All nutrition .pptx

COURSE TITLE: NUTRITION
COURSE DURATION: 3 months
INSTRUCTOR: Mrs: Hodan Hassen Mohamed
 Title's: Bsc in MLT, Bsc in PH and MPH
REQUIRED TEXT: HUMAN NUTRITION
RELATED BOOKS

Introduction to the
Science of Nutrition
and
Related Definitions
Lecture 1

BASIC CONCEPT OF
NUTRITION
LECTURE ONE

• Introduction
• Definitions
• Energy from food
• Functions of food nutrients
• Composition of human body
• Nutrition assessment of individual
• Sign of good nutrition
• The relationship of nutrition with other
sciences
• Nutrient intake limits

 Most of the organized studies of nutrition have
been confined to the 20th century.
 Although there was evidence of long-standing
curiosity about nutrition.
 Hippocrates, the father of medicine(400 BC)
considered food as one universal nutrient.
 Antonie Lauret Lavoisier(18th century, a French
chemist) is known as father of nutrition.
 In Islam there are many verses of the Quran
and Hadeeths in food and nutrition.
 Some of these fact has just been proved by the
modern science and some not.

 Nutrition has played a significant role in
our life, even from before our birth.
 Many people are concerned only with
food that relives their hunger or satisfies
their appetite .
 But in many times, these foods don't
supply their bodies with all the
component of good nutrition.

Food Diet Nutrients
Nutrition
Nutrition
requirement
Nitrogen balance
Nutrition science Adequate diet Junk food
Nutritional
status
Nutritional care Calories
Empty calories Malnutrition Metabolism
Nutritive value Dietetics Nutritional genomics

Foods are products derived from plants or
animals .
that can be taken into the body to yield
energy and nutrients for maintenance of
life ,for growth and repair tissues.
Food is that nourishes the body.
Food is a requirement of nutrition.

Diet is the foods and beverages a person
eats and drinks.

 1. Classification of foods by origin
 • Foods of plants origin
 • Foods of animal origin

 2. Classification of foods by chemicals
 • Carbohydrates
 • Proteins
 • Fats
 • Vitamins
 • Minerals

 3. Classification of foods by predominant
 functions
 • Energy supplying food: cereals, sugars,
 roots, tubers, fats and oils.
 • Body building foods: milk, meat, poultry,
 eggs, fish, pulses and groundnuts.
 • Repairing and maintenance foods:
 Vegetables, fruits, milk.

Food
Nutrients
1-Macronutrients
2-Micronutrients
Other
compounds
-fibers
-phytochemicals
-pigments
-additives
-and others
Food composition

Nutrients:
Chemical substances obtained from foods
used in the body to provide energy, structure
materials, regulating agents to support
growth, maintenance, repair of body's tissues
and may also reduce the risks of some
diseases.

 Macronutrients
• Are the nutrients which the body needed in
large amount such as carbohydrate, protein
and fats.
• Carbohydrates, protein and fats are the main
source of energy for human body.
• Are the energy yielding nutrients.
 Micronutrients
Are nutrients needed in lesser amounts such as:
Vitamins & minerals.

Nutrients
Inorganic
(water &Mineral)
Organic
(CHO, lipids , protein and
vitamins)
Organic nutrients: substance that contain carbon atom.
Inorganic: substances that do not contain carbon atoms.

Are nutrients a person must obtain from
food because the body cannot make
them for itself insufficient quantity to
meet physiological needs. Also called
indispensable nutrients.

• Nutrition is the science of foods, nutrients
and other substances they contain their
actions within the body (including
ingestion, digestion, absorption,
transport, metabolism and excretion).
• A broader definition includes the social,
economic, cultural, and psychological
implications of food and eating.

The amounts of nutrient which are needed
for covering the human needs to be healthy
depend on sex, age and few other factors.

An individual condition of health in relation to
digestion and absorption of nutrients.
 Nutritional care:
Application of the science of nutrition in
nourishing the body regardless of health
problems or potential problems.

Adequate diet: is a diet
providing all the needed nutrients in
the right total amounts.
Junk food:
Refers to foods that are harmful.

