NUTRITION

1. NUTRITION

2. What Is Nutrition? -The study of how your body uses the food that you eat.

3. What is a Nutrient A nutrient is a chemical substance in food that body needs to function properly such as in growing, in repairing itself, and in having supply of energy and helps maintain the body. All help build cells and tissues, regulate bodily processes such as breathing. No single food supplies all the nutrients the body needs to function.

4. The six Classifications of Nutrients Sugars • Carbohydrates Starches • Fats Cellulose • Proteins • Vitamins • Minerals • Water

5. Definition of a Calorie: • A unit of measure for energy in food. • Nutrients that have Calories: • Proteins • Carbohydrates • Fats

6. Nutrients that Provide Energy • A food Calorie is actually a kilocalorie, which is equal to 1000 calories. Calorie is useful in comparing the energy available from different foods when we are deciding what food to eat. For example, a small apple contains only 80 Calories, while a slice of apple pie contains almost 350 Calories. • Carbohydrates, fats,andproteins provide energy and perform other important functions. • We need energy for all activities. When our body uses carbohydrates, fats, and proteins, energy is released: calories.

7. Calories per gram: Protein 1 Gram = 4 calories Carbohydrates 1 Gram = 4 calories Fat 1 Gram = 9 calories

8. Variables which affect nutrient needs: 1. Age 2. Gender 3. Activity Level 4. Climate 5. Health 6. State of nutrition

9. Carbohydrates • Athletes are not the only people who need carbohydrates. Everyone needs them. • Carbohydrates are the sugarsandstarchesfound in foods. They are made up of carbon, hydrogen, and oxygen. • There are two general types of carbohydrates: simpleandcomplex.

10. Simple Carbohydrates • Simple carbohydrates are the different forms of sugar, which are easy for the body to process. These sugars are fructoseand glucose (found in fruits and vegetables, lactose (found in milk), and sucrose (refined and purified to produce table sugar). • The most important to the body is glucose – the form of the sugar that goes directly to the bloodstream and provides quick energy. All other sugars must be changed into glucose by the body before the cells can use them. The cells use glucose as their primary source of energy. Glucose that is not needed immediately is converted by body to glycogen, a form of starch stored in the muscles and liver, or it is converted to and stored as body fat.

11. Starches are complex carbohydrates that are made up of many units of glucose or other sugars, which form long chains. These chains must be broken down by the body into single units of glucose before they can be used. Starches take longer than sugars to be broken down into glucose. Starches provide energy to the body over longer periods than do simple sugars. Breads, cereals, pasta, and potatoes contain starch. Dietary Fiber is another complex carbohydrate, which comes from non-digestible part of plants. There two types of dietary fiber: soluble and insoluble. Soluble fiber combines with waste and other substances to assist in their removal from the body. (Found in: oat bran, beans, apples, carrots, and other vegetables). Insoluble fiber absorbs water and helps to provide needed bulk to the diet. (Found in: whole grains and the skins and seeds of fruits and vegetables). Complex Carbohydrates

12. Fats (Lipids) • Fats are the nutrients that contains the most concentrated form of energy. Fats are type of lipid. • Lipids are substances that are somewhat similar to carbohydrates, but they contain less oxygen and they do not dissolve in water. • Fat is one of essential nutrients important for properly body function. A small daily intake of fat is required. One gram of fat provides more than twice as much energy as one gram of carbohydrate. • Fats are part of many body tissues and are important as carriers of other nutrients, such as vitamins. Fats also carry the flavor of foods – making foods tastier, but consumption of fat should be closely monitored.

