An introduction to nutrition

1. An introduction to nutrition BY Dr. (Mrs.) T.I Runsewe-Abiodun (FWACPpaed.)

2. Importance of Nutrition: 1. Promotes satisfactory growth. 2. Prevents deficiency states 3. Prevents acute and chronic illness 4. Promotes development of physiological and mental potential 5. Provides reserves for stress 6. Helps in maintaining normal metabolism 7. Decreases the risk of hypoglycemia, azotemia and hyperbilirubinaemia

3. What are the nutrients?* • build and repair tissues • produce energy to 'fuel' growth and movement, and to keep warm • protect itself from infections. • Almost all foods contain a mixture of nutrients.

4. THE BASIC CONSTITUENTS OF NUTRITION: • Macronutrients – water, protein, carbohydrates, fat & calories • Micronutrients – Vitamins (A, B, C, D, E) Minerals (Fe, I2, Zn, Ca etc.)

5. Recommended daily dietary allowance. Age (yrs) Pro.(gm) Vitamins (gm) mg Energy A D E C Fe I (Kcal) Infants 0.0-0.5 2.2/kg 420 10 3 35 10 40 115xkg 0.5-1.0 2.0/kg 400 10 4 35 15 50 105xkg Children 01-03 23 400 10 5 45 15 70 1300 04-06 30 500 10 6 45 10 90 1700 07-10 34 700 10 7 45 10 120 2400 Males 11-14 45 1000 10 8 50 18 150 2700 15-18 56 1000 10 10 60 18 150 2800 Females 11-14 46 800 8 8 50 18 150 2200 15-18 46 800 8 8 60 18 150 2100

6. Carbohydrates • The body uses carbohydrates mainly as 'fuel' for energy. • Carbohydrates are either sugars or starches.

7. Types of sugars There are two main types of sugars: Simple sugars (e. g.glucose and fructose found in ripe fruit and honey) can be easily used by the body's cells. Complex sugars (e. g.lactose and sucrose found in milk and refined or cane sugar) need to be broken down during digestion into simple sugars for the body to use.

8. STARCH • It is broken down into glucose during digestion. • Starch is present in cereals (such as rice, maize, and wheat); starchy roots (such as cassava, yams and potatoes): and starchy fruit (such as plantain).

9. Proteins • Constitute about 20% of the BW of the adult. • Consist of Essential and Non-essential amino-acids • Non-essential amino acids can be synthesized and need not be supplied in the diet.

10. Proteins The 9 essential amino acids must be supplied in the diet: methionine threonine valine lysine phenylalanine leucine isoleucine tryptophan histidine

11. Proteins • *Arginine, taurine, cysteine are essential for LBW infants.

12. Proteins • Protein is the most important nutrient for building body cells. • It is especially important for growing children and pregnant and breastfeeding women.

13. Proteins • The body cannot store extra protein. • When a person does not eat enough, the tissue from their muscles breaks down to provide protein for important purposes such as fighting infections or producing breastmilk.

14. Protein digestion metabolism. Protein Stomach (acidic)  Rennin /pepsin (Hydrolyses)  Proteases  peptones  Intestine (alkaline medium) carboxypeptidase  Peptides and amino acid absorption through intestinal mucosa

15. Good sources of protein • meat, fish, eggs, milk (including breastmilk), groundnuts and beans. • Cereals such as rice, wheat and millet contain less protein, but if eaten with pulses (also known as legumes) such as lentils or beans they can be a good source of protein.

16. Fat • Fat is the most concentrated source of energy. • It is an important energy store in the body - if we eat more food than we need, the body changes it into storage fat. • Fat is also needed for other processes such as building cells and • helping the body to absorb vitamin A.

17. Good sources of fats • Good sources: fats and oils (such as maize oil, palm oil, coconut oil, margarine, butter, cooking fat) • fatty animal foods (such as meat, fatty fish. milk and cheese) • fatty vegetable foods (such as groundnuts and soya beans)

18. Energy (Calories) • Unit of measurement is the Kcal. • *Energy necessary to build body tissue  Calories ingested – Calories expended for other purposes.