• The energy released from carbohydrates,
proteins and fats can be measured in
calories.
• A calorie is the amount of heat necessary to
raise temperature of 1 gm of water by 1 C.
• 1000-calorie metric units are known as
kilocalories (kcal).
Empty-kcalorie foods
a popular term used to denote foods
contribute energy (from sugars, fat or both)
but lack in protein, vitamins and minerals
Example:(potato chips and candies).

the health profession responsible for the
application of nutrition science to
promote human health and treat disease
 Metabolism
The sum of all chemical reactions that take
place in the body which it maintains itself
produces energy for its functioning.

Nutrition science:
1-The study of nutrients and other substances in
foods and the body's handling of them.
2-Its foundation depends on several other sciences
including biology, biochemistry, and physiology.
3- Comprises the body of knowledge governing the
food requirement growth, activity, reproduction and
lactation.

 Undernutrition: deficient energy or nutrients.
•Symptoms of under nutrition (extremely thin,
losing muscle tissues, prone to infection and
disease, skin rashes, hair loss, bleeding gum
and night blindness).
 Overnutrition: excess energy or nutrient.
•Symptoms of overnutrition (heart disease,
diabetes, yellow skin, rapid heart rate and low
blood pressure).

• The proteins in the body undergo constant
turnover (degraded to amino acids and
resynthesized).
• Nitrogen balance is the difference between
the amount of nitrogen taken into the body
each day and the amount of nitrogen in
compounds lost.

 if: 1- More nitrogen is ingested than excreted, a person is
said to be in positive nitrogen balance (growing
individual such as children and pregnant).
 2- Less nitrogen is ingested than is excreted (negative
nitrogen balance, person eating either too little protein
or protein is deficient in one or more of the essential
amino acids, new protein cannot be synthesized and the
unused amino acids will be degraded, body function will
be impaired by the net loss of critical proteins.
 3- In contrast, healthy adults are in nitrogen balance and
the amount of nitrogen consumed in the diet equals its
loss in urine.

The amounts of nutrient which the food
consist of, determined by using:
 Food analysis.
 Food analysis tables.

1-Provide energy sources
2-Build tissues
3-Regulate metabolic process

1-Provide energy sources
• The major carbohydrates in the human diet
are starch, sucrose, fructose and glucose.
• Dietary carbohydrate (starches and sugars)
provided the body's primary source of fuel
for energy.
• Oxidation of carbohydrates to CO2 and
H2O in the body produces approximately 4
kcal/g.
• They also maintain the back-up store of
quick energy as glycogen (animal starch).

• Proteins are composed of amino acids that are joined
to form linear chains.
• The digestive process breaks down proteins to their
constituent to amino acids, which enter the blood.
• The primary function of protein is tissue building and
repairing body tissues.
• Dietary protein provides amino acids, amino acids
are the building unit necessary for construction and
repairing body tissues.
• Muscle protein is essential for body movement.
• Other proteins serve as enzymes.
• Other nutrients such as minerals and vitamins used in
tissue building and maintaining tissue.

• Minerals are also found in the fluids of the
body and influence their properties.
• There are 13 different vitamins, one vitamin
enables the eyes to see in dim light,
protect the lungs from air pollution
make the sex hormones,
stop the bleeding,
helps repair the skin,
replace old blood cells and lining of the
digestive tract.

• Many vitamins and minerals function as
coenzymes factors in cell metabolism.
• Other nutrients (water and fibers),
water provides the environment in which nearly
all the body's activities.
Also, in many metabolic reactions and supplies
the medium for transporting vital materials to
cells and waste products away from them.
• Dietary fibers help regulate the passage of food
material through the gastrointestinal tract and
influences absorption of various nutrients.

61%
17%
14%
6% 2%
water (61%)
Protein (17%)
Fats(13.8)
Minerals(6.1%)
Carbohydrates(1.5)

Evaluation of person's nutrition
1- Historical information (socioeconomic
status, drug use, diet and person's family
history).
2-A=Anthropometric data (height and weight).
3- B= biochemical data (Laboratory tests).
4-C=clinical assessment(Physical
examinations)
5-D=Dietary assessment

1. Well-developed body.
2. Ideal weight.
3. Good muscle development.
4. The skin is smooth and clear
5. The hair glossy and the eyes clear and
bright.
6. Appetite, digestion and elimination are
normal.
7. Have good resistance to infection.