13. Saturated fats are usually solid at room temperature. They contain maximum number of hydrogen atoms. Tropical oils, butter, and animal fats tend to be high in saturated fats. A diet high in saturated fats can lead to an increased chance of heart and blood vessel disease, obesity, and some types of cancer. Unsaturated fats are those fats that are liquid at room temperature. Olive oil and peanut oil are called monounsaturatedfatsbecause they lack one pair of hydrogen atoms. Fish oils and most vegetables oils, such as corn, soybean, and sunflower oils, are called polyunsaturated fats because they lack two or more pairs of hydrogen atoms. Types of Fates

14. Cholesterol • Eating foods high in fats, especially saturated fats may increase the level of cholesterol, a waxy, fat-like substance produced by body. • Cholesterol is part of cell membranes and nerve tissues. It is used by body to form vitamin D and other hormones. It is found only in foods that come from animals, such as butter, eggs, and meats. It is not an essential nutrient because the body produces cholesterol in liver. • As cholesterol levels in the body increase, the risk of heart and artery diseases increase. Some of the cholesterol tends to be deposited on the walls of the arteries, thereby reducing the flow of blood to the cells supplied by those arteries.

15. Two Forms of Cholesterol • Cholesterol is transported in the blood in two forms. LDL is the “bad” form that tends to deposit cholesterol on the walls of the blood vessels. • HDL is the “good” form that removes cholesterol from the cells and brigs it back to the liver and intestines to be recycled or excreted. • Exercise has been proven to raise HDL, low-fat diets lower LDL.

16. Protein • Proteins are substances found in every cell. The body needs proteins to build and repair all body tissues. Protein is an important part of blood cells. Proteins are made up of carbon, hydrogen, oxygen, and nitrogen atoms that are formed into basic units called amino acids. • There are 20 different amino acids. Nine of them are essential, and the other eleven amino acids can be produced by the body. Complete proteins Incomplete proteins Legumes

17. Vitamins, minerals,andwater are nutrients that work with the energy-providing nutrients to be sure that the body functions properly. Water is the most vital nutrient because it provides the means for all other nutrients to be carry throughout the body. Eating a variety of foods in the right amounts is usually all that is needed to get daily supply of vitamins and minerals. Vitamins, minerals, and water are not digested by our body, and they do not provide Calories. Instead vitamins, minerals, and water are released from foods we eat and are absorbed by the body’s tissues. They work with carbohydrates, fats, and proteins to promote growth and regulate body processes. Nutrients that Regulate

18. Vitamins (Amines necessary for life) • Are naturally organic compounds which are required in small quantities for normal metabolism & growth, that can not be synthesised by the body or produce it in a little amounts. • The sources of vitamins may be: 1- synthesised by intestinal microorganisms (little quantities). 2- must be obtained from the diet (not single food). The absence or deficiency of vitamins (Avitaminosis) lead to a disease.

19. Vitamins • Vitamins help build bones and tissues, and they also help change carbohydrates and fats into energy. • Because the body cannot make most vitamins, they must be supplied by the foods we eat. • Some diseases can develop because of lack of a particular vitamin. • Vitamins are compounds found in living things and are needed in small amounts for life and growth and to prevent diseases.

20. Causes of Vit. Defficincy • The main Causes of Vit. Deficiency: 1- Inadequate dietary Vit. Intake. 2- Inadequate absorption. e. g. biliary abstraction lead to decrease absorption of lipid soluble vits. 3- Insufficient usage i. e. Lack of transporting protein for some vits., failure to synthesise the active form of vit. 4- Increased requirments which occur during growth, pregnancy, lactation & wound healing 5- Increased vit. Loss or excretion i. e. Kidney malfunction. 6- Drug induced deficiency i. e. Loss of microbial synthesis in the intestine due to A.Biotics therapy.

21. Main functions of Vits. • Vitamins have diverse biochemical functions. Some have (1)hormone-like functions as regulators of mineral metabolism (such as vitamin D), or (2)regulators of cell and tissue growth and differentiation (such as some forms of vitamin A). (3)Others function as antioxidants (e.g., vitamin E and sometimes vitamin C).(4)The largest number of vitamins (such as B complex vitamins) function as precursors for enzyme cofactors, that help enzymes in their work as catalysts in metabolism.

