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Nutrients



L/O/G/O
By: SumayyaNaseem
Optometrist (PICO), COT & COA (JCAHPO USA),
MMSPH Student Abasyn University
Contents

           1. Types of Nutrients

       2. Good and Fair Sources

           3. Daily Requirements

    4. Functions of various Nutrients

       5. Nutrients and Diseases
Nutrients
Chemical substances that constitute food and are
responsible for the functions of food and protects body
from disorder.

No substance can be called food unless it contains at least
one nutrient.

Valuable food like milk contains a variety of nutrients and
performs about all food functions.
Types of Nutrients
       (Based on the amount required by the body)

 I. Macro Nutrients
      1. Proteins
      2. Carbohydrates
      3. Fats
      4. Water


 II. Micro Nutrients
      5. Vitamins
      6. Minerals
1. Proteins

  Found in membranes, enzymes, collagen, hair, nails and skins




         Contain Carbon, Hydrogen, Oxygen and Nitrogen – Most
         contain Sulphur – Some contain Phosphorus, iron, Copper
         and Zinc etc




                    About 20% of total weight is proteins
Functions of Proteins
Structural Support                                           Protection
        &                 Hormones &
Growth and Energy          Enzymes           In Blood

                                                            •Antibodies:
  • Proteins make                                           •Antibodies
   the Hair, Nails &                      • Hemoglobin: A
                                           Protein with      are proteins that
   muscles etc         • Control Growth
                         and Metabolic     Iron… Oxygen     bind to the
  • Growth and           activities        carrying         pathogens and
    maintenance of                         function         inhibit their
                       • Speed up
    body tissues         Biochemical                        activities.
                                          • Fibrinogen:
  • Provide energy       Reactions and     Helps in Blood
    when low calorie     Digestion.
                                           Clotting &
    intake                                 Healing
Sources
    Good Sources                       Fair Sources
       Animal Origin                      Plant Origin




• Egg, Meat, Milk
• Egg Proteins                   • Cereals, Pulses, Oil seeds
(the best among food proteins)
Daily Requirements
• One gm/kg body weight per day for adults
• Additional 15 gm per day during pregnancy
• Additional 25 gm during first six months of lactation and 18 gm
during 6-12 months of lactation
• Protein Requirements of Infants (g/Kg)

             Age (months)             Requirements per day
                 0–3                          2.30 gm
                 3–6                          1.85 gm
                 6–9                          1.65 gm
                 9 – 12                       1.50 gm
Proteins Deficiency Diseases
             1. MARASMUS




        1        2. KWASHIORKOR


            2

            3     3. CACHEXIA




       4     4. ANAEMIA
Proteins Deficiency Diseases
             5. PROTEIN-ENERGY MALNUTRITION
                 (PEM)



        5         6. SKIN RASHES, HAIR LOSS,


            6
                  BRITTLE NAILS, SKIN ULCERS




            7      7. WEIGHT LOSS




       8     8. EDEMA IN SEVERE CASES
DISORDERS CAUSED BY A HIGH-PROTEIN DIET




    KETOSIS      DIGESTIVE &    AFFECTS
                   KIDNEY       MENTAL
                 DISORDERS      HEALTH
2. CARBOHAYDRATES ( Hydrates of Carbon)

  Mono Saccharides (Glucose, Fructose, Galactose),
  Di Saccharides (Sucrose, Lactose, Maltose) and
  Poly Saccharides (Starches, Fiber , Cellulose, Glycogen)




         50 – 70 % of energy must be provided by carbohydrates.




              Carbohydrates and Proteins provide 4 Kcal per gm
Functions of Carbohydrates
                                                                       Ribose
Growth and Energy          For Brain          For NEAA &
                                                  Fats


 • Carbohydrates                                                    • Ribose –
  are a major and                           • Carbohydrates are     A Pentose
  instant source of   • Essential for the    essential for the      Carbohydrate ,
  energy - one         development of        synthesis of certain
                                                                    is part of RNA and
  gram provides 4      brain in children     non-essential
                                             amino acids and        DNA
  kcal of energy.
                                             oxidation of fats
 • RBCs and Brain
   cells use
   carbohydrates as
   energy
Sources
        Animal Origin               Plant Origin




                                      • Cereals
• Milk (largely)                       • Pulses
                                       • Fruits
• Meat (to some extent)             • Vegetables
                                        • Nuts
Daily Requirements
 250 – 325 grams per day

50 – 70 % of energy must be provided by carbohydrates

Pakistani foods in general contain 90% carbohydrates
Carbohydrates Deficiency Diseases
            1.   USAGE OF FAT AS FUEL
                 SOURCE: Low carbohydrate in our
                 diet causes the fat reserves to be used


        1
                 as fuel source.

                     2. KETOSIS: In the absence of
                     carbohydrates, the body starts using the

            2        proteins and convert it to sugars . This
                     causes ketosis which is nothing but the
                     accumulation of ketones in the body




            3         3. HYPOGLYCEMIA




       4     4. UNDERWEIGHT
3. FATS

  •   Very rich source of energy
  •   Energy of 9 Kcal per gram of fat




          • Simple Lipids - Triglycerides
          • Compound Lipids – Phospholipids
          • Derived Lipids – Cholesterol




            • 10 – 15 % of body weight is adipose tissue
Functions of Fats
Provision of energy and spares proteins from being used for
energy
Serve as vehicles for fat soluble vitamins like A, D, E, K
Support of viscera like heart, kidneys and intestines
Provide insulation beneath the skin
Make foods palatable/ eatable
EFAs decrease serum cholesterol and LDL
Cholesterol is a precursor of steroid hormones
Sources
    Good Sources                 Fair Sources
       Animal Origin                Plant Origin



                            Oil seeds like:
• Ghee
• Butter                            • Ground nut
• Milk and Eggs                      •Sunflower
• Cheese                              • Mustard
•Fats on meat                         •Coconut
• Fats on Fish
                            Cereals &Pulses
Daily Requirements

• 20-30% of energy must be provided by fats of which 50%
  should be vegetable origin.
• The FDA's RDI for fats is 65 g or 30 percent of your daily
  calorie intake.
• One Kg of adipose tissue yields 7700 kcal of energy
Fats Deficiency Diseases
                 1. Hair loss, cold
                    intolerance, bruising, poor growth, poor
                    wound healing and low body weight.

