World View of Nutrition

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World View of Nutrition

• The Faces of Global Malnutrition

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Malnutrition (Chp. 15) Objectives

• Understand the prevalence and programs designed
  to attack hunger in America
• Become familiar with malnutrition in the
  developing world and discuss its ramifications
  socially, economically, and agriculturally.
• Comprehend chronic types of worldwide malnutrition

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Protein-Energy Malnutrition

• Acute PEM
• recent severe food deprivation
• Chronic PEM
• long-term food deprivation
• Classifying PEM
• marasmus
• kwashiorkor
• combination

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Marasmus Kwashiorkor

• Infancy (lt 2 yrs)
• severe deprivation
• develops slowly
• severe weight loss
• severe muscle wasting
• low growth (lt60)
• no edema, no fatty liver
• anxiety, apathy
• possible good appetite
• hair thin,dry skin dry

• Older infants (1-3 y.o.)
• low protein, infections
• rapid onset
• some weight loss
• some muscle wasting
• growth 60-80
• edema enlarged fatty liver
• apathy, misery, irritable
• loss of appetite
• hair dry skin lesions

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• Marasmus-Kwashiorkor Mix
• edema of kwashiorkor with wasting of marasmus
  malnutrition and infections
• Infections
• antibodies are degraded to provide a.a. for other
  uses no synthesis of blood proteins thus weak
  and anemic
• dysentery infection of GI tract diarrhea
• Rehabilitation
• after first 24-48 hours protein and food energy
  given in small quantities and gradually increased

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Hunger

• Inability, day after day, to satisfy basic
  nutrition needs, gnawing emptiness that creates a
  constant focus on eating and how to obtain food
• Access to food must be secure before obtaining a
  nutritionally adequate diet and dealing with
  health issues become a goal.

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Malnutrition in the United States

• Food insecurity
• Anxiety about having enough to eat
• Worry about having no money to buy food
• Prevalence and distribution
• Strongly associated with poverty
• Linked with economic and social factors

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Groups at risk hunger, malnutrition

• The working poor
• May or may not qualify for food assistance
• The isolated
• Lack access to food resources
• Elders Children
• Economic difficulties -Dependent of family
• Physical ailments -Hunger effects school
• The Homeless
• Lack consistent cooking facilities
• Limited income, if any

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Attacking Hunger in America

• The Food Stamp program
• Extends food buying power
• Special Supplemental Nutrition Program for Women,
  Infants, and Children (WIC)
• Food, nutrition services for pregnant and
  lactating women, and children to age 5
• National School Lunch Program
• Free and reduced price meals
• Child and Adult Care Food Program

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Malnutrition in the Developing World

• Factors that contribute to hunger and
  malnutrition
• Social and economic factors
• Poverty
• Population growth
• Urbanization
• Infection and disease

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Malnutrition in the Developing World

• Factors that contribute to hunger and
  malnutrition
• Political disruptions and natural disasters
• War
• Refugees
• Sanctions
• Floods, droughts, mudslides, hurricanes
• Inequitable food distribution

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Malnutrition in the Developing World

• Agriculture and environment a tricky balance
• Environmental degradation
• Reduced food production
• Nutritional consequences

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Malnutrition in the Developing World

• Common forms of malnutrition
• Vitamin A deficiency
• Leading cause of preventable blindness
• Iron-deficiency anemia
• Limits productive of population
• Other vitamin, mineral deficiencies
• Iodine deficiency disorders
• Most common cause of preventable brain damage
• Overweight and obesity
• Differing cultural attitudes
• High calorie, low nutrient dense foods

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Malnutrition and AIDS

• Causes
• anorexia and inadequate intake
• malabsorption other GI disorders
• hypermetabolism
• food-drug interactions
• Wasting Syndrome
• 10 unintentional loss in body weight, with
  diarrhea/weakness/fever more than 30 days
• At 66 of IBW, death likely to occur

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Lean Tissue Loss

• 10 low albumin, anemia, low immunity
• 15-25 reduced healing
• 30 non-healing skin ulcers
• 35 to weak to sit
• 40 to weak to clear sputum

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Early Nutrition Intervention in HIV

• Improve nutrition-related immune function
• Support prevention of opportunistic infections
• Enhance response to therapy
• Preserve lean body mass
• Improve patients mental attitude

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Interventions for Malnutrition

• Individualized meal plans
• Food/grocery programs
• Nutrition supplements
• Enteral (tube-feeding) or TPN feeding
• Appetite stimulants
• Anabolic strategies
• exercise
• medication

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Oral Nutrition Interventions

• Food Safety --Vit/Min Supplements
• Healthy food choices
• Adequate food availability
• High energy and high protein food choices
• Common Dietary Problems
• anorexia --dry mouth
• nausea/vomiting --diarrhea/constipation
• mouth pain
• taste alterations

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• 1. Discuss differences between marasmus and
  kwashiorkor.
• 2. What is food insecurity?
• 3. Name 3 groups at risk for hunger /or
  malnutrition in the United States.
• 4. Name a government program that addresses
  hunger in the United States.
• 5. List 3 factors that contribute to hunger and
  malnutrition in the developing world. Has anyone
  in your group witnessed malnutrition and hunger
  in another country?
• 6. Name 2 common forms of malnutrition. How would
  these affect a persons daily living?
• 7. What is wasting syndrome?
• 8. List 3 common dietary problems in people
  w/HIV/AIDS.