22. Classification of Vits. • Vitamins are classified by their biological or chemical activity, not their structure. • Thus, each "vitamin" refers to a number of vitamer compounds that all show the same biological activity. such as "vitamin A", which includes the compounds retinal, retinol, and four known carotenoids. • In general Vits. Are classified to: • A- Water Soluble Vits.: • 1- (B) Complex Vits. • 2- Vitamin C (Ascorbic acid) • B- Lipid Soluble Vits.: • 1- Vit. A 2- Vit. D 3- Vit. E 4- Vit. K

23. Water-soluble Vitamins • Water-soluble vitamins dissolve in water. Because water-soluble vitamins are not stored by the body to any extent, foods reach in these vitamins must be eaten more often than foods with fat-soluble vitamins. • Fruits and vegetables are good source of water soluble vitamins. • Water-soluble vitamins are: Thiamin (B1), Riboflavin (B2), Niacin(B3), Pantothenic acid (B5), Pyridoxine Vitamin B6, Biotin (B7), Folacin (Folic acid) (B9) , Cobalamine Vitamin B12, Vitamin C (Ascorbic acid).

24. Thiamine or thiamin (B1) "sulfur-containing vitamin“, The major form is thiamine pyrophosphate (TPP), a coenzyme in the catabolism of CHO and A.A. Thiamine is used in the biosynthesis of the neurotransmitter acetylcholine and gamma-aminobutyric acid (GABA). Thiamine is found in a wide variety of foods at low concentrations, In general, cereal grains (Rice), nuts, meats, liver, yeasts, eggs and green vegetables. Thiamine dificiency may lead to beriberi (fatigue and decrease capacity to work) that affects the peripheral nervous system (polyneuritis), optic neuropathy.

25. Riboflavin (B2) It is the central component of the cofactors FAD (Flavin adenine dinucleotide)and FMN (Flavin mononucleotide). It plays a key role in energy metabolism, and for the metabolism of fats, ketone bodies, carbohydrates, and proteins. Meat, eggs, milk, cheese, leaf vegetables, liver, kidneys, yeast, mushrooms, and almonds are good sources of vitamin B2, but exposure to light destroys riboflavin. In animals, riboflavin deficiency results in lack of growth, weakness, ataxia, inflammation of the lining of mouth and tongue, mouth ulcers, a sore throat. A deficiency may also cause dry and scaling skin, fluid in the mucous membranes, and iron-deficiency anemia. The eyes may also become bloodshot, itchy, watery and sensitive to bright light.

26. Niacin (B3, nicotinic acid and vitamin PP) co-factors for nicotinamide adenine dinucleotide (NAD) & nicotinamide adenine dinucleotide phosphate (NADP). important in hydrogen transfer almost in every oxidation reduction reaction in the body, it is important in catabolism of fat, CHO and protein as well as cell signaling and DNA repair and anabolism reaction such as fatty acid and cholesterol synthesis and the production of steroid hormones in the adrenal gland. Niacin is found in liver, Meat, cereal, peanuts, Fruits, vegetables and legumes, and is also synthesized from tryptophan, an essential amino acid found in most forms of protein.

27. Niacin deficiency symptoms: • usually apparent in conditions of poverty, malnutrition and people eat maize as a staple food. causing decreased tolerance to cold. • Severe deficiency of niacin in the diet causes the disease pellagra, which is characterized by diarrhea, dermatitis, and dementia, thickening of the skin, inflammation of the mouth and tongue, digestive disturbances even death, if left untreated. Common psychiatric symptoms of niacin deficiency include irritability, poor concentration, anxiety, fatigue, restlessness and depression.

28. Pantothenic acid, pantothenate or vitamin B5 is a water-soluble vitamin, For many animals, pantothenic acid is an essential nutrient to synthesize coenzyme-A (CoA), as well as to synthesize and metabolize proteins, carbohydrates, and fats. Greek pantothen meaning "from everywhere" and small quantities of pantothenic acid are found in nearly every food, with high amounts in whole-grain cereals, legumes, eggs, meat, honey and yogurt, In ruminants synthesis of B5 by ruminal microorganisms to be 20 to 30 times more than dietary amounts. Vit. B5 deficiency is exceptionally rare. In case of severe starvation symptoms of deficiency are similar to other vitamin B deficiencies (Nausea, fatigue, reproductive problims & burning cramps in the limbs.

