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Title: NUTRITION%20AND%20HEALTH%20********************************


1
NUTRITION AND HEALTH
2
Objectives
  • To define nutrition and related words.
  • To identify nutritional requirements.
  • To understand Food pyramid.
  • To list types of nutrients and relation to
    health.
  • To define malnutrition and its classification.
  • To list main malnutrition problems.
  • To describe Obesity.

3
  • Nutrition is defined as the science of food and
    its relationship to health. Or,
  • The process of making use of food.
  • It is concerned primarily with the part played by
    nutrients in body growth, development and
    maintenance .

4
  • Dietetics is the practical application of the
    principles of nutrition it includes the planning
    of meals for the well and the sick.
  • Good nutrition means maintaining a nutritional
    status that enables us to grow well and enjoy
    good health.

5
  • Nutrients are substances (specific dietary
    constituents) that are crucial for human life,
    growth well-being.
  • Macronutrients (carbohydrates, lipids, proteins
    water) are needed for energy and cell
    multiplication repair.
  • Micronutrients are trace elements vitamins,
    which are essential for metabolic processes.

6
CLASSIFICATION OF FOODS
  • Classification by origin
  • - Foods of animal origin
  • - Foods of vegetable origin
  • Classification by chemical composition
  • - Proteins
  • Fats
  • Carbohydrates
  • Vitamins
  • Minerals

7
CLASSIFICATION BY PREDOMINANT FUNCTION
  • Body building foods
  • -meat, milk, poultry, fish, eggs, pulses etc
  • Energy giving foods
  • -cereals, sugars, fats, oils etc.
  • Protective foods
  • -vegetables, fruits, milk, etc

8
  • Community Nutrition
  • Identification of nutritional needs of
    population groups and available resources.
  • Nutritional Epidemiology
  • It is the investigation of the relationship
    between diet and disease.

9
  • Nutritional requirements
  • Recommended Dietary Allowances (RDA)
  • The level of nutrients considered to be adequate
    to meet the nutritional needs of all healthy
    persons.
  • Knowledge of RDA is necessary to
  • Assess the nutritional adequacy of diets for
    growth of infants, children and adolescents.
  • Maintain health in adults of both sexes and
  • during pregnancy and lactation.

10
The adequate diet Food Pyramids
  • Food Group System
  • Classifies food according to similarity in
  • nutrient content.
  • Foods placed in each group have a high nutrient
    density.

11
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12
Daily Food guide with Nutrient Pattern and
Recommended Quantity.
Comments Quantity Key Nutrients Group
Low-fat milk products have generally all the same nutrient content, however they are lower in calories and vitamin A. 3 cups for children 4 cups for teenagers 2 cups for adults Calcium, Protein Phosphorus, riboflavin Milk and Cheese
Legumes and nuts has a lower biological value than meat. They can be combined with animal or grain products to increase protein quality. Cholesterol and vitamin B12 are found only in animal sources. 2 servings Serving size 2-3 ounces 1 ounce of meat 1 egg or ½ cup cooked beans 1 ounce 30 gm Protein, Iron Niacin, Thiamin Red meat -gt Zinc Egg yolk and liver -gt Vitamin A Dry beans and Nuts -gt Magnesium Meats, poultry, fish, beans
13
Include one good vitamin C source daily, include deep yellow or dark green vegetable frequently, include unpeeled fruits and vegetables for fiber. 4 servings Serving size ½ Cup vegetable or fruit 1 Medium fruit Vitamin A Vitamin C Carbohydrate (fiber) Vegetable and fruits
During processing, some essential nutrients are lost. Less refined products are recommended 4 servings Serving size 1 slice bread ½ cup rice Carbohydrate Thiamin Niacin Iron Bread and Cereal
Unenriched, refined bakery products are included here because they provide low levels of nutrients compared to calories Fats should not be more than 35 of the total calories with 10 from polyunsaturated fats. Sugars should not be more than 10 of the calorie intake. Fats Carbohydrate Calories Fats and sweets
14
Food Pyramid
  • Lessons from Food Pyramid
  • Maintain a healthy weight.
  • Studies show that the healthiest range for
    body weight is when the body mass index (BMI) is
    about 17 to 22.

15
  • Eat good fats and avoid bad fats.
  • Good fats are the oils found in nuts, seeds,
    grains and fish.
  • They are high in the unsaturated fats necessary
    for good health.
  • Good fats should contribute 30 to 45 of the
    total fat.
  • Avoid saturated fats (animal fats and tropical
    oils e.g. coconut) to minimize the risk of heart
    disease.
  • Trans-saturated fats are mainly found in
    margarines and commercial baked foods.