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Spotlight on Metabolism
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Metabolism Objectives

• Understand how food energy is transferred to
  cellular energy along with the process of
  metabolism
• Comprehend how energy is extracted from carb,
  fats, and proteins
• Discuss how nutrients are biosynthesized and
  stored in the body
• Communicate the effects of fasting and starvation
  on metabolism

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Energy Fuel for Work

• Energy source
• Chemical energy in carbohydrates, fat, protein
• Catabolism
• Reactions that breakdown compounds into small
  units
• Anabolism
• Reactions that build complex molecules from
  smaller ones
• Food energy to cellular energy
• Stage 1 digestion, absorption, transport
• Stage 2 breakdown of molecules
• Stage 3 transfer of energy to a form cellscan
  use

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Catabolism
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Anabolism
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What is Metabolism?

• Cell is the metabolic processing center
• Nucleus
• Cytoplasm
• Cytosol organelles
• ATP is the bodys energy currency
• ATP adenosine triphosphate
• Form of energy cells use
• NAD and FAD transport shuttles
• Accept high energy electrons for use in ATP
  production

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Breakdown and Release of Energy

• Extracting energy from carbohydrate
• Glycolysis
• Pathway splits glucose into 2 pyruvate
• Transfers electrons to NAD
• Produces some ATP
• Anaerobic pathway
• Pyruvate to acetyl CoA
• Releases CO2
• Transfers electrons to NAD
• Aerobic reaction

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Glycolysis
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Breakdown and Release of Energy

• Extracting energy from carbohydrate
• Citric acid cycle--(aerobic)
• Releases CO2
• Produces GTP (like ATP)
• Transfers electrons to NAD and FAD
• Electron transport chain
• Accepts electrons from NAD and FAD
• Produces large amounts of ATP
• Produces water
• End products of glucose breakdown
• ATP, H2O, CO2

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Breakdown and Release of Energy

• Extracting energy from fat
• Split triglycerides into glycerol and fatty acids
• Beta-oxidation
• Breaks apart fatty acids into acetyl CoA
• Transfers electrons to NAD and FAD
• Citric acid cycle
• Acetyl CoA from beta-oxidation enters cycle
• Electron transport chain
• End products of fat breakdown
• ATP, H2O, CO2

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Breakdown and Release of Energy

• Extracting energy from protein
• Split protein into amino acids
• Split off amino group
• Converted to urea for excretion
• Carbon skeleton enters breakdown pathways
• End products
• ATP, H2O, CO2, urea

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Break-down and Release of Energy
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The Paths of Pyruvate and Acetyl Co A
Glucose Glycerol Amino
acids Pyruvate Lactic acid
(glucogenic) Amino acids Acetyl CoA Fatty
acids (ketogenic)
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Biosynthesis and Storage

• Making carbohydrate (glucose)
• Gluconeogenesis
• Uses pyruvate, lactate, glycerol, certain amino
  acids
• Storing carbohydrate (glycogen)
• Liver, muscle make glycogen from glucose
• Making fat (fatty acids)
• Lipogenesis
• Uses acetyl CoA from fat, amino acids, glucose
• Storing fat (triglyceride)
• Stored in adipose tissue

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Biosynthesis and Storage

• Making ketone bodies (ketogenesis)
• Made from acetyl CoA
• Inadequate glucose in cells
• Making protein (amino acids)
• Amino acid pool supplied from
• Diet, protein breakdown, cell synthesis

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Special States

• Feasting
• Excess energy intake from carbohydrate, fat,
  protein
• Promotes storage
• Fasting
• Inadequate energy intake
• Promotes breakdown
• Prolonged fasting
• Protects body protein aslong as possible

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• 1. Discuss catabolism vs. anabolism.
• 2. What is the form of energy used by cells?
• 3. Name the 4 parts of extracting energy from
  glucose. Which part produces the most ATP?
• 4. What is beta-oxidation?
• 5. Explain the difference between glucogenic and
  ketogenic amino acids.
• 6. What is gluconeogenesis? Lipogenesis?
  Ketogenesis?
• 7. Explain what happens in your body during
  feasting.
• 8. Explain what happens in your body during
  prolonged fasting.