29. Pyridoxine (B6) , pyridoxal and pyridoxamine. It is based on a pyridine ring, with hydroxyl, methyl, and hydroxymethyl substituents. It is converted to the active form pyridoxal 5-phosphate a co factor for all transaminases, A.A. decarboxylation. Pyridoxine assists in the balancing of sodium and potassium as well as promoting red blood cell production. It is linked to cardiovascular health, hormonal changes and aid the immune system. sources of B6 are Liver, Fish, nuts, grain, egg, milk, vegetables and M.O. synthesis. Lack of pyridoxine may cause anemia, nerve damage, anorexia, seizures, skin problems, and sores in the mouth.

30. Biotin (B7) also known as vitamin H or coenzyme R Biocytin is the active form of biotin a coenzyme for carboxylase enzymes, involved in the synthesis of fatty acids, A.A. and in gluconeogenesis. necessary for cell growth. It plays a role in the citric acid cycle egg yolk, nuts, honey, leaf vegetables, liver, are good sources of vitamin B7. Biotin deficiency is rare because, in general, intestinal bacteria produce biotin. Avidin of egg white protein which binds extremely strongly with biotin, minimizes the effectiveness of egg yolk's biotin and may lead to its deficiency. B7 deficiency results in alopecia (Hair loss), reduce growth, anorexia, Conjunctivitis, Dermatitis, immune system and neuromuscular dysfunction.

31. Folic acid (B9) also known as folate, vitamin M, vitamin Bc or folacin Folate is composed of the aromatic pteridine ring linked to para-aminobenzoic acid and one or more of glutamate. tetrahydrofolate & other derivatives after its conversion to dihydrofolic acid in the liver is the active form of folic ac. The body needs folate to synthesize & repair DNA, as well as to act as a cofactor in certain biological reactions. especially important in aiding rapid cell division & growth, such as in infancy and pregnancy, also to produce healthy red blood cells and prevent anemia. Leafy vegetables are principal sources of folic ac. such as spinach, turnip greens, lettuce, Legumes such as beans, peas and lentils, Egg yolk, Baker's yeast, Sunflower seeds, liver products, Kidney, fruits and tomato.

32. Folic acid (B9) deficiency symptoms: The deficiency of folic ac. can result in many health problems, the most notable one being neural tube defects in developing embryos. Common symptoms of folate deficiency include diarrhea, macrocytic anemia with weakness or shortness of breath, nerve damage with weakness and limb numbness (peripheral neuropathy), pregnancy complications, mental confusion, forgetfulness, mental depression, sore or swollen tongue, peptic or mouth ulcers, headaches, heart palpitations, irritability, and behavioral disorders. Low levels of folate can also lead to impaired DNA synthesis & repair and this could lead to chromosomal defects in sperms and cancer development.

33. Vitamin (B12) also known cobalamin Vitamin B12 refers to a group of cobalt-containing vitamers known as cobalamins: include cyanocobalamin (an artifact formed), hydroxocobalamin (another form, produced by bacteria), and finally, the two naturally occurring cofactors of B12 in the body: adenosylcobalamin (AdoB12), the cofactor of Methylmalonyl Coenzyme A mutase (MUT), and methylcobalamin (MeB12), the cofactor of 5-methyltetrahydrofolate-homocysteine methyltransferase(MTR). Vitamin B12 the key role in the normal functioning of the brain and nervous system, and for formation of blood. It is normally involved in the metabolism of every cell of the body, especially affecting DNA synthesis and regulation, fatty ac. synthesis and energy production.

34. Cobalamin (B12) deficiency symptoms: Neither plants nor animals are capable of producing vitamin B12. Only bacteria have the enzymes required for its synthesis, although many foods are a natural source of B12 because of bacterial symbiosis. The vit. is the largest and most structurally complicated vit. and can be produced industrially only through bacterial fermentation-synthesis. Animals may obtain vitamin B12 directly or indirectly from M.O., Vit. B12 is found in fish, meat, liver, poultry, eggs, milk, and milk products. Vitamin B12 deficiency can cause severe and irreversible damage, especially to the brain and nervous system like mania and psychosis and pernicious anemia. At slight deficiency, a symptoms such as fatigue, depression and poor memory.