Nutrition
food
science
physiology
biochemistry
biology
microbiology
Medicine

There are three main areas of
overlapping between nutrition and
medicine:
1-dietary control of disease.
2-the relationship between diet as a
possible causative factor in disease ex:
cancer, heart diseases etc.
3-the toxicology of natural and
processed foods.

CHAPTER TWO
Functions of Food
Food Composition
Food Exchange Lists
CARBOHYDRATES

COURSE TITLE: NUTRITION
COURSE VALUE: Three (3) credit hours per week
COURSE DURATION: 3months
INSTRUCTOR: Mrs: Hodan Hassen Mohamed
 Title's: Bsc in MLT, Bsc in PH and MPH
REQUIRED TEXT: HUMAN NUTRITION
RELATED BOOKS

1: Physiological functions of food.
The first function of the body is to provide energy.
The body needs energy to sustain the involuntary
processes essential for continuance of life, to carry
out professional, household and recreational
activities, to convert food ingested into usable
nutrients in the body, to grow and to keep warm.
The energy needed is supplied by the oxidation of
the foods consumed. supplied by the oxidation of the foods
consumed.

 The foods we eat become a part of us
 Thus one of the most important functions of
food is
 building the body.
 FOR Example A newborn baby weighing 2.7-3.2
kg can grow to its potential adult size of 50–60
kg.
 if the right kinds and amounts of food are eaten
from birth to adulthood.
 The food eaten each day helps to maintain the
structure of the adult body, and to replace worn
out cells of the body.

 The third function of food is to regulate activities
of the body. It includes regulation of such
 varied activities as:
 • Beating of the heart
 • Maintenance of the body temperature
 • Muscle contraction
 • Control of water balance
 • Clotting of blood
 • Removal of waste products from the body

 The fourth function of food is to improve our
body’s resistance to disease.
2: The Social Functions of Food
 Food has always been a central part of our
social existence.
 It has been a part of our community, social,
cultural and religious life.

 As food is an integral part of our social
existence, this function is important in daily
life.
 Refreshments served at get-togethers or
meetings create a relaxed atmosphere. The
menu for such get-together should bring the
people together, rather than divide them.

 In addition to satisfying physical and social
needs, food must satisfy certain emotional
needs.
These includes a sense of defense, love and
attention.
Thus familiar foods make us feel protected.
Anticipating needs and fulfilling these are
expressions of love and attention.
These sentiments are the basis of the normal
attachment to the mother’s cooking.
 Sharing of food is a token of friendship and
getting.

 Most food contain more than one nutrient.
 The nutrient contents of foods have been
determined
 by analyzing these in the laboratory.
 The composition of over 650 Indian foods has
been determined.
 The food composition tables give the
concentration of nutrients in 100 g of the safe
to eat.
 Therefore it is important to know how much of
the food purchased is edible

 the Food & Agriculture Organization (FAO)
(please refer to these books, which are listed
 Reading at the end of our study.
 It is good to remember that the nutritive value of
natural foods does not vary a great deal for a
particular variety of the same food from one
country to another.
 But there is a great variation in the
composition of prepared foods such as bread,
biscuits, cakes, etc.,

 In 1950, the American Diabetes Association
and the American Dietetic Association
collaboratively developed a system of food
lists to help diabetic patients to select foods
in their diets. Similar food lists were prepared
in other countries to help diabetics to choose
their foods.

 Each of the list includes a group of foods,
which supply about the same calories in the
portion indicated.
 Each food choice within a list is called an
exchange.
 It represents an amount of food that has
about the same macronutrient value as other
foods in the same group.
 The exchange lists are very useful tools in diet
planning in hospitals and in personal diet
management in the home.

GOOD OR BAD?
What are Carbohydrates?

 What are Carbohydrates?
 “Good” v. “Bad” Carbs
 What are the types of Carbohydrates?
 Dietary Fiber: How Much You Need.
 Tips for Adding More Fiber
 Tips for Avoiding Added Sugar
 How Many Carbohydrates, Do I Need
Daily?