        1
            2        2. PHRENODERMA: Rough and dry skin
                     due to lack of essential fatty acids




            3
                     3. As many vitamins and antioxidants are
                     fat soluble, therefore deficiency of fat
             .       affects the level and activity of vitamins and
                     can impact whole body.
DISORDERS CAUSED BY A HIGH- FAT DIET




    Obesity      Coronary       Cancer Colon
                Heart Disease     & Breast
                                  Cancer
4. WATER

 •Water is a chemical compound with the chemical formula H2O.
 •A water molecule contains one oxygen and two hydrogen atoms




         Safe drinking water is essential to humans even though it
         provides no calories




             • The human body contains from 55% to 78% water.
           • The body requires between 1 & 7 liters of H2O per day
                            to avoid dehydration
             •The precise amount depends on the level of activity,
                  temperature, humidity, and other factors.
Functions of Water
•   Water is at the center of life. This is why nobody can live more than 3 to 5
    days without any water intake.

•   Water is your body's principal chemical component and makes up about 60
    percent of your body weight.

•   Every system in your body depends on water. For example, water flushes
    toxins out of vital organs, carries nutrients to your cells and provides a
    moist environment for ear, nose and throat tissues.
5 Basic Functions of Water
•   Cell life
•   Chemical and metabolic reactions
•   Transport of nutrients
•   Body temperature regulation
•   Elimination of waste
Sources
•   Drinking Water
•   Drinks
•   Beverages
•   Fruits
Daily Requirements

• One man consumes 3.0 liters and women 2.2 liters
• Pregnant women should increase intake to 2.4 liters (10 glass) and
breastfeeding women should get 3 liters (12 glass), since an
especially large amount of fluid is lost during nursing
Water Deficiency Disorders
Dehydration:

Lack of water can lead to dehydration, a condition that occurs when you
don't have enough water in your body to carry out normal functions.
Even mild dehydration can drain your energy and make you tired. It can
be fatal too.

Dry mouth, sunken eyes, dry skin, cold hands and feet, weak and rapid
pulse, rapid and shallow breathing, confusion, exhaustion, and coma.

Seen in children with diarrhea, gastroenteritis and vomiting.
Nutrients by Sumayya Naseem 2003
5. Minerals
                 About 50 minerals are found in human body


Minerals are inorganic substances that serve a variety of functions such
as cofactors in :

• Enzyme-catalyzed reactions
• Regulation of acid-base balance
• Nerve conduction
• Muscle irritability and
• Structural elements in the body.

Each mineral is required in specific amounts ranging from various gm
per day. Some of the more important of these are calcium, phosphorus,
sodium, potassium and iron.

Macro minerals: The minerals, which are required in amounts
greater than 100 mg/ day.
Micro minerals: The minerals, which are required in amounts less
than 100 mg/ day.
(i) Calcium (1.5 – 2% of body weight)
    A major mineral element of the body (1.5 – 2% of body weight)
•   Functions:
    Formation of bones, milk and teeth, coagulation of blood, contraction of muscles
    and metabolism.

•   Sources:
    Milk and milk products, eggs, fish, green leafy vegetables and cereals. Absorption
    is increased by Vitamin D and decreased by phytates and oxalates.

•   Deficiency:
    Not clear cut even in the case of low intake. Rickets and Osteomalacia may not
    occur if vitamin D intake is sufficient

•   Requirements:
    Infants                                    500 mg per day
    Adolescents                               600 mg per day
    Adults                                    500 mg per day
    Pregnancy and Lactation                   1000 mg per day
(ii) Iron
•   Functions:
    Iron is essential for the production of haemoglobin, which helps deliver
    oxygen from the lungs to the body tissues, synthesize iron enzymes that are
    required to utilize oxygen for the production of cellular energy .

•   Sources:
•   Haem Iron – (bioavailability good) found in meat, poultry, liver.
•   Non-haem Iron – (bioavailability poor) found in chick peas, beans, cereals,
    green leafy vegetables and apricot etc
•   Cooking in iron vessels is another source.
•   Iron Supplements and Fortified foods.
Daily Requirements:
    AGE GROUP             DAILY IRON NEEDED
•   Infants 5-12 months            0.7 mg
•   Children 1-12 years            1.0 mg
•   Males 13-16 years              1.8 mg
•   Females 13-16 years            2.4 mg
•   Adult Males                    0.9 mg

    Adult Females
•   Menstruating                  2.8 mg
•   Pregnancy 1st half            0.8 mg
•   Pregnancy 2nd half            3.5 mg
•   Lactation                     2.4 mg
•   Post menopause                0.7 mg
• Iron Deficiency Disorders:
• Anemia:

Effects on Children:
• Impaired motor development and coordination
• Impaired IQ
• Decreased physical activity
• Fatigue

Effects on Adults:
• Decreased physical work and earning and Decreased immunity

Effects on pregnant women:

•   Increased maternal morbidity and mortality
•   Increased foetal morbidity and mortality
•   Increased incidence of Low Birth Weight
(iii) Iodine
•   Functions:
    It is known to be essential in maintaining the function of the thyroid and
    parathyroid glands in the human body and the production of thyroxine, a
    hormone associated with proper thyroid functioning. Iodine also promotes
    general growth and development within the body as well as aiding in
    metabolism.