35. Fat-soluble Vitamins - dissolve fat and can be stored in the body.

36. Lipid Soluble Vitamins (A, D, E & K) Vitamin A: is a group of nutritionally unsaturated hydrocarbons, which include retinol, retinal, retinoic acid and several provitamin A (carotenoids) among which beta-carotene is the most important (represented as two connected retinyl groups) while a and gamma-carotene have a single retinyl group, which give them less activity. Vitamin A function is important for development and growth, maintenance of the immune system, reproduction, Haematopoiesis, Bone metabolism, Antioxidant activity and good vision (needed by the retina of the eye in the form of retinal, which combines with protein opsin to form rhodopsin the light-absorbing molecule), Vitamin A also functions on Skin and cellular health by the oxidized form (retinoic acid), which is an important hormone-like growth factor for epithelial and other cells.

37. Vitamin A (retinol, retinal, retinoic acid and beta-carotene) Vitamin A is found naturally in many foods: cod liver oil, Carrot, Milk, Butter, cheese, Egg, Some fruites like (Apricot), Pea, Broccoli, tomatoes, pumpkin, spinach and sweet potato. Vitamin A deficiency can occur as either a primary (not consume an adequate intake of provitamin A carotenoids) or a secondary deficiency which is associated with chronic malabsorption of lipids, impaired bile production and release, and chronic exposure to oxidants. Zinc deficiency can also impair absorption, transport, and metabolism of vitamin A because it is essential for the synthesis of the vitamin A transport proteins and as the cofactor in conversion of retinol to retinal.

38. Vitamin A deficiency Due to the unique function of retinal as a visual chromophore, one of the earliest and specific manifestations of vitamin A deficiency is impaired vision, particularly in reduced light (night blindness), dryness of the conjunctiva and mucus-secreting epithelium is replaced by a keratinized epithelium. Other changes include impaired immunity (increased risk of ear infections, urinary tract infections), impaired reproductive system, hair hyperkeratosis and squamous metaplasia of the epithelium lining the upper respiratory passages and urinary bladder to a keratinized epithelium. a deficiency in Vitamin A leads to teeth enamel hypoplasia.

39. Vitamin D (D2ergocalciferol and D3Cholecalciferol) Vitamin D is responsible for intestinal absorption of Ca & phosphate. The most important compounds of vit D are vit D2 (ergocalciferol) and vit D3 (Cholecalciferol). Vit D can be ingested from the diet and the body can also synthesize vit D in adequate amounts by most mammals (from cholesterol) when sun exposure is adequate. (except Cats and dogs.) In the liver vit D is converted to calcidiol, 25-hydroxycholecalciferol, or 25(OH)D; which is converted by the kidney to calcitriol, the biologically active form of vit D.Calcitriol circulates as a hormone in the blood By binding to vit D-binding protein (VDBP), regulating the concentration of Ca and phosphate in the blood promoting growth, remodeling of bone, neuromuscular function and inflammation.

40. Vitamin D deficiency The main function of Vitamin D is maintenance of calcium and phosphorus levels in the blood (with the assistance of parathyroid hormone and calcitonin) A diet deficient in vitamin D causes rickets & osteomalacia. Dietary sources of vit D are: Mushrooms, Fish liver oils, eggs, milk & butter.

41. Vitamin E (tocopherols and tocotrienols ) Vit E  refers to a group of eight fat-soluble compounds that include both tocopherols and tocotrienols ( vitamin E is made up of four tocopherols (alpha, beta, gamma, delta) and four tocotrienols (alpha, beta, gamma, delta)). The slight difference between tocotrienols and tocopherols lie in the unsaturated side chain having three double bonds in its tail. α-tocopherol, is the most biologically active form of vit E,   most found in corn oil, soybean oil, Olive oil, margarine, sunflower oils and nuts.As a fat soluble antioxidant, it stops the production of reactive oxygen species formed when fat undergoes oxidation & free radicals in tissues (radicals scavenger). Other functions include enzymatic activities ( protein kinase C ), gene expression,  cell signaling and neurological function(s).