 Definition:
a biological compound
containing carbon, hydrogen,
and oxygen that is an
important source of food and
energy
 Your body uses carbohydrates
to make glucose which is fuel
that gives your body energy.
 Glucose can be used
immediately or stored.
 Healthier foods high in
carbohydrates are ones higher
in dietary fiber without added
sugar.
 Carbohydrates can be found in
the following:
 Fruits
 Vegetables
 Breads, cereals, and other
grains
 Milk & milk products
 Foods containing added sugar

 “Good” Carbohydrates have
more fiber and complex
carbohydrates.
 Guidelines recommend
choosing fiber-rich
carbohydrate choices.
 Fiber-rich foods include:
fruits, vegetables, & whole
grain breads & pastas.
 “Bad” Carbohydrates are
referring to foods with refined
carbohydrates.
 Refined Carbohydrates are
items that are made from
white flour or added sugar.
 Examples: white bread, cakes,
& cookies

 Complex Carbohydrates:
◦ Starch & dietary fiber
◦ Starch is in certain vegetables like potatoes, dry beans, cereals.
◦ Fiber is in vegetables, fruits, & whole grain foods.
◦ There are two different types of fiber -- soluble and insoluble.
Both are important for health, digestion, and preventing diseases.
 Simple Carbohydrates:
◦ Can be found naturally or as added sugars
◦ Added sugars have fewer nutrients than foods with naturally-
occurring sugars
◦ Examples of ingredients as added sugar: brown sugar, corn
sweetener, corn syrup, dextrose, fructose, fruit juice concentrates,
glucose, high fructose corn syrup, honey.

 It is recommended that you get 14 grams of dietary
fiber for every 1,000 calories that you consume
each day.
 If you need 2,000 calories each day, you should try
to consume 28 grams of dietary fiber.
 To find out how many calories you need each day
visit mypyramid.gov and enter your age, sex,
height, weight, and activity level in the My Pyramid
Plan Tool.

 Choose whole
fruits
 Try to eat two
vegetables with
your evening meal.
 Choose whole
grain foods more
often.
 Make a meal around
dried beans or peas
instead of meat.
 Start your day with a
whole grain breakfast
cereal.

 Choose water instead of sugar-sweetened
sodas.
 Choose 4 fluid oz of 100% fruit juice Choose
breakfast cereals that contain no or less
added sugar.

 Follow a meal plan that gives you 45%-65% of the
calories you consume as carbohydrates.
 My Pyramid.gov or DASH
 A diet plan that is based on no carbohydrates is
not the healthy approach to weight loss.
 Choose more complex carbohydrates and avoid
food items with added sugar.

 Now that you’ve started….
◦ Don’t Stop!
◦ Make physical activity a lifetime habit
◦ If you stop exercising you’ll rapidly
lose the beneficial effects.
◦ Maintaining good cardiovascular
fitness is an ongoing process.

 Centers for Disease Control and Prevention
◦ www.cdc.gov/nutrition
 My Pyramid
◦ www.mypyramid.gov
 DASH
◦ www.dashdiet.org
 Mayo Clinic
◦ www.mayoclinic.com/health/high-fructose-corn-syrup

CHAPTER TWO
PART THREE
Digestion, Absorption and
Utilizations of Nutrients

Carbohydrates
The digestion process begins with
chewing the food in the mouth.
The enzyme (salivary amylase)
starts the digestion of starch in the
mouth.

The food tastes sweet due to these
products of hydrolysis.
The activity of amylase continues in
its movement from the mouth to the
upper part of the stomach.
But as soon as the food mass comes
in contact with hydrochloric acid
secreted there.
Very little digestion of carbohydrate
occurs in the stomach.

The small intestine is so named
because of the small diameter of its
tube. It is about 20 ft long.
Most of the digestive activity takes place
in its three compartments namely the
duodenum, the jejunum and ileum.
Carbohydrate digestion occurs almost
completely in the small intestine, mainly
in the duodenum.
Pancreatic amylase breaks starches
into maltose and dextrins.
The maltase from mucosal cells

CONT……………………………………………..
breaks down maltose to glucose. The brush border,
on the surface of the epithelial cells lining the
intestines, is the site of this enzyme action.
The enzymes sucrase, lactase, maltase, and
isomaltase, found on the outer cell membranes
of the intestines, act on the sugars sucrose,
lactose, maltose and isomaltose respectively. The
monosaccharides formed—glucose, galactose and
fructose—pass through the mucosal cell and via the
capillary into the blood stream. These are carried to
the liver by the portal vein.

