Download MBBS Biochemistry PPT 78 Nutrition Health Is Priority Of All Human Beings Lecture Notes

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Induction To Todays Topic

What Is Priority Of Any

Human Being's Life?
Pick One First Most Important Thing

? Health
? Wealth
? Happiness
? Success
? Peace

Answer

Health Is Priority Of Al Human Beings


What is Most Important

Factor For Health?

Energy

Chemical Form Of Energy

ATP
ATP Producing Factors

? Air (Oxygen )

? Food/Diet (Nutrients)

Any Guesses For Todays Topic?


Specific Learning Objectives
? What is Nutrition ?

? Importance of Studying Nutrition

? Nutritional Goals and Guidelines

? Food Nutrients and their roles



? Calorific Values/Energy content

of Food nutrients

? Energy requirement by a body

? Basal Metabolic Rate (BMR)

? Respiratory Quotient(RQ)

? Specific Dynamic Action (SDA)
? Balanced Diet and its Importance

? RDA of various Nutrients

? Nutritional Disorders and Preventive Measures

? PEM- Kwashiorkor and Marasmus

? Obesity

INTRODUCTION
What is Nutrition?

Nutrition is a wide branch of Science

which deals with:

vHuman food its role in human body
vEnergy contents of food nutrients
vEnergy requirement by Human Body
vNutritional Disorders


Importance Of Studying Nutrition

Evidenced Based Eating

(EBE)
Know Do's and Don'ts Of Eating

So That One Can Understand Its Truth of

Significance

Implement Do's and Avoid Don'ts

Of Eating

Evaluate Its Significance in form of

Strength and Health

Spread To Others - Family and Patients

STUDY OF NUTRITION

WILL

ANSWER FOLLOWING

QUESTIONS
? WHY TO EAT FOOD ?
? What and How to Eat Food?
? What are dietary nutrients and their role

in human body?

? What are Macro and Micronutrients?
? What Quality and Quantity of dietary

nutrients to be ingested?

? What happens if food is eaten in a

balanced/imbalanced manner?

vKnowledge Of Nutrition Explores

vHow thoughtful y and rightly one can

choose particular food/ type of diet?

vPlanning of balanced diet in various

phases and conditions for good health
vNutritional Studies Involves

vRelation of Nutrients in health and

disease

vUnderstand and Prevent Nutritional

disorders due to under and over

nutrition

vNutrigenomics- Effect of Nutrients on

Genes

What Is Main Purpose

of Eating Food ?
?Food/Diet is a prime

requisite for human body

health, survival and

existence
Importance of Food Nutrients

What we eat is directly/indirectly

related to

Composition and Function of

Sub Cellular Organelles,

Cells,Organs,System,

Body as Whole

? Main purpose of Food is to:

? Supply basic building blocks, to build

Macrobiomolecules, for structural

composition of Cells,Organs,System and its

function

? Provide Energy (Fuel) for cellular activities

? Enable to ingest and provide accessory

growth factors




? Role Of Human Food

? Build Cel and Subcel ular Structures
? Maintain all body functions
? Regulates Metabolism
? Therapeutic benefits of food

?Healing of diseases
?Prevention of diseases


? Remember Proper Nutrition

? Maintains normal growth, health

and reproduction.

? Rewards healthy and happy life

? Improves life span
Remember

Defective Nutrition

Is Root Cause Of Many Disorders

How Should Be Our Eating?
One Should Eat

To Live

A Healthy and Happy Life

SOP's Of Eating Nutritive Food

? Simple
? Natural
? Balanced (Mixed)
? Appropriate quality and quantity
? Fixed
? Regular
? Timely
? Utilization of unutilized stores (Fasting)
Essentials for Healthy Life

?Ingest food Nutrients

with

?Proportionate Quantity
?Appropriate Quality

?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/Moderate,

to patients to maintain their good

health's.
DIETARY GOALS

Phase Wise Diet

? Maintenance of a state of positive health and optimal

performance in populations at large by maintaining

ideal body weight.

? Ensuring adequate nutritional status for pregnant

women and lactating mothers.

? Improvement of birth weights and promotion of

growth of infants, children and adolescents to achieve

their ful genetic potential.

? Achievement of adequacy in al nutrients

and prevention of deficiency diseases.

? Prevention of chronic diet-related disorders.

