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Nutrition Issues

Nutrition Issues. Normal Dietary requirement of protein 1g/Kg/Day for adults Proteins provide 4 kcal (17kJ)/gram of protein. HISTIDINE ISOLEUCINE LEUCINE LYSINE METHIONINE PHENYLALANINE THREONINE TRYPTOPHAN VALINE. ALANINE ARGININE ASPARGINE ASPARTIC ACID CYSTEINE GLYCINE CYSTINE

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Nutrition Issues

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  1. Nutrition Issues

  2. Normal Dietary requirement of protein 1g/Kg/Day for adults • Proteins provide 4 kcal (17kJ)/gram of protein

  3. HISTIDINE ISOLEUCINE LEUCINE LYSINE METHIONINE PHENYLALANINE THREONINE TRYPTOPHAN VALINE ALANINE ARGININE ASPARGINE ASPARTIC ACID CYSTEINE GLYCINE CYSTINE GLUTAMIC ACID PROLINE HYDROXYPROLINE TYROSINE SERINE GLUTAMINE 9 Essential and 13 Non-Essential Amino Acids

  4. Functions of Protein • Tissue growth,maintenance and repair • After anabolic needs are met excess of proteins are catabolized for energy • After the energy requirements are met the aminoacids are used to synthesize carbohydrates and fats

  5. Final Products of Protein Catabolism • CO2 and Water • High energy molecule (ATP) • Urea • Ammonia • (Note creatinine is derived from creatine and Uric acid is derived from purines)

  6. Individual functions of AA • Glycine- synthesizes purines-porphyrins-creatinine-glutathione-conjugated bile salts. Eliminates toxins in liver • Glutamic acid- metabolism of ammonia, formation of GABA. Important AA in wheat (gliadin), in MSG flavor enhancer • Phenylalanine and Tyrosine-hormone precursor epinephrine, norepinephrine and thyroxin, melanin • Histidine- essential for infant, only essential in uremic adults. Precursor for histamine

  7. Individual functions of AA • Tryptophan- precursor of nicotinic acid and serotonin (5-HT) • Proline and hydroxyproline- porphyrines and B12 • Arginine- essential for urea formation in liver (ornithine-arginine (urea-cycle) • Cysteine, cystine, methionine- principal source for sulfur, synthesis of choline, and creatine

  8. Individual functions of AA • Taurine- synthesized from dietary cysteine or methionine ( concern in formula fed infants may develop taurine deficiency) Human milk is rich in taurine

  9. Carbohydrates- classified by number of sugar units they contain • Mono • Di • Oligo -3-10 • Polysaccharides • Major source of food energy • 4 kacl/g (17 kJ/g) • Protein sparing

  10. Classification of Carbohydrates (CHO)

  11. Classification of Carbohydrates (CHO)

  12. Sorbitol Synthesized from glucose No effect on blood glucose Used in diabetic foods Mannitol Used as drying agent for certain foods

  13. Alpha-galactoside Found in soybeans and legumes Not digested 100% fermented in colon- increases SCFA, fecal output, and prebiotic effects Fructo-oligosaccharides Jerusalem artichoke, chicory, onion Reduced calorific value not digested Prebiotic Stimulate intestinal bifidobacteria Oligosaccharides

  14. Role of minerals and vitamins in • Gluocse metabolism- • Magnesium • Phosphorus • Thiamin (B1) • Riboflavin (B2) • Niacin (B3) • Pyridoxine (B6) • Pantothenic acid

  15. Simple carbohydrates found in fruits, vegetables and milk Refined sugars are ‘added’ sugars Complex carbohydrates found in grains, tubers and legumes Carbohydrate drops off as fat content increases In rich countries there is a decrease in complex and increase in simple sugars due to increased use of processed food ?Solution keep fat in the diet less than 30% Keep carbs 50-65% substantial ones being complex sugars and fibers Carb facts

  16. Carb Disorders: Lactose/Sucrose/Galactosemia/ DM • Lactose Intolerance- Adult onset-Afro-Asian-Mediterranean ethnicity Avoid milk/ Cheese-Yogurt better • Sucrose Intolerance-avoid table sugar, highly sweetened foods

  17. Disorders of Carbs! • Lactose intolerance • Sucrose intolerance • Galactosemia- vomiting, liver damage, growth retardation and cataracts • Diabetes Mellitus

  18. Nutrition goals for DM patients • Balance food intake with insulin to maintain normal glucose levels • Achieve optimal lipid levels • Provide adequate calories for weight maintenance /growth • Prevent or control nutrition related risk factors- obesity, lipids, HTN • Improve overall health by optimal nutrition

  19. Nutrition goals for IDDM (T1) patients • ~60% of total energy from carbs • 12-20% of energy from proteins • Less than 10% from fats • Up to 10% (6-8%) of total energy from polyunsaturated fat • Limit daily cholesterol to 300-200 mg

  20. Too much fiber? Caution! • Excessive fiber in the diet can reduce mineral absorption resulting in negative balance of iron, zinc and other trace elements. It can interfere with consumption of a balanced diet.

