema
? No mental changes
? No characteristic change in hair
? Appetite is normal
? Skin becomes dry and atrophic
? Child looks older than his age
?Feels Hungry
?Diarrhoea &
Dehydration
?Alert but miserable
Differentiation Between
Kwashiorkar
And
Marasmus
Features
Kwashiorkor
Marasmus
Displaced Child
Neglected Child
Age Of Onset
1-5 years
Below 1 year
Cause
Deficiency of dietary
Deficiency Of dietary
Protein
Proteins and Calories
Serum Albumin
< 2gm%
2-3 gm%
Edema
Significantly Present
Absent
Muscle Wasting
Not severe
Markedly sever
Growth Retardation
Present
Markedly noted
Features
Kwashiorkor
Marasmus
Attitude and
Lethargic ,apathetic
Irritable and fretful
Appearance
Face looks plump
Shrunken with skin and
bones
Appetite
Anorexia
Normal
Skin Changes
Crazy pavement
Dry and atrophic
Dermatitis
Hair Changes
Sparse, soft thin and
No characteristic
curly
change
Serum Cortisol
Decreased
Increased
Investigations for PEM
? Ful Blood Counts
? Blood Glucose
? Serum Electrolytes, Ca, P
? Serum Proteins and Albumin
? Septic screening
? Stool & urine for parasites & Microbes
? Mantoux test
NON-ROUTINE TESTS
? Hair analysis
? Skin biopsy
? Urinary Creatinine
? Measurement of trace elements
levels, iron, zinc & Iodine
Complications of P.E.M
? Hypoglycemia
? Hypothermia
? Hypokalemia
? Hyponatremia
? Heart failure
? Dehydration & shock
? Infections (bacterial, viral & thrush)
Treatment
? Slow refeeding
?Small frequent feeding round the
clock
?Patient encouragement of food
? Nutritional rehabilitation
?Play and teaching
?Control infections
In Acute/ life threatening Cases:
?Fluid and Electrolytes
?K and Mg shifts
?Oral rehydration, slowly
70-100 ml/kg
?Infections: Main cause of death
? Aggressive treatment
?Other deficiencies
? Anemia and Heart failure,
? Care with transfusions and no diuretics
? Vitamin A: immediate treatment
? Dietary support:
? 3-4 g protein & 200 Cal /kg body
wt/day + Vitamins & Minerals
? Prevention of hypothermia
? Counsel parents & plan future care
including immunization & diet
supplements.
KEY POINT FEEDING
? Continue breast feeding
? Add frequent smal feeds
? Use liquid diet
? Give vitamin A & Folic acid
? With diarrhea use lactose-free or soya
bean formula
PROGNOSIS
? Kwashiorkor have greater risk of
morbidity & mortality compared to
Marasmus and under weight
? Early detection & adequate treatment
are associated with good outcome
? Late il -effects on IQ, behavior &
cognitive functions are doubtful and not
proven
Over Nutrition Disorders
Obesity
Obesity
?
Generalized, excessive
accumulation of fat in
subcutaneous & other tissues
? Classification according to
"desirable" weight standard:
? Overweight ~ >10%
? Obese ~ >20%
Obesity Is Identified By
Measurement Of Body Mass Index
(BMI)
What Causes Obesity
? 3 major factors contribute to
the development of obesity:
?Genetic background
?High Dietary intake
?Low Physical activity
q Psychic disturbances
q Endocrine & metabolic
disturbances are rare
Biochemical Alterations
? Increased stores of TAG in adiposecytes
? Increased biosynthesis of Endogenous
Lipids
? Derangements in Insulin activity
? Increased risk of Diabetes mel itus
? Biochemical Derangements in Lipid Profile
? Increased Risk of Atherosclerosis , CAD ,
Stroke
Clinical Manifestations:
v Fine facial features on a heavy-
looking stout child
v Larger upper arms & thighs
v Genu valgum common
v Relatively small hands & fingers
tapering
v Adiposity in mammary regions
v Pendulous abdomen with Striate
v In boys, external genitalia appear
small though actually average in
size
v In girls, external genitalia normal
& menarche not delayed
v Psychologic disturbances
common
v Bone age advanced
Treatment of Obesity
1st principle: Decrease
energy intake
Initial medical exam to
diagnose pathological
causes
Plan the right diet
a.Avoid all sweets, fried foods
& fats
b.Limit milk- intake not >2
glasses/day
c.For 10-14 yrs, limit to 1100-
1300 cal diet for several
months
2nd principle: Increase energy
output
I. Obtain an activity history
II. Increase physical
activity
III. Involve in hobbies to
prevent boredom
Complication of
Obesity
Pickwickian Syndrome/
Obesity Hypoventilation Syndrome
? Pickwickian syndrome is a
condition in which severely
overweight people
? Fail to breathe rapidly enough or
deeply enough,
? Resulting in low blood oxygen
levels and high blood carbon
dioxide (CO2) levels
?Rare complication
of extreme
exogenous obesity
Signs And Symptoms
?Severe cardio respiratory
distress & alveolar
hypoventilation
?Includes polycythemia,
hypoxemia, Cyanosis, CHF
?Low Metabolic rate
?Lethargic and Fatigue
? Obesity Hypoventilation
Syndrome have:
? Concurrent obstructive sleep
apnea, a condition
characterized by snoring.
? Interrupted sleep
? Excessive Daytime Sleepiness
Lets Fight For Malnutrition
Questions
? Short Notes
? Food Groups ,their constituents and
their role
? Basal Metabolic Rate (B.M.R.) & its
importance.
? Calorific value of food and its
calculations.
? Respiratory Quotient.(R.Q)
? Specific Dynamic Action (S.D.A.)
? Balanced diet
? Factors affecting BMR
? Biological value of Proteins.
? Nitrogen Balance & types.
? Role of Fiber in diet/Significance of
dietary fibers.
? Protein Energy Malnutrition (PEM) /
? Differentiate between Kwashiorkor
and Marasmus.
Eat Natural Foods
This post was last modified on 05 April 2022