? Maintenance of the health of the elderly and

increasing life expectancy
Nutritional Goal Is To Accomplish

Structural Composition And Function

Of Every Body Cel To best

? Quantity of food promotes a constant

BMI


? Quality of food promotes functionality

43

DIETARY GUIDELINES

Do's and Don'ts Of Eating Food

? Eat variety of foods to ensure a balanced diet.

? Ensure provision of extra food and healthcare to

pregnant and lactating women.

? Promote exclusive breastfeeding for six months and

encourage continue breastfeeding til two years or

as long as one can.

? Feed home based semi solid mixed foods to an

infant after six months.
? Ensure adequate and appropriate diets for

children and adolescents, both in health and

sickness.

? Eat plenty of vegetables and fruits

? Ensure moderate use of edible oils and animal

foods and

? Very less use of ghee/ butter

? No use of Vanaspati/ trans fats

? Avoid undereating /very less eating to

loose weight.

? Overeating to prevent overweight and

obesity

? Exercise regularly and be physical y

active to maintain ideal body weight.

? Restrict salt intake to minimum
? Ensure use of safe and clean foods with natural

antioxidants

? Adopt right pre-cooking processes and appropriate

cooking methods.

? Drink plenty of clean water and take beverages in

moderation

? Minimize the use of processed foods rich in salt,

refined sugar and trans fats.

? Include micronutrient-rich foods in diets of elderly

people to enable them to be fit and active

? Nutrition Influences on:

? Health
?Appearance
?Behavior
?Mood

48


Mixed Type Of Diet Is A Healthy Diet



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

?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 Main Nutrients of Food Items

? Carbohydrates
? Lipids (Fats)
? Proteins
? Vitamins
? Minerals
? Water (Most Important)
Classification Of Nutrients

? There are four ways to classify 6 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

66


? Non energy yielding/Non Calorific

?Vitamins
?Minerals






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.

Weird fact

These foods include:
?Cheese (hard, soft, cottage)

Ourbrainsare

80%fat.

?Yogurt
?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

?Fish and shellfish

now Marks and

Spencer's best-selling

?Beef, pork and lamb

lunchtimesnack.

?Eggs are included in this group too.
Athletes eat lots of protein; they help to

build muscles.

Body Composition














GROUPS OF NUTRIENTS:

?Carbohydrates
?Proteins
?Lipids
?Vitamins
?Minerals
?Water

Carbohydrates


?Nutritional Carbohydrates:

?Sugars-simple Carbohydrates

?Starch-complex Carbohydrates




? Simple Carbohydrates:

? Mono and Disaccharides include:

vGlucose

vFructose

vLactose

vFruits,Milk,Juices and

Sweets


?Complex Carbohydrates

are Present in

?Starches

?Cellulose

vLegumes
vWhole grains

? Simple Carbohydrates

? pop, candy, sweets, fruits
? Recent studies reported Refined sugars are

Brain damaging and Poisons

? Complex Carbohydrates

? pasta, rice, breads, potatoes

80
Dietary Fiber

?Dietary Fiber

?Indigestible complex

Carbohydrate

?Non calorific
Substances As Dietary Fiber

? Cellulose
? Hemicellulose
? Pectin's
? 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 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

Advantages Of Dietary Fiber Contd---

?Dietary fiber corrects

?Hyperglycemia
?Hypercholesterolemia
Advantages Of Dietary Fiber Contd---

? Fiber Reduces risk of:

?Diverticular disease of colon
?Colon cancer
?Varicose veins

Advantages Of Dietary Fiber Contd---

?Good satiety and non

calorific value of dietary

fiber

?Helps in management of

obesity.
Disadvantages 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.

Role Of Carbohydrates

v Readily available source
v Supply 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

? RDA for Carbohydrates-

400-600 gm/day

? An Adult individual with

his/her routine activities

should adjust the

Carbohydrates intake.


? Ingestion of Starchy food is more

preferable.

? Refined sugars have high glycemic

index so quantity should be reduced.

? Excess of Glucose transforms to

Lipids viz Fatty acids,TAG,Cholesterol

? Dietary fiber in form of Celluloses to

be ingested.

Hypoglycemia and Hyperglycemia

Relates To Glycemic Index (GI) of Foods



?Dietary Proteins

?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.