19. Energy (Calories) • *Protein digestion may be metabolised as much as about 30% above the basal level. • *Chates and fat digestion- 4 and 6% respectively. • *Chates and fat have a sparing effect on the SDA of protein and upon each other by the ingestion and assimilation of food.

20. Energy Needsand Expenditures*: • *Basal metabolism 55kcal/kg/24hr, • *Growth, Physical activity 15 – 25 kcal/kg/24hr, • *Fecal loss (unabsorbed fat) 10% of intake.

21. Energy • Carbohydrates, fats and to a lesser extent, protein all provide energy. • We need more energy when we are physically active. • Energy needs also increase when we have infections or are recovering from illness, or during pregnancy and lactation.

22. Energy requirement • 1st 10Kg – 100 – 120 Kcal/kg/24hr • Next 10kg – 50Kcal/kg/24hr • Next 10kg – 20Kcal/kg/day • Periods of rapid growth and development near puberty require caloric consumption.

23. Calories derivation – Balanced diet • Chate – 45 – 55% • Fat – 24 – 38% • Protein – 9 – 15%

24. Micronutrients These are vitamins and minerals which the body need in very small amounts to function well.  The most important vitamins are:

25. Vitamin A • VITAMIN A - to reduce the severity of infections, keep the eyes healthy, and to help children grow properly.

26. Vitamin A • We store vitamin A in our livers. If we eat a lot of vitamin A at one time (e. g. during the mango season) our livers can store enough vitamin A to last several months. • Vitamin A is said to be 'stable'. This means that not a lot of the vitamin is lost through moderate cooking processes. • However, some vitamin A is lost through deep frying, sustained boiling until the vegetable or fruit disintegrates, and through sun drying.

27. Vitamin A There are two forms of vitamin A in food. • RETINOL found in animal products is the best form of vitamin A. Good sources are breastmilk, animal milk, liver, kidney, eggs, butter and ghee. • CAROTENE found mainly in orange, yellow and green vegetables and fruits destroys harmful chemicals (called free radicals) produced during infection.

28. Good food sources of Vitamin A • When we eat carotene, most of it is changed to retinol. • Six molecules of carotene make one molecule of retinol. • Good sources are 1. Red palm oil, 2.Orange and yellow fruits such as mangoes, pawpaw, pumpkin, carrots, maize, yellow sweet potatoes and bananas 3. Vegetables; dark green and medium green leaves such as spinach, the leaves of cassava, cowpeas, sweet potatoes and beans.

29. The B vitamins • THE B VITAMINS - Thiamine, riboflavin and niacin help the body to 'burn' nutrients to release energy. Good sources: meat, poultry, fish, liver, wholegrain cereals, peas, beans, nuts, oil seeds, milk and eggs. -

30. Folate • Folate helps the body to grow and make healthy red blood cells. • Women need more folate than men because they lose blood during menstruation. • Pregnant women, mothers who have recently given birth, and people with sickle cell disease also require increased folate. • Almost all foods contain some folate.

31. Good sources of folate • Good sources: liver and kidney, fresh vegetables (particularly dark green leaves), fish, beans and groundnuts. • Folate is destroyed when foods are stored or cooked for a long time.

32. Vitamin C • It helps the body to use calcium and other nutrients to build bones. • It also increases the body's ability to absorb iron from non-meat or fish sources, • It also helps to fight infections. • Good sources: fresh or lightly cooked vegetables, fresh fruit such as oranges, mangoes and pawpaw (papaya), apples, fresh milk and breastmilk.  

33. Vitamin D* • VITAMIN D - helpsthe body to absorb and use calcium and phosphorous to build healthy bones and teeth. • The best way to get enough is to go outside with your face and arms uncovered for at least 10 minutes most days. • Even if it is cloudy, there is enough light for production of vitamin D.Good sources: Milk and milk products, cheese

34. Minerals: Iron • The following minerals are important:IRON - to make haemoglobin for red blood cells. Good sources: meat, fish and breastmilk. Liver, kidney, spleen and heart are especially rich in iron. There is a useful amount of iron in beans, peas, nuts and cereals, but it is more difficult to absorb in this form.