•   Sources: Cod fish, Shrimps, Fish and Fortified salt.

•   Daily Requirements:
    In your entire lifetime you will need less than a teaspoon of iodine to ensure
    good health, we need 150 micrograms (or 20,000th of a teaspoon) to meet your
    daily requirement.

•   Deficiency Disorders: Goiter ,Cretinism and
                          Mental Retardation.
6. Vitamins....The Vital Amines
  Vitamins are classified as:
• Fat Soluble Vitamins: A, D, E and K
• Water Soluble Vitamins: C and B complex

Vitamin B Complex:
   –   Vitamin B1 (thiamine)
   –   Vitamin B2 (riboflavin)
   –   Vitamin B3 (niacin or niacinamide)
   –   Vitamin B5 (pantothenic acid)
   –   Vitamin B6 (pyridoxine)
   –   Vitamin B9 (folic acid)
   –   Vitamin B12 (various cobalamins)
Vitamin A
Functions:
• Contributes towards the production of retinal pigments needed for vision in
  dim light
• Maintain normal function of glandular and epithelial tissue lining; of
  intestinal, respiratory tract, urinary tract, skin and eyes
• Supports skeletal growth
• Increases immunity – anti-infective
• Protects against epithelial cancers

Sources:
• Animal: Liver, eggs, butter, cheese, whole milk, fish and meat – cod liver oil
• Plants: Green vegetables, yellow fruits, Carrot
• Fortified Foods: Banaspati Ghee, Margarine, Milk, Bread
VITAMIN A DEFICIENCY - a public health problem

OCULAR: (XEROPTHALMIA)
• Night Blindness
• Conjunctival Xerosis
• Bitot’s Spots
• Corneal Xerosis
• Keratomalacia

EXTRA-OCCULAR:
• Growth Retardation
• Infections
• Degeneration of myelin sheath of nerve cells
• Alteration of mucosa of renal pelvis and urinary bladder predisposing to calculi
• Atrophy of germinal epithelium – reproduction defective

TOXICITY:
• Excess of Vitamin A in the body may cause Nausea, Vomiting, Anorexia, Sleep
  Disorder, Desquamation of Skin, Papiloedema, Enlarged Liver, Teratogenesis

TREATMENT:
• Massive doses of Vitamin A – All children with corneal ulcer must receive Vitamin A
Nutrients by Sumayya Naseem 2003
RDA (RECOMMENDED DAILY
ALLOWANCE )


                        Retinol   OR   Beta Carotene
                        (mcg)             (mcg)

•   Adults               600               2400

•   Lactating Mothers    950               3800

•   Infants              350               1200

•   Children 1-6         400               2400

•   Age 7 – 19           600               2400
Vitamin K
FUNCTIONS
• Helps coagulation of blood

SOURCES
• Green leafy vegetables like spinach, cabbage, lettuce, Milk, Eggs (Vit.K1)
• Some amounts are formed by the bacterial action of intestinal flora(Vit.K2)
• Deficiency usually does not occur even if not supplied in diet

DEFICIENCY
• May occur in liver disease
• There is delay in normal coagulation time with more bleeding on slight
  injury

RDA
• 1000 IU per day
• Infants at risk must receive a single IM injection of Vitamin K after birth
Vitamin E
Fat Soluble compound -----Tocopherols

FUNCTIONS:
• Helps in reproduction

SOURCES:
• Vegetable oils, Cotton seed, Sunflower seed, Egg yolk, Butter,
  Fortified Cooking Oils and Butter.

DEFICIENCY:
• Sterility in animals – Threatened abortion

RDA:
• Adults        10 mg
• Infants       3 mg
Vitamin D
Nutritionally important forms in man are:
1.   Calceferol (Vitamin D2)
2.   Cholecalciferol (Vitamin D3)

Functions:
•   Intestine & Kidneys: Promotes intestinal absorption of Ca and Phosphorus
•   Bone: Stimulates normal mineralization
•   Others: Permits normal growth

Sources:
•    Animal fats, Fish liver oils, Liver, Egg yolk, Butter, Cheese, Milk
•    Fortified foods like Ghee, Margarine, Bread, Whole Milk, Infant Foods
•    Exposure to UV rays of Sunlight convert cholesterol in skin to
     Vit. D
VITAMIN D DEFICIENCY DISORDERS

•   Rickets in children: A disease characterized by deformed bones
•   Osteomalacia in adults especially pregnant and lactating mothers

TOXICITY
•   Excessive intake is harmful and may manifest itself as: anorexia, nausea,
    vomiting, thirst, drowsiness, coma and cardiac arrhythmias

RDA
•   Adults                           2.5 mcg (100 IU)
•   Infants and Children            5.0 mcg (200 IU)
•   Pregnancy & Lactation           10.0 mcg(400 IU)
Nutrients by Sumayya Naseem 2003
Vitamin C (Ascorbic Acid)
Functions:
• Plays an important role in tissue oxidation
• Needed for the formation of collagen
• Facilitates iron absorption from gut

Sources:
• Fresh fruits like citrus, guava, green leafy vegetables, germinating pulses
  and amla.