16
  • 3. Eat whole-grain carbohydrates. Why?
  • whole-grain are more nutritious than refined
    carbohydrates
  • Being more slowly digested
  • Place less stress on pancreatic insulin
    production.
  • Sources of whole grain carbohydrates include
    whole meal bread, whole wheat, brown rice.
  • Avoid white bread, baked goods and pasta made
    with white flour.

17
  • 4. Avoid red meat as a protein source and
    emphasize plant proteins.
  • Red meat consumption is linked to a variety of
    chronic diseases increases the risk of hip
    fracture.
  • Animal proteins are usually packaged with
    saturated fat.

18
  • 5. Eat plenty of vegetables and fruits.
  • Potatoes are not included as a vegetable.
  • Dark green leafy vegetables, and fruit are
    clearly beneficial.
  • A diet high in fruits and vegetables lowers blood
    pressure and cholesterol and reduces the risk of
    cancer.
  • 6. Take a multivitamin daily.
  • This recommendation is insurance against any
    inadvertent deficiencies.

19
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20
Mediterranean Pyramid
21
Energy Supplying Nutrients
Main types of Nutrients
  • Protein
  • Lipids
  • Carbohydrates

Non-Energy Supplying Nutrients
  • Vitamins
  • Minerals
  • Water

22
PROTEINS
  • Proteins are complex organic nitrogenous
    compounds.
  • They also contain sulfur and in some cases
    phosphorous and iron.
  • Proteins are made of monomers called amino acids.
  • There are about 20 different aminoacids which are
    found in human body.
  • Of this 8-9 aa are termed essential as they
    are not synthesized in human body and must be
    obtained from dietary proteins.

23
Protein Needs
  • Adults 0.8 gm/kg body weight per day
  • Excess protein is not used to build more muscle
  • If the body needs energy, the extra amino acids
    are used for energy
  • If the body does not need energy, the extra amino
    acids can be converted to fat and stored.
  • Sources
  • Complete proteins have all essential amino acids
    (animal sources)
  • Incomplete proteins lack one or more essential
    amino acids (plant sources)

24
Functions of Proteins
  • Body building
  • Repair and maintenance of body tissues
  • Maintenance of osmotic pressure
  • Synthesis of bioactive substances and other vital
    molecules e.g. immunoglobulins

25
Lipids
  • Lipids include cholesterol and triglycerides
  • Fat is necessary for health
  • Functions
  • Main source of energy (9Kcal/g).
  • Spare protein.
  • Adipose tissue holds the body organs and nerves
    in place.
  • Maintain body temperature.
  • Transportation of fat soluble vitamins.

26
Classification
  • Saturated fat
  • Animal foods generally are rich sources
  • Palm and coconut oil also are rich sources
  • Monounsaturated fat
  • Olives, peanuts, and canola oil are rich sources
  • Polyunsaturated fat
  • Corn, sunflower, cotton seed, and nut oils are
    rich sources
  • Hydrogenated fat

27
Hydrogenated fat
  • Hydrogenation process hardens liquid oils into
    more solid margarine.
  • It makes unsaturated fat in oil more saturated
  • Also it produces an unhealthy type of fat called
    trans fatty acid
  • Saturated fat and trans fatty acids may be
    harmful to health
  • Baked products and fried foods are often made
    with hydrogenated fats

28
Cholesterol
  • Cholesterol is necessary for cell membranes and
    the production of vitamin D, bile, and certain
    hormones
  • It is found only in animal foods
  • High blood cholesterol levels are associated with
    increased risk of heart disease

29
Fats yield fatty acids and glycerol on
hydrolysis
  • Fatty acid content of different fats ( in per
    cent)
  • Saturated
    Monounsaturated Polyunsaturated
  • Fats fatty acids fatty
    acids fatty acids
  • Coconut oil 92 6
    2
  • Palm oil 46 44
    10
  • Cotton seed oil 25 25
    50
  • Groundnut oil 19 50
    31
  • Sunflower oil 8 27
    65
  • Corn oil 8 27
    65
  • Soya bean oil 14 24
    62
  • Butter 60 37
    3

30
Fat requirements
  • The WHO Expert committee on Prevention of
    Coronary Heart Disease has recommended only 20 to
    30 per cent of total dietary energy to be
    provided by fats. (lt30)
  • At least 50 per cent of fat intake should consist
    of vegetable oils rich in essential fatty acids.