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)

? Types of Amino Acids (20 AA)

? Nutritional y Nonessential AA (10) ? can be

biosynthesized by body

? Nutritional y Essential AA (8) ? Not biosynthesized

must be made available through diet

? Nutritional y Semi-essential AA (2)- Made in body to

less amount need also from diet
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
Evaluating Protein Quality



? Biologic Value (BV) of Protein:

?Amount of ingested Nitrogen

retained in the body

compared with Nitrogen

absorbed.

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.

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.

? Net Protein Utilization (NPU):


?Percentage of Nitrogen

consumed that is retained in
the body.
? Biological value of protein affects

Nitrogen balance.

?Low B.V proteins leads to negative

nitrogen balance.

?Increased loss of NPN substance

Urea in urine.

? Plant proteins are of low B.V

? Since deficient in one or two

essential amino acids.
?Complete Proteins with

high biological value

?Maintain Positive/Nitrogen

equilibrium

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


Mutual Supplementation

Of

Dietary Proteins

Improves Biological Value

Of Proteins
? Eating combination of Pulses and

Grains provides al required

essential Amino acids for tissue

Protein biosynthesis.

? Dal and Roti
?Rice and Dal
? Idli and Sambhar
?Rajma Chanwal
?Chhole Chanwal

Functions Of Dietary

Proteins

? Supply amino acids for growth &

repair of body tissues

? Biosynthesize all tissue Proteins

?Hemoglobin

?Nucleoproteins

?Glycoprotein

?Lipoproteins
? Protein serve as a source of

energy :

?When there is shortage of

Lipids & Carbohydrates in the

body.

? Proteins has role in metabolism

osmoregulation ,transport and

acid-base balance

?Enzymes

?Hormones

?Antibodies

?Receptors

?Transport Proteins

?Osmotic Proteins

?ETC Components

?Collagen (bones)

?Keratin (nails & hair)
? 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

?No Pork Meat/ 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 sulfur containing

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

formation of Hemoglobin

? Fluorine helps reduce

incidence of tooth decay

? Zinc plays an important role

in the formation of protein

? Zn 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 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

defend free radical activities.

? Antioxidants prevents Peroxidation of

biomolecules ?PUFA,DNA etc

? Antioxidants protect membrane damage.

? Antioxidants prevent Oxidative Stress.

Dietary Sources Of Antioxidants

? Pigmented Fruits and Vegetables

? Broccoli

? Bananas

? Berries

? Cherries

? Cantaloupe

? Carrot

? Mango

? Papaya

? Pumpkin

? Red Pepper

? Spinach

? Strawberries

? Sweet potato




Fresh Fruit and Vegetables

These contain Fibre ,Minerals, Vitamins

and Antioxidants




?Water makes up

around 65% of

body weight

Remember

?It's important to drink

at least 8 glasses 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 body 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

Constituents

OR

Energy Content Of Food

Nutrients

Calorimetry
?Calorimetry is a term used

to measure energy content

of food nutrients.

? Calorific value of food is defined

as :

? An amount of energy released

by combustion of 1 gram of

nutrient

(Carbohydrate/Lipid/Protein)
Determination

Of

Calorific Values of Food

Instrument Used For

Nutrients Energy Measurement

OR

Computing Calorific Values Of Nutrients
?Bomb Calorimeter is an

instrument used to

determine Calorific values

of food nutrients.

What Is Bomb Calorimeter?


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 Nutrients placed inside it

and determines calorific value of

foods.




? Nowadays there are highly

automated efficient

combustion Calorimetric

systems available

? To compute an energy

contents of food and body.
Unit For Measuring

Calorific Values Of Food Nutrients

Calorie/kilocalorie

? Calorie /kilocalorie is a Unit

for measuring heat energy, of

food and energy requirement

for body.

? When you hear "Calorie," it is

real y a Kilocalorie

210
Is There Any Difference

Between Calorie and kilocalorie?

? "Calorie" we refer to in food is

actually kilocalorie.

? One (1) kilocalorie is same as one

(1) Calorie(upper case C).

? Calories and kilocalories are used

interchangeably to mean same thing.

Calorie and Kilocalorie

? "Calories" when we're talking about food

? "kilocalories" when we're talking about exercise
Definition of Calorie

? 1 Calorie is amount of heat

required to raise temperature

of 1 gram of water with 1

degree Celsius.