Deficiency Disorders:
• Rare – Scurvy characterized by swollen and bleeding gums, subcutaneous
  bleeding, bleeding in to joints, delayed wound healing and anemia.
RDA
• 40 to 60 mg per day
Nutrients by Sumayya Naseem 2003
Vitamin B1 (Thiamine)
Functions:

Maintain good appetite, normal digestion, muscle tone and healthy mental attitude

Sources:

•   Good sources are: Soya bean, Peanuts, Whole grains, Cereals, Nuts & ground nuts.
•   Fairly good sources are Liver, Organ meat, Poultry, Egg yolk, Beans and Peas
•   Mother milk is a good source also.
•   Thiamine is lost during cooking due to leaching of the vitamin in to cooking water
    or when washed and also lost in foods having baking soda

         RDA
         Ranges between 0.5 mg – 2 mg per day
Vitamin B1 Deficiency Disorders
• Wernicke’s Encephalopathy
• Beri Beri
   – Dry Beri Beri (when nervous system is affected)
   – Wet Beri Beri (when there are cardiac symptoms and signs)
   – Infantile Beri Beri (when mothers are thiamine deficient)


Prevention
• Encourage people to eat thiamine rich diet
• Stop Alcohol
• Supplements for lactating mothers
Nutrients by Sumayya Naseem 2003
Vitamin B2 (RiboFlavin)
Functions:

• Plays an important role in cellular growth
• It is a cofactor involved in a number of enzymes involved in energy
  metabolism

Sources:

• Rich sources are eggs, liver, green leafy vegetables, milk & Products
• Fair sources are wheat and pulses – Meat and fish contain small
  amounts
• Losses are due to leaching of this vitamin in to cooking water

RDA
• 0.7 to 2.2 mg per day
Vitamin B2 Deficiency Disorders
• Ariboflavinosis (severe form)

• Hyporiboflavinosis (milder form)

• Skin and mucosa are affected – angular stomatitis, glossitis,
  circumcorneal vascularisation, keratitis, susceptibility to cataract

• Impaired neuromotor function, impaired wound
  healing, peripheral neuropathy
Vitamin B3 (niacin or niacinamide)
Functions:
• Essential for Carbohydrates, fats and proteins metabolism
• Essential for the normal functioning of skin, intestines and nervous
  system
• An essential amino acid tryptophane serves as its precursor

Sources:
• Coffee, Peanuts, Liver, Kidney, meat, poultry, fish, legumes and ground
  nuts
• Milk is a poor source but a rich source of tryptophane
• In maize niacin is in bound form and not available to body
Vitamin B3 Deficiency Disorders

• Pellagra: characterized by Diarrhea, Dermatitis and Dementia
                                           (occurs in maize eating communities)
• Glossitis and Stomatitis
  (Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may
    involve the cheeks, gums, tongue, lips, throat, and roof or floor and Glossitis: Tongue Inflammation)



RDA
• 0.7 to 2.2 mg per day
Vitamin B5 (Pantothenic acid)
     Functions:
     Metabolism
     Sources:
•     Major source is meat. The most significant sources of
     pantothenic acid in nature are coldwater fish ovaries and royal
     jelly.
•    It is found in nearly every food, with high amounts in whole
     grain cereals, legumes, eggs, meat, royal jelly, avocado,
     and yogurt.
•    Whole grains are another good source of the vitamin, but milling
     removes much of the pantothenic acid, as it is found in the outer
     layers of whole grains
•     Pantothenic acid is an ingredient in some hair and skin
     care products
Vitamin B5 Deficiency Disorders
•   Impaired energy production, due to low CoA levels, which could cause:
    irritability, fatigue, and apathy. Neurological symptoms can also appear in
    deficiency. They include numbness, paresthesia, and muscle cramps and
    Hypoglycemia.

•   Additional symptoms could include restlessness, malaise, sleep
    disturbances, nausea, vomiting, and abdominal cramps.

•   In a few rare circumstances, more serious (but reversible) conditions have
    been seen, such as adrenal insufficiency and hepatic encephalopathy.

•   One study noted painful burning sensations of the feet were reported in
    tests conducted on volunteers. Deficiency of pantothenic acid may explain
    similar sensations reported in malnourished prisoners of war.

     RDA
     RDA: 6 mg/day
Vitamin B6 (PYRIDOXINE)
  Functions:
  Plays an important role in the metabolism of carbohydrates, fats and
  proteins

  Sources:
  Widely distributed in food e.g. milk, liver, meat, egg yolk, fish, whole grain
  cereals, legumes, and vegetables.

  Deficiency:
• Rare but occurs with niacin deficiency
• Peripheral neuritis
• INH (Isoniazid for TB) is a known antagonist and patients on INH must
  get 10 mg pyridoxine per day

   RDA
• 2 mg per day – In pregnancy and lactation 2.5 mg per day
Vitamin B9 (Folic Acid)
Functions:
Plays an important role in the synthesis of nucleic acids
Needed for the normal development of blood cells in the bone marrow

Sources:
Leafy vegetables, dairy products, Milk, eggs, cereals

Deficiency Disorders:
Megaloblastic anemia, glossitis, chielosis , GI disturbances like diarrhea.
Severe deficiency may cause infertility and sterility.
Folic acid antagonists like alcohol, pyramethamine and cotrimoxazole may cause
   abortion, congenital malformations
Requirements are greatest when rapid cell multiplication like growth & pregnancy

RDA
• Healthy adults and children     100 mcg per day
• Pregnancy                        400 mcg per day
• Lactation                        150 mcg per day
Vitamin B12 Cobalamins
Functions:
Cooperates with folates in the synthesis of DNA and helps in Synthesis of fatty
   acids in myelin

Sources:
• Liver, kidney, meat, fish, milk cheese
• Not found in vegetables
• Synthesized by bacteria in colon

Deficiency Disorders:
• Rare and usually in vegetarians
• Megaloblastic anemia (Pernicious Anemia)
• Demyelinating neurological lesions in the spinal cord

RDA
• Infants and children                       0.2 mcg per day
• Adults                                     1 mcg per day
• Pregnancy and Lactation                    1.5 mcg per day
Nutrients by Sumayya Naseem 2003
L/O/G/O