31
Carbohydrates
  • Functions
  • Carbohydrate is the main source of energy,
    providing 4 Kcals per one gram
  • Carbohydrate is essential for the synthesis of
    certain non-essential amino acids.
  • Necessary for normal fat metabolism.
  • Necessary for integrity of nerve cells.
  • Lactose allow growth of beneficial bacteria in
    the intestine.
  • Important for normal elimination (excretion)
    fibers
  • Recommended carbohydrate intake is 55 to 65 of
    calories, primarily from starchy foods

32
Classification of Carbohydrates
  • Monosaccharides glucose fractose
  • Disaccharides Sucrose (G F)
  • Oligosaccharides (3-10).
  • Polysaccharides (11-1000)
  • a-Indigestable e.g. cellulose
  • b-partially digestable e.g.raffinose
  • c-Digestable e.g. starch
  • The inability of the body to metabolize
    carbohydrates properly DM

33
Fiber
  • Indigestible plant material e.g. cellulose
  • Dietary fiber is mainly non-starch polysaccharide
  • It is found in vegetables, fruits and grains.
  • Soluble fiber swells or dissolves in water
  • Rich sources include apples, bananas, citrus
    fruits, carrots
  • Importance
  • Reduces cholesterol absorption
  • Slows absorption of glucose

34
Fiber
  • Insoluble fiber remains unchanged in water
  • Rich food sources include brown rice, wheat bran,
    and whole grain products
  • Importance
  • High fiber diet reduces the risk of heart
    disease, diabetes type II, diverticulosis,
    hemorrhoids, constipation, and possibly
    colorectal cancer
  • Refined foods lose fiber-rich parts during
    processing

35
Non-Energy Supplying Nutrients
  • Vitamins
  • Minerals
  • Water

36
Vitamins
  • Regulate growth,
  • maintain tissues, and
  • help carbohydrates, proteins, and fats release
    energy
  • Provide no calories (energy)
  • Needed in very small amounts

37
Classes of Vitamins
  • Water Soluble 8 different B vitamins and
    vitamin C
  • Fat Soluble Vitamins A, D, E, and K
  • Most healthy people do not need supplements
    vitamins can be obtained by eating a variety of
    foods
  • Supplementation can increase the risk of
    consuming toxic high levels

38
Fat soluble vitamins
  • Vitamin A
  • Vitamin A covers both
  • a pre-formed vitamin, retinol, and
  • a pro-vitamin, beta carotene, which is converted
    to retinol in the intestinal mucosa.
  • Sources
  • Retinol in liver, code liver oil eggs (animal
    sources)
  • Beta carotene Coloured plants e.g. carrot,
    mango, apricot, pumpkin,.. (plant sources)

39
VITAMIN A
  • Sources
  • liver
  • milk
  • eggs
  • spinach
  • carrots
  • tomatoes
  • butter

40
Functions of Vitamin A
  • It is essential for normal vision.
  • It is necessary for maintaining the integrity and
    the normal functioning of glandular and
    epithelial tissue which lines intestinal,
    respiratory and urinary tracts as well as the
    skin and eyes.
  • It supports growth, especially skeletal growth
  • It may protect against some epithelial cancers
    such as bronchial cancers.

41
Vitamin D
  • The nutritionally important forms of Vitamin D in
    man are
  • Calciferol (Vitamin D2) and
  • Cholecalciferol (Vitamin D3)

42
  • Sources
  • liver
  • caviar
  • Butter
  • Eggs
  • Ultraviolet rays

43
Functions of vitamin D
  • Intestine Promotes intestinal absorption of
    calcium and phosphorus
  • Bone Stimulates normal mineralization, Enhances
    bone reabsorption, Affects collagen maturation
  • Kidney Increases tubular reabsorption of
    phosphate

44
Deficiency of vitamin D
  • Deficiency of vitamin D leads to
  • Rickets in children
  • Osteomalacia in adults

45
  • Vitamin E
  • Antioxidant- Protects RBCs from haemolysis.
  • Present in wheat germ and green leafy vegetables
  • Vitamin K
  • Important for blood coagulation
  • Present in leaves of plants natural (flora).
  • Deficiency causes haemorrhagic manifestations.

46
VITAMIN E
  • contains in
  • liver
  • corn
  • eggs
  • vegetable oils

47
Water soluble vitamins
  • Thiamine (B1)
  • Function essential for the utilization of
    carbohydrates.
  • Present in brewer yeast, beans and legumes.
  • Deficiency Beri-beri

48
Deficiency of thiamine
  • Beriberi may occur in three main forms
  • peripheral neuritis,
  • cardiac beriberi,
  • infantile beriberi, signs of peripheral
    neuropathy.

49
  • Riboflavin (B2)
  • Important for cellular metabolism, oxidation and
    reduction.
  • Present in milk, liver, meat, eggs, fish and
    vegetables.
  • Deficiency angular stomatitis magenta tongue.