42. Vitamin E deficiency Signs of vitamin E deficiency include neuromuscular problems such as spinocerebellar ataxia myopathies, and Heart disease, Deficiency can also cause anemia due to oxidative damage to red blood cells,retinopathy, Cancer and impairment of the immune response.There is also some laboratory evidence that vitamin E deficiency can cause male infertility.

43. Vitamin K Vitamin K is a group of structurally similar, fat-soluble vitamins that the body needs for modification of certain proteins required for blood coagulation (prothrombin (factor II), factors VII, IX, and X), and in metabolic pathways in bone ( osteocalcin) and other tissue. They are 2-methyl-1,4naphthoquinone derivatives. This group of vitamins includes two natural vitamers: vitamin K1 (phylloquinone) and vitamin K2 ( the main storage form in animals, has several subtypes called menaquinones). Three synthetic types of vit K are known: K3, K4, and K5. Vitamin K1 is found chiefly in leafy green vegetables such as spinach, cabbage, cauliflower, broccoli, some fruits, such as avocado, kiwifruit and grapes, Colonic bacteria synthesize a significant amounts of vitamin K.

44. Vitamin K deficiency Symptoms of K1 deficiency include anemia, bruising, bleeding of the gums or nose, Osteoporosisand coronary heart disease.

45. Minerals • Minerals are simple substances found in the environment that are essential to the body’s functioning. • Minerals are used to regulate a wide range of body processes, from bone formation to blood clotting, and they are important for the body structure. • Most minerals are either quickly used or lost in waste products, therefore we must eat mineral-rich foods daily to replenish our supply. Iron is an exception –it tends to be kept and recycled by the body, except when there is a blood loss.

46. Major Minerals: calcium, phosphorus, magnesium, potassium, sulfur, sodium, and chlorine • Calcium keeps the nervous system working well and is needed for blood clotting. Osteoporosis is disease caused by calcium deficiency. • Sodium and potassium help regulate the passage of fluids in and out of cells. Too much sodium in the diet may aggravate high blood pressure or hypertension, increasing the risk of heart attack, stroke or kidney disease. Table salt is one source of sodium in the diet. Most sodium comes in food. • Deficiency of potassium can lead to muscle weakness and abnormal heart beat.

47. Trace Minerals: iron, iodine, manganese, zinc, copper, and fluorine • The majority of the minerals needed for the body to function are only required in very small, or trace amounts. • Iron is a vital part of hemoglobin – a substance in red blood cells that carries oxygen to all parts of the body. Insufficient iron may cause anemia, a disease in which the body has either too few red blood cells or too little hemoglobin. As result too little oxygen is carried to cells of the body. • Iodine is needed for the thyroid gland to function properly. The thyroid gland produces hormones that control how quickly chemical reactions occur in our body. Too little iodine – thyroid gland enlarged. The primary sources are seafood and iodized table salt.

48. Water is found in every cell, in the spaces around the cells, in the fluid tissues of the body, and in body cavities Water carries dissolved nutrients throughout our body and assists in all of its functions such as: digesting foods, removing wastes, regulating temperature, and cushioning sensitive parts of our body. Each day we lose two to three quarts of water and if this water is not replaced the body can dehydrate. When minerals are dissolved, they break apart into ions. The ions formed in body fluids are called electrolytes. These ions play a central role in water balance in the body. Water

49. Clinical Nutrition

50. Illness Example : Cancer Altered Digestion and Absorption Altered Nutrient Excretion Altered Food Intake Altered Metabolism Examples: Loss of appetite, altered food likes/dislikes, difficulty chewing and swallowing, reduced saliva secretion Examples: radiation enteritis, surgical resection of GI tract, diarrhea Example: increased energy needs due to altered energy use in cancer Examples: fecal loss of fat-soluble vitamins and calcium in clients with cancers that affect enzyme secretion or bile salt production Malnutrition