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Nutrients by Sumayya Naseem 2003

  • 1. Nutrients L/O/G/O By: SumayyaNaseem Optometrist (PICO), COT & COA (JCAHPO USA), MMSPH Student Abasyn University
  • 2. Contents 1. Types of Nutrients 2. Good and Fair Sources 3. Daily Requirements 4. Functions of various Nutrients 5. Nutrients and Diseases
  • 3. Nutrients Chemical substances that constitute food and are responsible for the functions of food and protects body from disorder. No substance can be called food unless it contains at least one nutrient. Valuable food like milk contains a variety of nutrients and performs about all food functions.
  • 4. Types of Nutrients (Based on the amount required by the body)  I. Macro Nutrients 1. Proteins 2. Carbohydrates 3. Fats 4. Water  II. Micro Nutrients 5. Vitamins 6. Minerals
  • 5. 1. Proteins Found in membranes, enzymes, collagen, hair, nails and skins Contain Carbon, Hydrogen, Oxygen and Nitrogen – Most contain Sulphur – Some contain Phosphorus, iron, Copper and Zinc etc About 20% of total weight is proteins
  • 6. Functions of Proteins Structural Support Protection & Hormones & Growth and Energy Enzymes In Blood •Antibodies: • Proteins make •Antibodies the Hair, Nails & • Hemoglobin: A Protein with are proteins that muscles etc • Control Growth and Metabolic Iron… Oxygen bind to the • Growth and activities carrying pathogens and maintenance of function inhibit their • Speed up body tissues Biochemical activities. • Fibrinogen: • Provide energy Reactions and Helps in Blood when low calorie Digestion. Clotting & intake Healing
  • 7. Sources Good Sources Fair Sources Animal Origin Plant Origin • Egg, Meat, Milk • Egg Proteins • Cereals, Pulses, Oil seeds (the best among food proteins)
  • 8. Daily Requirements • One gm/kg body weight per day for adults • Additional 15 gm per day during pregnancy • Additional 25 gm during first six months of lactation and 18 gm during 6-12 months of lactation • Protein Requirements of Infants (g/Kg) Age (months) Requirements per day 0–3 2.30 gm 3–6 1.85 gm 6–9 1.65 gm 9 – 12 1.50 gm
  • 9. Proteins Deficiency Diseases 1. MARASMUS 1 2. KWASHIORKOR 2 3 3. CACHEXIA 4 4. ANAEMIA
  • 10. Proteins Deficiency Diseases 5. PROTEIN-ENERGY MALNUTRITION (PEM) 5 6. SKIN RASHES, HAIR LOSS, 6 BRITTLE NAILS, SKIN ULCERS 7 7. WEIGHT LOSS 8 8. EDEMA IN SEVERE CASES
  • 11. DISORDERS CAUSED BY A HIGH-PROTEIN DIET KETOSIS DIGESTIVE & AFFECTS KIDNEY MENTAL DISORDERS HEALTH
  • 12. 2. CARBOHAYDRATES ( Hydrates of Carbon) Mono Saccharides (Glucose, Fructose, Galactose), Di Saccharides (Sucrose, Lactose, Maltose) and Poly Saccharides (Starches, Fiber , Cellulose, Glycogen) 50 – 70 % of energy must be provided by carbohydrates. Carbohydrates and Proteins provide 4 Kcal per gm
  • 13. Functions of Carbohydrates Ribose Growth and Energy For Brain For NEAA & Fats • Carbohydrates • Ribose – are a major and • Carbohydrates are A Pentose instant source of • Essential for the essential for the Carbohydrate , energy - one development of synthesis of certain is part of RNA and gram provides 4 brain in children non-essential amino acids and DNA kcal of energy. oxidation of fats • RBCs and Brain cells use carbohydrates as energy
  • 14. Sources Animal Origin Plant Origin • Cereals • Milk (largely) • Pulses • Fruits • Meat (to some extent) • Vegetables • Nuts
  • 15. Daily Requirements  250 – 325 grams per day 50 – 70 % of energy must be provided by carbohydrates Pakistani foods in general contain 90% carbohydrates
  • 16. Carbohydrates Deficiency Diseases 1. USAGE OF FAT AS FUEL SOURCE: Low carbohydrate in our diet causes the fat reserves to be used 1 as fuel source. 2. KETOSIS: In the absence of carbohydrates, the body starts using the 2 proteins and convert it to sugars . This causes ketosis which is nothing but the accumulation of ketones in the body 3 3. HYPOGLYCEMIA 4 4. UNDERWEIGHT
  • 17. 3. FATS • Very rich source of energy • Energy of 9 Kcal per gram of fat • Simple Lipids - Triglycerides • Compound Lipids – Phospholipids • Derived Lipids – Cholesterol • 10 – 15 % of body weight is adipose tissue
  • 18. Functions of Fats Provision of energy and spares proteins from being used for energy Serve as vehicles for fat soluble vitamins like A, D, E, K Support of viscera like heart, kidneys and intestines Provide insulation beneath the skin Make foods palatable/ eatable EFAs decrease serum cholesterol and LDL Cholesterol is a precursor of steroid hormones
  • 19. Sources Good Sources Fair Sources Animal Origin Plant Origin Oil seeds like: • Ghee • Butter • Ground nut • Milk and Eggs •Sunflower • Cheese • Mustard •Fats on meat •Coconut • Fats on Fish Cereals &Pulses
  • 20. Daily Requirements • 20-30% of energy must be provided by fats of which 50% should be vegetable origin. • The FDA's RDI for fats is 65 g or 30 percent of your daily calorie intake. • One Kg of adipose tissue yields 7700 kcal of energy
  • 21. Fats Deficiency Diseases 1. Hair loss, cold intolerance, bruising, poor growth, poor wound healing and low body weight. 1 2 2. PHRENODERMA: Rough and dry skin due to lack of essential fatty acids 3 3. As many vitamins and antioxidants are fat soluble, therefore deficiency of fat . affects the level and activity of vitamins and can impact whole body.
  • 22. DISORDERS CAUSED BY A HIGH- FAT DIET Obesity Coronary Cancer Colon Heart Disease & Breast Cancer
  • 23. 4. WATER •Water is a chemical compound with the chemical formula H2O. •A water molecule contains one oxygen and two hydrogen atoms Safe drinking water is essential to humans even though it provides no calories • The human body contains from 55% to 78% water. • The body requires between 1 & 7 liters of H2O per day to avoid dehydration •The precise amount depends on the level of activity, temperature, humidity, and other factors.
  • 24. Functions of Water • Water is at the center of life. This is why nobody can live more than 3 to 5 days without any water intake. • Water is your body's principal chemical component and makes up about 60 percent of your body weight. • Every system in your body depends on water. For example, water flushes toxins out of vital organs, carries nutrients to your cells and provides a moist environment for ear, nose and throat tissues.
  • 25. 5 Basic Functions of Water • Cell life • Chemical and metabolic reactions • Transport of nutrients • Body temperature regulation • Elimination of waste
  • 26. Sources • Drinking Water • Drinks • Beverages • Fruits