Calorific Values of Nutrients
? Macronutrients ( Calorific Values):

?Fats = 9 Cal/g

?Carbohydrates = 4 Cal/g

?Proteins = 4 Cal/g

( 5.3 Cal/g in Bomb Calorimeter)

?Carbohydrates and

Fats are completely

oxidized in 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
Calculation of Calorific Value

of

Food Stuffs

? Food energy is an amount of

energy liberated by food

nutrients.

? Through digestion absorption

and assimilation of food

nutrients.
Calorific values of Foods

? Food Items contain mixture of

nutrients.

? Calorific value of foods depends

upon an amount of nutrients

present in it.

From Total Energy Content

50-60 % Of Energy

Is Provided By Carbohydrates
Energy is provided by the following

Carbohydrates: (Primary Source)

Energy Provided 60% (45-65%) of the diet
1gm provides 4 kcal

Fats:

Energy Provided 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:

Energy Provided 11% (9-15%) of the diet
1gm provides 4 kcal

How To Calculate

Energy Content Of Foods?
Calculate Calorific Value of

100 gm Wheat Flour?

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 amounts of calorific

nutrients in 100 gm of food with their

physiological calorific values.

? Final y adding up their values.

Energy Requirements by

A 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

1st year of life.

?Approximate 2500

Kcal/day for an Adult

individual


An Amount of Energy Needed by a body is

Utilized for Fol owing Factors:

1. Basal Metabolism (BMR)

2. Physical Activities

3. Specific Dynamic Action of foods(SDA)/

Thermic effect of Food Nutrients




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 minimum amount

of energy required by a

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 minimum resting

energy expended by an

individual in an awake,

alert , post absorptive

phase present in

thermoneutral

environment.

? An energy required in basal condition is

consumed for an 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

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

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

Methods For BMR Calculation


? Direct Method For BMR

Determination Using :

?Benedict Roth Apparatus
?Dubois Apparatus
? Benedict-Roth Apparatus

? Calculates an amount of

Oxygen consumed under a

specific basal condition.

? Oxygen consumption for 2-6

minutes and measure the value

from graph.

? Indirect Method of BMR

Determination:

?Analysis of an expired air
?Determining O2 consumption and

CO2 output.

? Total heat production is determined

and is then

? Calculated per sq.m of body surface per

hour
? Indirect Calorimetry:

Calculates Respiratory Quotient

? Oxygen Consumption

? Carbon Dioxide Production

? Spirometer or Respirometer

apparatus is used to measure

an amount of Oxygen

consumed and Carbon dioxide

produced.

? This helps in calculating an

energy expenditure.
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 of 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 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 an 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 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-Insulin Therapy
? Pregnancy

? Physical Activity- Exercises
? Circadian Rhythms

? Emotional State

? Smoking and Caffeine

? Body temperature

? Diseases

? Digestive Processing

(Specific Dynamic Action)

? Aquatic Salinity (Osmoregulation)



BMR and Metabolism



? High rate of Metabolism Increased BMR

? Decreased Metabolism Decreased BMR
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(Adipose cytes).

? 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 body Fat percentage

lower is the BMR.

Climate/Environment Temperature

? BMR is decreased in summer
? BMR is increased in winters
? People living in warmer climates

has lower BMR than living in

colder climates
Nutrition and Metabolic Status

?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.

? BMR lower in Diabetes mel itus

? On Insulin therapy BMR is

increased

Pregnancy

?BMR is raised by 5%

in pregnancy.
BMR And 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
Factors Affecting BMR

List Of Conditions

Increasing And Decreasing BMR

S.No BMR Increased

BMR Decreased

High Metabolism

Low Metabolism

1

At Growing Age

Infant and Geriatric

2

Active Body

Sedentary Body

3

Exercise

No Exercise

4

Males

Females

5

Winters

Summers

6

Hyperthyroidism

Hypothyroidism

7

More Body Surface Low Body Surface area

Area


S.

BMR Increased

BMR Decreased

No
8

Pregnancy

No Pregnant Women

9

Fevers

Malnutrition

10 After Surgeries

Starvation

11 Lean Body

Obese body

12 Smoking

Non Smoker

13 Day and Night

Only Day workers

Workers

14 Insulin Therapy

Diabetes Mellitus

15 Stress

No Stress
Significance Of BMR Calculation

? BMR values help in calculating

energy requirement of an

individual body which help in

planning of diets.