50
VITAMIN B6
  • Pyridoxine (vitamin B6) plays an important role
    in the metabolism of amino acids, fats and
    carbohydrate.
  • The requirement of adults vary directly with
    protein intake.

51
VITAMIN B12
  • Vitamin B12 is a complex organo-metallic compound
    with a cobalt atom (Cyanocobalamine)
  • Vitamin B 12 cooperates with folate in the
    synthesis of DNA.
  • Vitamin B 12 has a separate biochemical role,
    unrelated to folate, in synthesis of fatty acids
    in myelin.

52
Vitamin B12 deficiency
  • Vitamin B12 deficiency is associated with
    megaloblastic anaemia (pernicous anaemia),
    demyelinating neurological lesions in the spinal
    cord and infertility (in animal species).
  • Dietary deficiency of B12 may affect subjects who
    are strict vegetarians and eat no animal product.

53
  • Nicotinic acid
  • Important for nervous system and epithelium.
  • Present in yeast, liver, peanut, meat and
    intestinal flora.
  • Deficiency
  • Pellagra
  • Dermatitis
  • Dementia
  • Diarrhoea

54
VITAMINS OF GROUP B
  • Sources
  • liver
  • kidneys
  • legumes
  • curds
  • cheese
  • fish
  • bread

55
VITAMIN C
  • Vitamin C (ascorbic acid) is a water-soluble
    vitamin.
  • It is the most sensitive of all vitamins to heat.
  • Vitamin C has an important role to play in tissue
    oxidation
  • It is needed for the formation of collagen of
    connective tissue, which accounts for 25 per
    cent of total body protein.
  • Present in vegetables and fruits.

56
VITAMIN C
  • contains in
  • pepper
  • fresh cabbage
  • berries
  • strawberry
  • citrus
  • green peas
  • green onions

57
Deficiency of vitamin C
  • Deficiency of vitamin C results in scurvy.
  • Signs of scurvy are
  • Swollen and bleeding gums,
  • Subcutaneous bruising,
  • Bleeding into the skin or joints,
  • Delayed wound healing,
  • Anaemia and weakness.

58
Minerals
  • Minerals are certain elements that may
  • regulate chemical reactions in the body
  • be part of organic molecules
  • Iron in hemoglobin
  • Calcium in bone and teeth
  • Small amounts are needed for health

59
Calcium
  • Most plentiful mineral in the body
  • Needed for strong bones and teeth
  • Involved in regulating blood pressure, clotting
    blood, and muscular movements
  • Bones store calcium
  • Osteoporosis
  • Bones lose mineral density and strength
  • Aging people, especially menopausal women, are at
    risk

60
Calcium
  • contains in
  • milk,
  • cottage cheese,
  • cheese,
  • yoghurt,
  • parsley.

61
Iron
  • Most of the bodys iron is in hemoglobin, which
    is in red blood cells
  • The iron in hemoglobin picks up oxygen in the
    lungs and transports it to cells
  • Iron deficiency is one of the most common
    nutritional disorders worldwide

62
Iron
  • Sources
  • liver
  • red meat,
  • apples,
  • dried fruit
  • molasses.

63
Water
  • Variety of functions
  • helps transport of materials in the body, and
  • involved in many chemical reactions.
  • Beverages and most foods, especially fruits and
    vegetables, supply water
  • Diuretics such as alcohol and caffeine increase
    losses of water from body

64
Water
  • To be properly hydrated, a person needs at least
    8 cups of water daily
  • Dehydration can be deadly
  • Sports drinks replenish minerals and water that
    are lost during heavy exercise

65
  • Malnutrition
  • Definition
  • Malnutrition is a pathological state resulting
    from a relative or absolute deficiency or excess
    of one or more essential nutrients.

66
  • The major forms of malnutrition are
  • Under-nutrition
  • It is a pathological state resulting when
    nutrient intake does not regularly meet the
    nutrient needs for cell activities and body
    maintenance. It includes
  • Macronutrient deficiency e.g., protein-energy
    malnutrition (marasmus kwashiorkor).
  • Micronutrient deficiency e.g. iron deficiency
    anaemia, vitamin A deficiency, Iodine
    deficiency.etc.

67
The major malnutrition problems in the world
are1. Proteinenergy malnutrition (PEM)2. Iron
deficiency anaemia3. Iodine deficiency disorders
(IDD)4. Vitamin A deficiency (VAD)
68
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69
Iron deficiency
  • Over 2 billion people suffer from some form of
    iron deficiency
  • Anaemia linked to iron and/or folic acid
    deficiency is among the worlds major nutritional
    disorders
  • Africa South Asia have the highest overall
    incidence of anaemia, followed by Latin America
    East Asia
  • Parasitic infestation contributes to high percent
    of cases in developing countries.