  • 27. Daily Requirements • One man consumes 3.0 liters and women 2.2 liters • Pregnant women should increase intake to 2.4 liters (10 glass) and breastfeeding women should get 3 liters (12 glass), since an especially large amount of fluid is lost during nursing
  • 28. Water Deficiency Disorders Dehydration: Lack of water can lead to dehydration, a condition that occurs when you don't have enough water in your body to carry out normal functions. Even mild dehydration can drain your energy and make you tired. It can be fatal too. Dry mouth, sunken eyes, dry skin, cold hands and feet, weak and rapid pulse, rapid and shallow breathing, confusion, exhaustion, and coma. Seen in children with diarrhea, gastroenteritis and vomiting.
  • 30. 5. Minerals About 50 minerals are found in human body Minerals are inorganic substances that serve a variety of functions such as cofactors in : • Enzyme-catalyzed reactions • Regulation of acid-base balance • Nerve conduction • Muscle irritability and • Structural elements in the body. Each mineral is required in specific amounts ranging from various gm per day. Some of the more important of these are calcium, phosphorus, sodium, potassium and iron. Macro minerals: The minerals, which are required in amounts greater than 100 mg/ day. Micro minerals: The minerals, which are required in amounts less than 100 mg/ day.
  • 31. (i) Calcium (1.5 – 2% of body weight) A major mineral element of the body (1.5 – 2% of body weight) • Functions: Formation of bones, milk and teeth, coagulation of blood, contraction of muscles and metabolism. • Sources: Milk and milk products, eggs, fish, green leafy vegetables and cereals. Absorption is increased by Vitamin D and decreased by phytates and oxalates. • Deficiency: Not clear cut even in the case of low intake. Rickets and Osteomalacia may not occur if vitamin D intake is sufficient • Requirements: Infants 500 mg per day Adolescents 600 mg per day Adults 500 mg per day Pregnancy and Lactation 1000 mg per day
  • 32. (ii) Iron • Functions: Iron is essential for the production of haemoglobin, which helps deliver oxygen from the lungs to the body tissues, synthesize iron enzymes that are required to utilize oxygen for the production of cellular energy . • Sources: • Haem Iron – (bioavailability good) found in meat, poultry, liver. • Non-haem Iron – (bioavailability poor) found in chick peas, beans, cereals, green leafy vegetables and apricot etc • Cooking in iron vessels is another source. • Iron Supplements and Fortified foods.
  • 33. Daily Requirements: AGE GROUP DAILY IRON NEEDED • Infants 5-12 months 0.7 mg • Children 1-12 years 1.0 mg • Males 13-16 years 1.8 mg • Females 13-16 years 2.4 mg • Adult Males 0.9 mg Adult Females • Menstruating 2.8 mg • Pregnancy 1st half 0.8 mg • Pregnancy 2nd half 3.5 mg • Lactation 2.4 mg • Post menopause 0.7 mg
  • 34. • Iron Deficiency Disorders: • Anemia: Effects on Children: • Impaired motor development and coordination • Impaired IQ • Decreased physical activity • Fatigue Effects on Adults: • Decreased physical work and earning and Decreased immunity Effects on pregnant women: • Increased maternal morbidity and mortality • Increased foetal morbidity and mortality • Increased incidence of Low Birth Weight
  • 35. (iii) Iodine • Functions: It is known to be essential in maintaining the function of the thyroid and parathyroid glands in the human body and the production of thyroxine, a hormone associated with proper thyroid functioning. Iodine also promotes general growth and development within the body as well as aiding in metabolism. • Sources: Cod fish, Shrimps, Fish and Fortified salt. • Daily Requirements: In your entire lifetime you will need less than a teaspoon of iodine to ensure good health, we need 150 micrograms (or 20,000th of a teaspoon) to meet your daily requirement. • Deficiency Disorders: Goiter ,Cretinism and Mental Retardation.
  • 36. 6. Vitamins....The Vital Amines Vitamins are classified as: • Fat Soluble Vitamins: A, D, E and K • Water Soluble Vitamins: C and B complex Vitamin B Complex: – Vitamin B1 (thiamine) – Vitamin B2 (riboflavin) – Vitamin B3 (niacin or niacinamide) – Vitamin B5 (pantothenic acid) – Vitamin B6 (pyridoxine) – Vitamin B9 (folic acid) – Vitamin B12 (various cobalamins)
  • 37. Vitamin A Functions: • Contributes towards the production of retinal pigments needed for vision in dim light • Maintain normal function of glandular and epithelial tissue lining; of intestinal, respiratory tract, urinary tract, skin and eyes • Supports skeletal growth • Increases immunity – anti-infective • Protects against epithelial cancers Sources: • Animal: Liver, eggs, butter, cheese, whole milk, fish and meat – cod liver oil • Plants: Green vegetables, yellow fruits, Carrot • Fortified Foods: Banaspati Ghee, Margarine, Milk, Bread
  • 38. VITAMIN A DEFICIENCY - a public health problem OCULAR: (XEROPTHALMIA) • Night Blindness • Conjunctival Xerosis • Bitot’s Spots • Corneal Xerosis • Keratomalacia EXTRA-OCCULAR: • Growth Retardation • Infections • Degeneration of myelin sheath of nerve cells • Alteration of mucosa of renal pelvis and urinary bladder predisposing to calculi • Atrophy of germinal epithelium – reproduction defective TOXICITY: • Excess of Vitamin A in the body may cause Nausea, Vomiting, Anorexia, Sleep Disorder, Desquamation of Skin, Papiloedema, Enlarged Liver, Teratogenesis TREATMENT: • Massive doses of Vitamin A – All children with corneal ulcer must receive Vitamin A
  • 40. RDA (RECOMMENDED DAILY ALLOWANCE ) Retinol OR Beta Carotene (mcg) (mcg) • Adults 600 2400 • Lactating Mothers 950 3800 • Infants 350 1200 • Children 1-6 400 2400 • Age 7 – 19 600 2400
  • 41. Vitamin K FUNCTIONS • Helps coagulation of blood SOURCES • Green leafy vegetables like spinach, cabbage, lettuce, Milk, Eggs (Vit.K1) • Some amounts are formed by the bacterial action of intestinal flora(Vit.K2) • Deficiency usually does not occur even if not supplied in diet DEFICIENCY • May occur in liver disease • There is delay in normal coagulation time with more bleeding on slight injury RDA • 1000 IU per day • Infants at risk must receive a single IM injection of Vitamin K after birth
  • 42. Vitamin E Fat Soluble compound -----Tocopherols FUNCTIONS: • Helps in reproduction SOURCES: • Vegetable oils, Cotton seed, Sunflower seed, Egg yolk, Butter, Fortified Cooking Oils and Butter. DEFICIENCY: • Sterility in animals – Threatened abortion RDA: • Adults 10 mg • Infants 3 mg
