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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. Functions of Protein. Tissue growth,maintenance and repair After anabolic needs are met excess of proteins are catabolized for energy

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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. 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

  4. 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)

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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.

  10. ?Artificial Sweeteners • 43lbs of sugar per year (10-12% of energy intake)- Dental issues and DM • Risks • Saccahrin- Bladder Cancer • Aspartame Safety concerns

  11. 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

  12. 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

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

  14. 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

  15. 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 .

  16. 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

  17. ?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.

  18. 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

  19. 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

  20. Stored as preformed retinol Plant sources-carotenoids(Beta-carotene,alpha-carotene, lutein, and lycopene are found in human plasma) 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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

  28. 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)

  29. ?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

  30. Thiamine deficiency (Beriberi) • Thiamin deficiency affects the cardiovascular, muscular, nervous and gastrointestinal systems. • The earliest manifestation of thiamin deprivation includes anorexia, fatigue, depression, irritability, poor memory, inability to concentrate and vague abdominal and cardiac complaints.

  31. Alcoholics and Lack of Thiamine • Polyneuropathy (factors other than thiamin deficiency may also be involved) • Wernicke’s disease (signs opthalmoplegia,nystagmus and ataxia) • Korsakoff’s psychosis (signs are memory defect and confabulation) and • Amblyopsia (dim vision).

  32. Significant losses of riboflavin can occur by exposure to light Coenzyme activity in Krebs cycle Food Sources- Beef liver 2.8 Water Soluble vitamins: The B group (B-complex) Riboflavin (B2)

  33. Riboflavin deficiency • cheilosis, angular stomatitis, glossitis, seborrheic dermatitis and ocular manifestations: • photophobia, itching, burning and circumcorneal capillary engorgement. • The seborrheic dermatitis is usually found in the nasolabial region, near the inner and outer canthi of the eyes, behind the ears and on the posterior surface of the scrotum

  34. Niacin functions in energy metabolism in the amide form as part of the coenzymes- glycolysis, the Krebs cycle Food Sources- Chicken 9.2 Roast lamb 4.6 Salmon 6.5 Veal 9.9 Peanuts roasted 13.5 Whole wheat flour 6.4 Water Soluble vitamins: The B group (B-complex) B3 (Niacin)

  35. Niacin deficiency: Pellagra4 D’s-dermatitis, diarrhea, dementia and death • Usually associated with diets based chiefly on corn and proteins containing inadequate amounts of tryptophan.

  36. Niacin Megadoses(3-6 g/day) Toxicity • Niacin lowers cholesterol • Niacinamide does not lower cholesterol • Toxicity: • Short term-vasodilation, burning or stinging sensations in the face and hands, nausea, vomiting, and diarrhea. • In the longer term- varying degrees of hyperpigmentation of the skin, abnormal glucose tolerance, hyperuricemia, peptic ulcers, hepatomegaly, and jaundice

  37. required for carbohydrate and fat metabolism- coenzyme in gluconeogenesis and Krebs cycle biotin deficiency: namely decreased protein synthesis and hypercholesterolemia Food Sources: Liver, Chicken 170 Banana 2.6 Oatmeal 21 BIOTIN

  38. Biotin Deficiency Features • Scaly dermatitis, grayish pallor, extreme lassitude, anorexia, nausea, anemia, depression, muscle pain, parethesia, hypercholesterolemia and electrocardiogram changes • Seen with bizarre food habits, i.e. consumption of large quantities of raw egg whites and little else. Seborrheic dermatitis in infants under six months may be responsive to biotin administration.

  39. Pantothenic acid deficiency • Abdominal pain and soreness, nausea, personality changes, insomnia, impaired adrenal function, weakness and cramps in the legs, paresthesia of the hands and feet and impaired antibody production.

  40. active coenzyme form of pyridoxal phosphate (PLP) coenzyme in transamination, decarboxylation and transulfuration reactions of amino acids. involved in the synthesis of the neurotransmitters serotonin and norepinephrine Food Sources- Brown rice 0.14 Wheat flour 0.34 Beef liver 0.94 Banana 0.58 Water Soluble vitamins: The B group (B-complex) B6 (Pyridoxine)

  41. B6 Deficiency • Seborrheic dermatitis, cheilosis, glossitis, stomatitis, altered tryptophan metabolism, depression and confusion • B6 deficiency in alcoholics may be as high as 20-30 % • Up to one-fifth of oral contraceptive users show biochemical evidence of vitamin B6 deficiency

  42. B6Toxicity • Oral doses of 1-150 mg/day of vitamin B6 have been used therapeutically without ill effect • A transient dependency has been induced in adults given a supplement of 200 mg • Cause ataxia and severe sensory-nervous system dysfunction

  43. B6 Health benefits • Reduces the symptoms of carpal tunnel syndrome and premenstrual syndrome in some women • May decrease the frequency and severity of asthma attacks. • Useful in homocystinuria and high circulating homocysteine levels, as well as in diabetic neuropathy and in normal immune function

  44. Absorption of vitamin C occurs in the jejunum and ileum Relatively high concentrations of vitamin C are found in the retina and other eye tissues, the adrenal and pituitary glands, brain, pancreas, kidney, liver and spleen. Food Sources- Kiwi fruit 96 Oranges 53/ Juice 34.4 Broccoli 93 Parsley 133 Red sweet peppers 190 Vitamin C (Ascorbic Acid)

  45. weak, spongy and bleeding gums loose teeth, resorbed dentine, swollen tender joints, hemorrhage rough skin, muscular aches and pains and irritability impaired iron absorption, impaired folic acid, serotonin and adrenaline metabolism and psychological changes Deficiency of vitamin C

  46. Gastrointestinal disturbances Uricosuria Excessive absorption of iron Impaired bactericidal activity of the leukocyte Interferes with urine glucose testing ? Benefits: Cardiovascular health Blood pressure Platelets function Vitamin C Megadose Toxicity

  47. Dietary Goals • Enjoy a variety of foods/maintain a balanced diet • Maintain ideal weight by reducing excessive energy consumption and increasing physical activity • Reduce fat intake to no more than 30% of total energy with no more than 10% of total energy as saturated fat. • Moderate consumption of alcohol • Limit intake of sugar • Avoid too much salt, and • Increase intake of whole grain cereals, fresh fruit and vegetables

  48. ?Breast Milk • Exclusive breast feeding up to 6 months and longer! • Complementary foods may be introduced from about 6 months of age. • Exclusively breast fed infants follow a slower but normal growth pattern than bottle fed infants at around 4 to 6 months of age and may therefore require a separate growth curve.

  49. contains digestive enzymes such as amylase and lipase contains immunologic substances such as IgA, lactoferrin, lysozymes, macrophages and other antibodies that confer passive immunity lactobacillus factor present in breast milk less susceptible to respiratory, enteric and ear infections. not present does not encourage lactobacilli colonization- predisposes to respiratory, enteric and ear infections Breast vs. Bottle (formula) feeds

  50. Breast milk-Long term Benefits! • breastfed infants may have reduced risk of- • diabetes mellitus, • certain types of cancer and • raised serum cholesterol later in life • TRIPLE BENEFITS of Breast feeding- • Breast milk is readily available, relatively safe and enhances intestinal development • Breastfeeding is satisfying for both the mother and child. • The closeness of this coupling enhances maternal-infant bonding

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