 Digestion of proteins starts in the
stomach, which serves as a
storehouse, where some protein
hydrolysis begins.
Milk is clotted by a special enzyme
rennin and acid is added.
 Gastric juice, which is secreted by the
stomach, contains hydrochloric acid,
pepsin, rennin, mucin and other
substances.

 The stomach lipase does act on emulsified
fats in milk, cream, butter and egg yolk, but
most of the hydrolysis of fats takes place in
the small intestine.
 As soon as the food enters the duodenum,
the gall bladder releases some bile and the
pancreas secrete enzyme-rich juices.

 Cholesterol is hydrolysed by pancreatic
cholesterol esterase from ester form and
absorbed in the same manner as lipids.
 The fat soluble vitamins A, D, E and K are also
absorbed in a similar fashion.
 Some forms of the vitamins A, E and K and
carotene do not need bile acids for their
absorption.
 The digestive process is also aided by friendly
bacteria which live in the intestinal tract.
They help in hydrolysing food and manufacture
some of the nutrients (e.g., vitamin K, folic acid
and some Bcomplex vitamins).

 Vitamins and water pass unchanged from
the small intestine into blood by passive
diffusion.
 Mineral absorption, which is more
complex, occurs in three stages. In the
first stage, chemical reactions occur in the
stomach and intestines, which are affected
by the pH of the mix.
 In the second stage, these are carried
across the membrane into intestinal
mucosal cell.
 In the third stage, minerals are
transported into the blood stream or are
bound within the cell.

 Important interactions occur between
minerals in the gastrointestinal tract, which
affect the amount that is absorbed.
 There is simultaneous absorption of vitamins,
minerals and fluids through the intestinal
mucosa.
 About 8 liters of fluids move to and from
across the membrane of the gut to keep the
nutrients in solution.
 The current understanding of the sites and
routes of absorption of nutrients is depicted
in

 Several factors affect the digestion process.
These include:
 1. Psychological factors, which play an
important role in food acceptance, ingestion
and digestion.
 If one likes the sight, smell and taste of food, it
increases secretions of saliva, stomach juices
and motility of gastrointestinal tract.
 Even the thought of food increases these
secretions.
 On the other hand, if these are not liked, it
depresses the secretions.

2. Generally well cooked foods are more
digestible than raw foods.
3. Sound teeth to bite, cut and tear food into
smaller pieces helps digestion, absence of
molars, incisors and/or canine teeth affects
the person’s ability to grind the food
adversely and hence digestion is poor.

 Large intestine consists of cecum, colon,
rectum and the anal and is about 5 feet long.
 About 500 to 1,000 ml of water in the chyme
enters the colon each day.
 Most of it is absorbed and only 50 to 200 ml
is excreted in the faeces.
 Since the colonic contents move forward very
slowly,
most of the nutritionally valuable matter is
absorbed.

 Absorption and Transportation
 Absorption is the process of sucking up the
nutrients in the body.
 Most of the absorption takes place in the
small intestine. Absorption of food from the
digestive tract into the blood and lymph takes
place after the digested food is moved
forward by peristaltic waves (muscular
contraction and relaxation) into the small
intestine.

 These peristaltic waves push the food against the
absorbing surface of the intestinal wall.
 The intestinal wall is lined with four to five million
tiny finger-like projections called villi.
 .The cells which cover villi permit the absorption of
final products of digestion— small molecules of
sugars, amino acids and fat products and water,
into the vessels that carry away the blood and
lymph.

Metabolism of all nutrients occurs within the cells
of our body.
The final oxidation of nutrients into carbon
dioxide and water occurs in the mitochondria.
About 40 per cent of the energy released is used
to synthesize ATP, the remainder is released as
heat.
 The ATP formed provides energy for the synthetic
reactions in the cell.
 Fatty acid breakdown also occurs in the
mitochondria.
 The individual cells die and are replaced by new
cells formed as part of normal life processes.

 Glycolysis: Within the tissue cells, the first
phase of glucose breakdown occurs in the
cytoplasm.
 This anaerobic stage of carbohydrate
breakdown is known as glycolysis, in which
glycogen or glucose is converted to pyruvic
acid. This is schematically presented.