  • 43. Vitamin D Nutritionally important forms in man are: 1. Calceferol (Vitamin D2) 2. Cholecalciferol (Vitamin D3) Functions: • Intestine & Kidneys: Promotes intestinal absorption of Ca and Phosphorus • Bone: Stimulates normal mineralization • Others: Permits normal growth Sources: • Animal fats, Fish liver oils, Liver, Egg yolk, Butter, Cheese, Milk • Fortified foods like Ghee, Margarine, Bread, Whole Milk, Infant Foods • Exposure to UV rays of Sunlight convert cholesterol in skin to Vit. D
  • 44. VITAMIN D DEFICIENCY DISORDERS • Rickets in children: A disease characterized by deformed bones • Osteomalacia in adults especially pregnant and lactating mothers TOXICITY • Excessive intake is harmful and may manifest itself as: anorexia, nausea, vomiting, thirst, drowsiness, coma and cardiac arrhythmias RDA • Adults 2.5 mcg (100 IU) • Infants and Children 5.0 mcg (200 IU) • Pregnancy & Lactation 10.0 mcg(400 IU)
  • 46. Vitamin C (Ascorbic Acid) Functions: • Plays an important role in tissue oxidation • Needed for the formation of collagen • Facilitates iron absorption from gut Sources: • Fresh fruits like citrus, guava, green leafy vegetables, germinating pulses and amla. Deficiency Disorders: • Rare – Scurvy characterized by swollen and bleeding gums, subcutaneous bleeding, bleeding in to joints, delayed wound healing and anemia. RDA • 40 to 60 mg per day
  • 48. Vitamin B1 (Thiamine) Functions: Maintain good appetite, normal digestion, muscle tone and healthy mental attitude Sources: • Good sources are: Soya bean, Peanuts, Whole grains, Cereals, Nuts & ground nuts. • Fairly good sources are Liver, Organ meat, Poultry, Egg yolk, Beans and Peas • Mother milk is a good source also. • Thiamine is lost during cooking due to leaching of the vitamin in to cooking water or when washed and also lost in foods having baking soda RDA Ranges between 0.5 mg – 2 mg per day
  • 49. Vitamin B1 Deficiency Disorders • Wernicke’s Encephalopathy • Beri Beri – Dry Beri Beri (when nervous system is affected) – Wet Beri Beri (when there are cardiac symptoms and signs) – Infantile Beri Beri (when mothers are thiamine deficient) Prevention • Encourage people to eat thiamine rich diet • Stop Alcohol • Supplements for lactating mothers
  • 51. Vitamin B2 (RiboFlavin) Functions: • Plays an important role in cellular growth • It is a cofactor involved in a number of enzymes involved in energy metabolism Sources: • Rich sources are eggs, liver, green leafy vegetables, milk & Products • Fair sources are wheat and pulses – Meat and fish contain small amounts • Losses are due to leaching of this vitamin in to cooking water RDA • 0.7 to 2.2 mg per day
  • 52. Vitamin B2 Deficiency Disorders • Ariboflavinosis (severe form) • Hyporiboflavinosis (milder form) • Skin and mucosa are affected – angular stomatitis, glossitis, circumcorneal vascularisation, keratitis, susceptibility to cataract • Impaired neuromotor function, impaired wound healing, peripheral neuropathy
  • 53. Vitamin B3 (niacin or niacinamide) Functions: • Essential for Carbohydrates, fats and proteins metabolism • Essential for the normal functioning of skin, intestines and nervous system • An essential amino acid tryptophane serves as its precursor Sources: • Coffee, Peanuts, Liver, Kidney, meat, poultry, fish, legumes and ground nuts • Milk is a poor source but a rich source of tryptophane • In maize niacin is in bound form and not available to body
  • 54. Vitamin B3 Deficiency Disorders • Pellagra: characterized by Diarrhea, Dermatitis and Dementia (occurs in maize eating communities) • Glossitis and Stomatitis (Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor and Glossitis: Tongue Inflammation) RDA • 0.7 to 2.2 mg per day
  • 55. Vitamin B5 (Pantothenic acid) Functions: Metabolism Sources: • Major source is meat. The most significant sources of pantothenic acid in nature are coldwater fish ovaries and royal jelly. • It is found in nearly every food, with high amounts in whole grain cereals, legumes, eggs, meat, royal jelly, avocado, and yogurt. • Whole grains are another good source of the vitamin, but milling removes much of the pantothenic acid, as it is found in the outer layers of whole grains • Pantothenic acid is an ingredient in some hair and skin care products
  • 56. Vitamin B5 Deficiency Disorders • Impaired energy production, due to low CoA levels, which could cause: irritability, fatigue, and apathy. Neurological symptoms can also appear in deficiency. They include numbness, paresthesia, and muscle cramps and Hypoglycemia. • Additional symptoms could include restlessness, malaise, sleep disturbances, nausea, vomiting, and abdominal cramps. • In a few rare circumstances, more serious (but reversible) conditions have been seen, such as adrenal insufficiency and hepatic encephalopathy. • One study noted painful burning sensations of the feet were reported in tests conducted on volunteers. Deficiency of pantothenic acid may explain similar sensations reported in malnourished prisoners of war. RDA RDA: 6 mg/day
  • 57. Vitamin B6 (PYRIDOXINE) Functions: Plays an important role in the metabolism of carbohydrates, fats and proteins Sources: Widely distributed in food e.g. milk, liver, meat, egg yolk, fish, whole grain cereals, legumes, and vegetables. Deficiency: • Rare but occurs with niacin deficiency • Peripheral neuritis • INH (Isoniazid for TB) is a known antagonist and patients on INH must get 10 mg pyridoxine per day RDA • 2 mg per day – In pregnancy and lactation 2.5 mg per day
  • 58. Vitamin B9 (Folic Acid) Functions: Plays an important role in the synthesis of nucleic acids Needed for the normal development of blood cells in the bone marrow Sources: Leafy vegetables, dairy products, Milk, eggs, cereals Deficiency Disorders: Megaloblastic anemia, glossitis, chielosis , GI disturbances like diarrhea. Severe deficiency may cause infertility and sterility. Folic acid antagonists like alcohol, pyramethamine and cotrimoxazole may cause abortion, congenital malformations Requirements are greatest when rapid cell multiplication like growth & pregnancy RDA • Healthy adults and children 100 mcg per day • Pregnancy 400 mcg per day • Lactation 150 mcg per day
  • 59. Vitamin B12 Cobalamins Functions: Cooperates with folates in the synthesis of DNA and helps in Synthesis of fatty acids in myelin Sources: • Liver, kidney, meat, fish, milk cheese • Not found in vegetables • Synthesized by bacteria in colon Deficiency Disorders: • Rare and usually in vegetarians • Megaloblastic anemia (Pernicious Anemia) • Demyelinating neurological lesions in the spinal cord RDA • Infants and children 0.2 mcg per day • Adults 1 mcg per day • Pregnancy and Lactation 1.5 mcg per day