  21. ?Artificial Sweeteners • 43lbs of sugar per year (10-12% of energy intake)- Dental issues and DM • Saccahrin • Aspartame • Acesulfane-K • Sucrose polymers

  22. saccharin • A petroleum by product 200-700 times sweeter • ?Bladder cancer • Pregnant women and children –AVOID saccharin containing canned drinks

  23. aspartame • Dipeptide of aspartic acid and phenylalanine (180 times sweeter) • Safety concerns • acesulfame-k • (200 times sweeter) • sucrose polymers by chlorination of sucrose 600 times sweeter very popular

  24. a safe sweetener for people with diabetes produced by hydrogenation of xylose dental heath benefits in caries prevention may help prevention of osteoporosis reduce ear infections-ear wax- Increases gut SCFA Increases energy by enhancing ATP production Increases utilization of fat Replenishes glycogen Anabolic — keeps biosynthetic pathways open Anticatabolic —helps maintain lean muscle mass Antioxidant —generates NADPH, keeping glutathione in an active state Increases endurance Reduces free radical and oxidative damage XYLITOL

  25. LIPIDS aka FAT • Insoluble in water • Soluble in non-polar state • High energy value • Deliver fat soluble vitamins, essential fatty acids-triglycerides-pospholipids-sphingolipids-sterols-waxes-glycolipids-lipoproteins

  26. Number of carbon atoms • Classified as • Short chain (C4-6) • Medium chain (5-12) • Long chain (12 or more) • “Saturated “ fatty acids- palmitic and stearic acids • Mono-unsaturated fatty acid- oleic acid

  27. Poly unsaturated fatty acids • Linoleic acid - essential • Linolenoic acid - essential • Arachidonic acid

  28. Fat Facts • Cholesterol only in animal cells • Ergosterol in plant cells • Waxes are in plants and fruits but not in land animal species • Most concentrated source of energy! • 9 kcal/g (37kJ/g) • Makes food palatable/ gives aroma

  29. Fat Facts • Essential fatty acids are required – • Growth • Reproduction • Skin integrity • Utilization of fat/ cell membrane maintenance • Prostaglandin precursors

  30. Fat Facts • Industrial countries diet energy source is 38% fat. This is very high. • Evidence for an effect of dietary cholesterol on blood cholesterol is inconclusive • Foods that have a high cholesterol content include: liver, egg yolk, kidney, brains, sweetbreads, shellfish and fish roe .

  31. Fat Facts • Peanut oil and olive oil are examples of fats which are rich in the monounsaturated fatty acid, oleic acid. • Monounsaturated fatty acids in the diet have a lowering effect on LDL cholesterol

  32. Fat Facts: Trans Fatty Acids • Trans unsaturated fatty acids are produced commercially in large amounts to form shortening and margarines.

  33. omega-3 (n-3) (α-linolenic acid), omega-6 (n-6) fatty acids • Is it essential? • role as structural components of biological membranes- retina, brain • the long chain n-3 and n-6 fatty acids are precursors of prostaglandins, prostacyclins, thromboxanes and leuko-trienes • Also synthesize arachidonic acid and docosahexanoic acid (DHA)

  34. Role of DHA • Part of phospholipids. • Very high levels are found in the retina, cerebral cortex, testes and sperm • DHA in the diet improves learning ability as well as visual acuity. • Availability of dietary DHA is critical for the development of preterm infants, since DHA uptake by brain and retina increases substantially during the last trimester of pregnancy

  35. ?DHA deficiency • Associated with: • fetal alcohol syndrome • attention deficit hyperactivity disorder • cystic fibrosis • phenylketonuria • unipolar depression • aggressive hostility and • adrenoleukodystrophy • A decrease in DHA in the brain may be associated with cognitive decline during aging and with onset of sporadic Alzheimer's disease.

  36. Role of fish and fish oils- high in EPA (eicosa pentanoic acid) and DHA (docosa hexanoic acid) • Beneficial in-hypertension, hyperlipidemia, thrombosis, coronary heart disease and immunological disorders • Lowers Triglycerides • Omega-3 fatty acids tend to increase bleeding time by inhibiting platelet aggregation • Eating 4 to 6 ounces (120-170 g) of fish several times a week is helpful

  37. Treatment of Hyperlipidemias: ❑ decreased total fat ❑ decreased saturated fat ❑ decreased energy intake ❑ limited cholesterol intake ❑ limited simple sugar intake ❑ increased complex carbohydrates ❑ moderate alcohol consumption

  38. Fat Alert • High levels of certain dietary fat are thought to increase the risk of many types of cancer, especially colon, lung, ovary and prostate cancers • omega-3 fatty acids may protect • reduce cancer risk include limiting the total fat intake and using vegetable oil instead of animal fat