35. Minerals: Iodine • IODINE - is used by the thyroid gland to produce hormones that regulate the way the body uses energy and keeps warm. The hormones are also important to the functioning of the brain and nervous system. • Good sources: fish. seafood and iodised salt. Iodine is also transferred to vegetables grown in iodine-rich soil. Iodine deficiency is common in mountainous areas far from the sea and places where there are frequent floods, because iodine is washed away from the topsoil.

36. Minerals: calcium • CALCIUM - neededto build and maintain bones and teeth. Pregnant and breastfeeding women, growing children, and older women need extra calcium. Good sources: milk (including breastmilk), small fish with edible bones, beans and peas, finger millet and dark green leaves.

37. Minerals: Zinc • ZINC - helps the body to fight infections and enables it to grow and develop normally. Good sources: meat, chicken, fish, wholegrain cereals and pulses (nuts, beans, peas and lentils) and breastmilk.

38. WATER Source of water: Fluid intake, Oxidation of foods

39. WATER * Water* • Extra water is needed to replace fluid lost during diarrhoea or during sweating or fever. • Breastmilk contains plenty of water, so babies less than six months old who are exclusively breastfed do not need to drink water or other fluids.

40. WATER • Water content of infant is higher (70 – 75% of BW) than that of adults (60 – 65%.) • Water constitutes 70% of BW; 5% blood- plasma, 15% interstitial fluid,50% intracellular fluid.

41. WATER • Infants take higher amount of H2O/Kg BW (10 – 15% of BW) • Adults:2 – 4% of BW but when calculated /unit caloric intake it becomes almost identical. • Water requirement is dependent on caloric intake.

42. Planning good mixed meals* • Most meals are based on cereal staples (such as rice, maize or millet porridge, or bread), or starchy vegetable staples (such as boiled cassava or yams). • These staples are usually not expensive, and provide most of the energy in a meal. • Cereal staples also contain fibre, vitamins, and some protein (but not complete protein).

43. Planning good mixed meals* • Starchy staples such as cassava do not provide protein. • Neither cereal nor vegetable staples provide the complete range of vitamins and minerals needed by the body.

44. Feeding Recommendations Up to 6 months of Age • Breastfeed as often as child wants, day and night, at least 8 times in 24 hours • Do not give other foods or fluids

45. Feeding Recommendations 6 Months up to 12 Months • Breastfeed as often as child wants. • Give adequate servings, about 1 milk tin(150-200ml) of: -Thick porridge of ogi mixed with soya flour/epa lilo/ede/eja/soya milk/milk. Add sugar and epo pupa (serve with bowl and spoon) -Mixtures of mashed foods made out of isu/iresi/potatoes. Mix with eja/epa lilo/ede/eja/soya flour/moin-moin/ekuru/akara. Add green vegetables -Soft family fufu,amala,lafun,iyan eba, tuwo with family soup(ewedu/ila/gbegiri) • Feed any of the above 3 times a day if breastfeeding • If not breastfeeding, feed 5 times a day • Give a snack like osan,ogede wewe, carrot etc. if affordable, give eyin and buredi

46. Feeding Recommendations 12 months up to 2 years • Breastfeed as often as child wants, • Give adequate servings, about 1½-2 milk tins (300-400ml) of: -Mixtures of mashed foods made out of either eko, iresi,sapala,ogede, cocoyam,isu. Mix with either eja/epa lilo/ede/eja/soya flour/moin-moin/ekuru/akara. Add green vegetables (Give 2 times a day) -Soft family fufu: amala,lafun,iyan eba, tuwo with family soup(ewedu/ila/gbegiri) -Thick porridge like ogi. Mix with soya flour, epa lilo, eja, ede or milk. Add sugar and epo pupa. (serve with bowl and spoon). Give once or two times a day • Give snacks in between meals

47. Feeding Recommendations 2 years or older • Give family foods at 3 meals each day. • Give as extra, thick enriched porridge(2 times a day) OR 2 extra family meals • Give nutritious snacks between family meals e.g. ogede, osan, akara, moin-moin, robo, soya-milk, kuli-kuli etc. • Assist and ensure the child has enough food during each meal • Serve food on separate plate for each child