Editor's Notes

  1. Marasmus is a disease caused by a severe deficiency of protein and calories that affect infants and very young children, often resulting in weight loss and dehydration. Marasmus can develop into starvation and cause fatality caused by a lack of essential nutrients. People with marasmus appear bony with little muscle tissueKwashiorkorKwashiorkor is a disease caused by a severe deficiency of protein in diets that contain calories mostly from carbohydrates such as yams, rice and bananas. It usually affects older children. People with kwashiorkor appear puffy in the abdomen area from retention of fluid, according to the University of Maryland Medical Center. Common symptoms of both marasmus and kwashiorkor include fatigue, irritability, diarrhea, stunted growth and impairment of cognition and mental health.CachexiaCachexia is a condition that involves protein deficiency, depletion of skeletal muscle and an increased rate ofprotein degradation. Cachexia causes weight loss and mortality and is associated with cancer, AIDS, chronic kidney failure, heat disease, chronic obstructive pulmonary disease and rheumatoid arthritis, Patients with malignant cancer of the stomach, colon, liver, billiary tract and pancreas experience undernutrition from reduced intake of protein, calories and micronutrients, and have fatigue and a negative nitrogen balance as a result of loss of muscle mass from cachexia.  
  2. KetosisBody cells, especially brain cells, prefer to burn glucose for energy, and yet high-protein diets that are low in carbohydrate cause the body to burn fat instead. In the process of breaking fat into a form that the body can use, a acidic waste product called ketone bodies are produced by the body cells. The condition in the body, known as ketosis, in interpreted by your body as a starvation signal. Your body responds by slowing your metabolism, in order to respond in the most efficient way to this perceived starvation. This means you body cells use less energy, and caloric demand decreases. In other words, your metabolism slows and it becomes easier to gain weight.