? To know an effect of food and

drugs on BMR.

? BMR value checks 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:

vPerson to Person
vMode of life style
vType of Occupation

? Action to Action

?Duration of Action

?Intensity of Action
Energy Requiring Factors For Physical

Activities

? Age
? Sex
? Body Surface Area ?

? Body weight ,Size and Height

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)

Diet Induced

Thermogenesis (DIT)

SDA also termed as

Calorigenic Action Of Food




? SDA is an extra heat produced over and

above calculated calorific value when

food nutrients consumed by a body.

? SDA is referred as an increased heat

production fol owing an intake of food.
Dietary Proteins

Has Highest SDA Values

? 25 gm of dietary proteins when

consumed in 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.



? Protein rich meal eaten in hot

weather feels the body hot

and sweaty.

? Protein rich meal in cold

weather provide cozy and

comfortable feeling.
Significance Of SDA

? Heat of SDA can be utilized

for maintaining body

temperature but not for

muscular activity.

? SDA produced heat is expended

for digestion and absorption of

food.
Conditions with Decreased SDA

? Conditions where amino acid catabolism

decreased

? SDA is decreased

?Starvation
?Growth
?Pregnancy
?Convalescence period (Recovery )

SDA of food is an amount of energy

required to digest mixed food

(Carbohydrate, protein, lipid, fruit &

vegetable).
Approximately 10% of BMR is

required as SDA of food


Adult 60 Kg, requires BMR =24 Cal/kg

BMR

= 1440 Cal

SDA

= 144 Cal

Total = 1584 Cal (BMR+SDA)

Balanced Diet

OR

Prudent Diet

(Wise, Wel Judged,Judicious,Wel Advised)

(Thoughtful, Careful, Right Way Of Eating)

?Human body if considered as a

Machine

?Food is our fuel
? Maintaining General health and

wel being of human body is first

priority

? Nutrition is a first need of human

beings to acquire good health.

? Health and Unhealth of body directly

depends upon

? Nutritional status of an individual
What and How We Build Our Body

Depends On What We Eat ???

Food Nutrients Determines:

?Bodies composition and built of

cells/Organs/Systems

?Bodies capacity to grow, repair and

reproduce

?Bodies strength to cope up with:

? Interacting environmental pol utants

?Multi tasking ability

?Routine Stress
What Is a Balanced Diet?

How Truly We Plan for Our Eating?

Let Us Think for a Moment

Do We??????

Yes /No????????
We Plan and Implement

? Comparatively ? Comparatively

More

Less

?Trips

?Career

?Fests

?Academics

?Parties

?Exams

?Games

Lets Us Well Plan Our Diet

And Implement

For Eating Our Food

For

HEALTH ,HAPPINESS, PEACE AND SUCCESS




Balanced Diet

Planned Diet

at Various Physiological States

Balanced Diet A Healthy Diet

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.

? 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.
Right Diet wil

Build Human Body Systems Strongly

And Protect Our Gene Functions

?Withstand Stress to carry out multi tasking activities
?Prevent from almost al diseases of any system

?Infection , Immune Disorders
?Depression
?Genetic Disorders
?Metabolic Disorders
?Hormonal Disorders
?Anemia

Points To Consider

While Planning For Balanced Diet

1. Physiological States
2. BMR (Considering al factors)
3. Physical activities of an individual
4. SDA
? Food included during planning of

balanced diet should be local y

available

? 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.

? Food eaten should contain al the

chief essential nutrients 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 dietary intake should

be increased

? To develop fetal growth and

maintain reproduction

Indian Balanced Diet

? Nutrition Expert Group

constituted by ICMR

? Taking into account of Indian

available foods

? Has recommended composition

of Balanced diets for Indians.
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









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.

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

?Its necessary to maintain balanced diet

since:

?What we eat today, will affect our health

in future.






Tips For Eating Wel

Know And Implement

Do's and Don'ts of Eating

Eat More Natural

and

Home Made Food
? Eat regular meals
? Do not skip breakfast
? Eat foods from al food groups

/According to 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)
? Say No to Alcohol
? Limit Tea and coffee
? Drink plenty of clean water
? Maintain a healthy weight.
? Keep body active- Work/Exercise

Regularly Recal the 8 tips


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


Significance Of Balanced Diet

Balanced Diet

Makes Life

Healthy And Happy
? Eating balanced diet right from the

beginning of life builds:

? Organ system of human body with

ful of strength and vital capacity

? This prepares body to face any

critical conditions.