70
Consequences of iron deficiency
  • Reduces work capacity, thus productivity,
    earnings
  • Associated with 50 of maternal deaths
  • Retards fetal growth, causes low birth weight
    (LBW) increases infant mortality
  • Impairs ability to resist disease in childhood,
    reduces learning

71
Improving Iron status
  • Iron tablets
  • Iron fortification of basic foods (bread)
  • Increased consumption of iron rich foods
    factors which enhance absorption
  • Control of parasitic infections

72
Iodine deficiency disorders (IDD)
  • In 1990 1.6 billion people worldwide at risk of
    IDD
  • At least 655 million with goitre
  • 43 million with some degree of mental impairment
  • 11 million with cretinism
  • Moderate Iodine deficiency is associated with
    average reduction of over 13 IQ points

73
Prevention of IDD
  • Adequate intake of Iodine can prevent all IDD
  • make milder forms of goiter disappear
  • improve development of older children mildly
    affected
  • Severe forms of IDD such as cretinism, cannot be
    reversed But,
  • can only be prevented by adequate intake of
    Iodine during pregnancy
  • Now, iodizing salt is all over the world

74
Vitamin A deficiency (VAD)
  • May be subclinical, severe or moderate
  • Clinical (xerophtalmia)
  • 2.8 million children 0-4 years old
  • Blindness, total or partial
  • at least half a million children a year
  • about half die within a few months

75
Deficiency of vitamin A
  • The signs of vitamin A deficiency are
  • Follicular hyperkeratosis,
  • Night blindness
  • Conjunctival xerosis
  • Bitot's spots
  • Corneal xerosis
  • Keratomalacia

76
Improving vitamin A status
  • Increased intake of vitamin A rich foods e.g.
    eggs, butter, whole milk, liver, red palm oil,
    dark green, yellow red fruits vegetables
  • Fortification of basic foods with vitamin A
  • Supplements e.g. 2 capsules of Vitamin A per year
    to young children

77
  • Over-nutrition
  • It is a pathologic state resulting when
    nutritional intake exceeds the body needs, which
    leads to caloric excess over an extended period
    of time.

78
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79
Definition
Obesity is Disorder of Body Regulatory
Systems leads to Excess Body Fat
  • Assessment
  • Body Mass Index (BMI)
  • Waist Circumference (WC)
  • Waist to Hip ratio (WHR)

80
Causes Associated Factors
  • Genetic Complex Polygenic
  • Environmental and Behavioral
  • Signaling factors
  • Hormonal
  • Neurologic
  • Psycological

81
Assessment of Obesity
  • The international standard for assessing body
    size in adults is the body mass index (BMI).
  • BMI is computed using the following formula BMI
    Weight (kg)/ Height (m²)
  • Evidence shows that high BMI (obesity level) is
    associated with type 2 diabetes high risk of
    cardiovascular morbidity mortality

82
BMI (WHO - Classification)
  • BMI lt 18.5 Under Weight
  • BMI 18.5-24.5 Healthy weight range
  • BMI 25-30 Overweight (grade 1 obesity)
  • BMI gt30-40 Obese (grade 2 obesity)
  • BMI gt40 Very obese (morbid or grade 3
    obesity)

83
Waist circumference
  • Waist circumference predicts mortality better
    than any other anthropometric measurement.
  • It has been proposed that waist measurement alone
    can be used to assess obesity, and two levels of
    risk have been identified
  • MALES FEMALE
  • LEVEL 1 gt 94cm gt 80cm
  • LEVEL2 gt 102cm gt 88cm

84
Waist circumference
  • Level 1 is the maximum acceptable waist
    circumference irrespective of the adult age and
    there should be no further weight gain.
  • Level 2 denotes obesity and requires weight
    management to reduce the risk of type 2 diabetes
    CVS complications.

85
Waist Hip Ratio (WHR)
  • Visceral obesity (apple shaped)
  • Peripheral obesity (Pear shaped)

86
  • WHR
  • gt 0.8 F
  • gt 1.0 M
  • WHR
  • lt 0.8 F
  • lt 1.0 M

Visceral Vs Peripheral
87
Interpretation of WHR
  • High risk
  • Females WHR gt0.80 or gt80
  • Males WHR gt0.95 or gt95
  • It indicates central (upper body) or visceral
    obesity and is considered high risk for diabetes
    CVS disorders.
  • A WHR below these cut-off levels is considered
    low risk (peripheral obesity).
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