  39. ?Vitamins • Organic compounds essential in small quantities for the normal metabolism • cannot be synthesized by the body and must be obtained from the diet • no one food contains all of them • classified according to their solubility in water and fat solvents

  40. The fat soluble vitamins include: vitamin A (retinol) vitamin D (calciferol) vitamin E (tocopherol) and vitamin K (menadione) stored in appreciable amounts in body tissues and, do not have to be supplied daily Habitual intake of excessive amounts of fat soluble vitamins is toxic. The water soluble vitamins include: vitamin B1 (thiamin), vitamin B2 (riboflavin), vitamin B3 (niacin), biotin, vitamin B6 (pyridoxine), pantothenic acid, folate, vitamin B12 (cobalamin) and vitamin C (ascorbic acid). not stored to any great extent and therefore need to be included in the diet every day Some Toxicity reported in very high doses

  41. Stored as preformed retinol Plant sources-carotenoids(Beta-carotene,alpha-carotene, lutein, and lycopene are found in human plama) Food Sources- (IU/100g) Butter-3058 Cheese-1059 Carrot, raw-28129 Apricots- 2619 Liver- Beef -36106 Lamb -25998 Chicken-16375 Halibut- 179 Sardines-224 Vitamin A

  42. Vitamin A TOXICITY • Excessive ingestion of carotenoids,-not toxic to man results in carotenemia and yellow discoloration of the skin • Chronic toxicity- • anorexia, nausea, vomiting, abdominal pain, dry skin, rashes, headaches, loss of hair, abnormal skin pigmentation, increased fragility and pain in the long bones, menstrual irregularities and enlargement of the liver and spleen • Safe dose not to exceed – • 10,000 IU for children or • 25,000 IU for adults

  43. vit A cancer benefits- • maintains epithelial tissues • tumor surveillance by the immune system is dependent on adequate levels of vitamin A • gene expression may be directly influenced by vitamin A and retinoids. • Beta carotene is an antioxidant

  44. Essential for calcium homeostasis (a hormone and prehormone) precursor or provitamin D (ergosterol (plants)* and 7-dehydrocholesterol** (in the skin) with ultraviolet light exposure required *converts to D2 (ergocalciferol) **converts to D3 (liver) (prehormone) (cholecalciferol) 1.25-dihydroxy D3 (hormone) (kidney) which then acts upon its target tissues (intestine, bone and kidney) to regulate calcium and phosphorus absorption and metabolism Food Sources- (IU/100g) Egg 52 Cheese 12 Cow’s milk 40 (100ml) Sardines 272 Salmon 624 Livers- 50-65 Codliver oil 16,700 Vitamin D Breast milk is low in vitamin D

  45. Habitual intake of excessive vitamin D is toxic. The symptoms include nausea, anorexia, polyuria, pruritis and calcification of soft tissues such as the kidney and heart. In infants can result in bossing of the skull, mental retardation and death. Mild vitamin D toxicity is manifested in elevated serum calcium levels. Recommended daily intake: (400 IU) cholecalciferol. Avoid intakes above (3200 IU) cholecalciferol Benefits- can reduce the risk of osteoporosis may be important in regulating blood pressure and improving some forms of hypertension anticarcinogenic effect in colon carcinogenesis vit D TOXICITY

  46. Alpha-tocopherol- function not fully known May function as an antioxidant by reducing the free radicals (other enzymes involved : glutathione peroxidase, catalase and superoxide dismutase) Food sources- oils- Wheat germ 192.4 Soybean 18.2 Nuts- Almonds 5.6 Filbert 23.9 vitamin E

  47. Rare A vitamin K inhibitor and can prolong clotting time Can cause bruising bleeding No proven benefits Safe dose 400 units Food Sources- Spinach/ Turnips/ Broccoli 1.9-1.7 Butter 1.6 Chicken 1.3 Fish- Halibut 1.1 vit E TOXICITY

  48. sources of vitamin K are green leafy vegetables such as cabbage and spinach half of the human supply of vitamin K is derived from bacterial synthesis in the intestine, absorbed from the lower intestine and colon Food Sources (mg/100g) Broccoli 270 Spinach 400 Lettuce 122 Cabbage 145 vitamin K

  49. A coenzyme thiamin pyrophosphate (TPP) is involved in energy metabolism Milling of grains removes those portions which are the richest in thiamin (the endosperm, the aleurone layer and the bran). Food Sources Wheat germ 1.86 Bran flakes 1.3 Water Soluble vitamins: The B group (B-complex) Thiamine (B1)

  50. ?Get more vitamin B1 • Cooking removes thiamine • Conserved when consumed without excessive cooking (enriched bread, breakfast cereals). • Parboiling of rice facilitates retention of some of the thiamin • Main site of thiamin absorption is the jejunum • Absorption is decreased by folate deficiency and alcoholism

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