?Metabolic stress
?Infections etc

?Balanced diet Significantly

? Maintains bodies normal growth , health

and reproduction.

? Prevents from suffering of nutritional

disorders.

? Increases span of healthy and happy life.
Nutritional Disorders

Result/Outcome/Punishment

Due to Extreme

Imbalanced/Uncontrol ed

Ingestion Of Nutrients

(Ignorance,Negligence,Nonimplementation,

Disobedience)

Do Reflection Analysis

of Dietary Habits
MALNUTRITION/

DEFECTIVE NUTRITION

q A pathological/diseased state

resulting from

q Relative or absolute

deficiency or excess of one
or more essential nutrients.

Forms of Malnutrition

v

Undernutrition:

Kwashiorkor, Marasmus
Specific Deficiency:
Hypovitaminoses, Mineral Deficiencies

v

Overnutrition:

Obesity, Metabolic Syndrome
Specific Toxicities: Hypovitaminoses

v

Imbalances: Electrolyte Imbalance
Why Human beings suffer from

Nutritional Disorders?

Due to What Factors ?

Do Reflection Analysis

? No Planning and Implementing in of Eating

(Thoughtful and Righteous way)

? Do's and Don'ts of Food Habits

?Ignorance/Il iteracy

?Lack of general awareness

?Negligence

?Disobedience

? Economical Status-

? Low and High

? No proper distribution

? No Regularity and Control on Diet habits

?Wrong food habits

?No Control/Regulation on eating habits

?No Change (quit/adopt) for Good Cause

? Results in Nutritional Disorders
? Availability of food is not uniform due to:

?Unequal distribution of food items
?Unequal economical status of human

population

?No proper planning in Occupations

? Undefined Number of

?Farmers/Food Growers and Distributors
?Doctors
?Teachers
?Engineers
?Other Miscellaneous Professions

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.
Unhealthy GIT Affects

Absorption Of Nutrients

Leads To

Nutritional Deficient Disorders

Chronic Use of Chemicals, Alcohol,

Drugs Trauma and Infections

Lead To Il -health Of GIT
Protein Energy Malnutrition(PEM)/

Protein Calorie Malnutrition (PCM)

? Protein Energy Malnutrition (PEM)

? Protein and Energy (Carbs and Lipids)

deficiency go hand in hand.

? This combination leads to protein-

energy malnutrition
?PEM is 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)
PEM

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

? 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 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

?Addicted person

?Eating-disorders

?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


PEM Forms Kwashiorkor and Marasmus

Il ustrates

Two Faces Of Same Coin

Kwashiorkor
Risk of Development

? Kwashiorkor means sickness of

displaced/deposed /replaced child

? It affects when a first born child, is

replaced by a second born child.

?Kwashiorkar describe

sickness of weaning.

?Weaning- Process of

withdrawl of mothers milk

and replace with adult

diet
KWASHIORKOR Historical Aspects

? Word Kwashiorkor was introduced in

medical literature(1933),by Cecil y
Wil iams, a British Nurse.

? Kwashiorkor is Ghanaian name for

an Evil Spirit

Biochemical Cause

? Kwashiorkar is an extreme

condition of Protein Energy

Malnutrition

? Caused due to ingestion of

Protein deficient diet.
Features of Kwashiorkor

? Age of onset- 1 to 5 years
? Child gets displaced by mothers

attention.

? Ingestion of low dietary Proteins
? Weaning protocol not fol owed
? 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.
? Term Marasmus is derived from the

Greek word, which means wasting.

? Marasmus involves an 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


Types Of Adipose Tissue And Roles


Appetite Related Hormones





Obesity

?

