Download MBBS Biochemistry PPT 56 Nutrition Lecture Notes

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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