Generalized, excessive
accumulation of fat in
subcutaneous & other tissues

? Classification of Obesity

according to "desirable"
standard weight :

? Overweight ~ >10%
? Obese ~ >20%


Obesity Is Identified By

Measurement Of Body Mass Index

(BMI)



What Causes Obesity

? 3 major factors contribute for

development of obesity:

?Genetic background (non-modifiable)

?High Dietary intake (modifiable)

?Low Physical activity (modifiable)

q Psychic disturbances

q Endocrine & metabolic

disturbances (rare)
Obesity Affects Quality Of Human Life




Biochemical Alterations Of Obesity

? Increased stores of TAG in adiposecytes
? Increased biosynthesis of Endogenous Lipids
? Affects receptor structures on cel membrane
? Derangements in endocrine activity
? Increased risk of Diabetes mel itus
? Biochemical Derangements in Glucose and

Lipid Profile

? Increased Risk of Atherosclerosis , CAD ,

Stroke


Dysregulation of Adipocytokines in

Obesity

? Adipocytokines function as classic circulating

hormones

? Communicate with other organs including brain,

liver, muscle, the immune system, and adipose

tissue itself.

? Dysregulation of Adipokines has been implicated

to increases inflammation, insulin resistance , type

2 diabetes, and cardiovascular disease.


Leptin and Adiponectin

Regulate Feeding Behavior and Energy Expenditure


Leptin

? Leptin is a hormone that is produced mainly by

Adiposecytes.

? " Leptin's primary target is in hypothalamus of

brain

? "Leptin is a Master" Hormone that regulates body

weight.

? It is often referred to as "satiety hormone" or

"starvation hormone.

? Leptin dampens/ suppresses appetite










An individual lacking a

functional leptin protein

or receptor manifested

voracious feeding

and leads to obesity

Adiponectin

? ADIPOQ gene
? Produced in adipose tissue
? Protein hormone involved in

? Blood Glucose regulation
? Fatty acid breakdown and oxidation

? Adiponectin reduces inflamation
? Adiponectin inversely correlated with body mass

index


Adiponectin mRNA serum levels are

decreased in obesity







Upper Abdominal Obesity

? Increased abdominal circumference (> 102 cm in men and

88 cm in women)

? Waist to hip ratio (> 1.0 for women and >0.8 for men)

? Visceral fat within abdominal cavity is more hazardous to

health than subcutaneous fat around abdomen

? Also called, `Apple shaped obesity'

? Increased Risk of diabetes mellitus, stroke, coronary artery

disease, Cancer and early death


Complications of

Obesity
Metabolic Syndrome Major

Complication/Consequence Of Obesity

Metabolic Syndrome

X Syndrome

? Affects Receptors on Plasma membrane

? Protein Hormone Receptors altered

? Role of messengers for coordination and

communication disturbed

? Dysregulation of Enzyme activity

? Affects over all Metabolism

? Insulin Resistance

? Hyperlipoproteinemias


Central Obesity is Dreadful

Increases Risk Of Metabolic Syndrome


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 Psychologic disturbances common

v Bone age advanced

v In boys, external genitalia appear

small though actually average in

size

v In girls, external genitalia normal &

menarche not delayed


Obesity Affects Endocrine System

Obesity And Thyroid Dysfunction


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



Management Of Obesity
Treatment of Obesity

1st principle: Decrease

energy intake

Initial medical exam to

diagnose pathological

causes

Plan right diet

a.Avoid all sweets, fried foods &

fats

a.Limit milk- intake not >2

glasses/day

a.For 10-14 yrs, limit to 1100-

1300 cal diet for several months
2nd principle: Increase energy

output:

I. Obtain an activity history

I. Increase physical activity

I. Involve in hobbies to

prevent boredom

Advise To

? Stop Alcohol
? Cessation of Smoking


Orlistat FDA Approved Drug Inhibits

Pancreatic Lipase ,TAG Digestion In GIT

Thoughtful and Rightful Knowledge

Implementation Wil Prevent Obesity
Over Al Messages

Lets Al Of Us Fight For Malnutrition






Eat Food Cautiously with Awareness

With Good Purpose Than Sensual Pleasure

Our Body Is Precious Gift

Health Is First Priority

THINK AND EAT

Cautiously,Moderately

Careful y and Rightly

Do Not Make Our Body As Dustbin


Eat As Fol ows

Sleep And Food Cycle Affects Health


Change for Positivity

?Adopt Do's
?Quit Don'ts

Best For Human Health

Thoughtful and Rightful

Eating And Living Style

Simple, Natural-

Planned ,Organized ,Regular, Disciplined

Simple , Humble, Care and Share

Yes for Good Stead Fast No For Bad

4/4/2022

540
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.

? Obesity: Causes and Consequences

THANKS

This post was last modified on 05 April 2022