 Amino acids, the products of protein digestion are
absorbed by the tissues and used to synthesise
 tissue proteins, antibodies, some hormones and
vitamins.
 Amino acids are very labile compounds, which can be
converted to one another and into other substances.
 The first step in this process is called deamination, the
removal of amino group (—NH2).
 The amino group may be transferred to a keto-acid to
form amino acids, which are normally formed in the
body.
 Hence these amino acids are not essential to be
supplied in the diet.

LEARNING OBJECTIVES
 Introduction
 Nature, Composition and Classification
 Properties
 Functions
 Food Sources
 Utilization in the Body
 Regulation of Blood Sugar
 Recommended Dietary Allowances
 Clinical Problems

 In this chapter we will consider
carbohydrates, the primary fuel for our body.
 Can you imagine a meal without rice, chapati
or some other cereal preparation? No. Rice,
wheat and other grains are an important part
of each of our meal everyday.
 Thus cereals are our staple food.
 about 65 to 80 per cent energy is provided by
carbohydrates.

 There are practical reasons for the universal
use of carbohydrates in diets.
 The yield of cereals, the primary source of
carbohydrates, is high per unit area.
Therefore, they are widely available and are
an economic source of energy.
They are easily filled and have a long shelf-
life in dry storage.
They are mild flavored and combine well
with other foods.
Carbohydrate foods are easy to prepare.
.

Let us consider the nature, composition,
properties, functions, food sources, utilization,
requirement, and effect of deficiency of
carbohydrates.

 Carbohydrates are synthesized by all green
plants using solar energy, water from the soil
and carbon dioxide from the air.
 This complex process is called
photosynthesis, the prefix photo indicates
the importance of sunlight in this process.
 Plants are thus the primary source of food in
the world.

 Carbohydrates contain carbon, hydrogen and oxygen.
The suffix hydrate indicates that water and oxygen
occur in the same proportion as in water.
 The members of the simplest class of carbohydrates
have a single unit—monosaccharide (mono or one,
saccharine or sugar containing).
 Glucose is an example of this class.
 The disaccharides contain two sugars linked together
to form a chain.
 Cane or beet sugar (sucrose), milk sugar (lactose),
and
 maltose (malt sugar) are members of this class.

 Carbohydrates made up, of long chains of
sugars are called polysaccharides (poly—
many).
 Among them are starch, dextrins, glycogen,
cellulose, hemicelluloses, pectins, plant gums
and mucilages.

 Simple carbohydrates include mono- and
disaccharides.
 These are small molecules, which dissolve in
water and are absorbed very quickly in the
body.
 In contrast, starches and dietary fibers are
very large, complex molecules, containing
several hundred small sugar units and are
absorbed slowly.
 Therefore polysaccharides are referred to as
complex carbohydrates.

 Glucose, the most common monosaccharide,
is present in honey, fruits and corn syrup.
After absorption of food it is transported
through blood and hence is present in blood
as an easily available source of energy.

 Sugars are soluble in water, are sweet to taste
and are hygroscopic (absorb water from
theatmosphere).
 As they are hygroscopic, they need to be stored
in air tight containers.
 Sugars vary in their solubility in water; sucrose is
more soluble than glucose.
 Carbohydrates, can be ranked according to their
sweetness.
 Fructose is the sweetest and the most soluble
sugar.
It is followed by sucrose, glucose, dextrin and
lactose.

 Carbohydrates have many important functions in
the body:
 1. The primary function of carbohydrates in the
body is to supply energy.
 Each gramme of carbohydrate, as starch or
sugar, provides 4 kcal/g.
 Carbohydrates are a source of readily available
energy, which is needed for physical activities as
also the work of the body cells.
 The brain and the central nervous system are
dependent on the constant supply of glucose
from the blood to meet their energy needs.

2. Carbohydrates act also as reserve fuel supply in
the form of glycogen, stored in muscles and
liver.
The total amount of glycogen in the body is over
300g.
But it must be maintained by regular intake of
carbohydrates at frequent intervals, so that the
breakdown of fat and protein tissue is prevented.
3. Carbohydrates serve other special functions in
the body.
Carbohydrates provide chemical framework,
which combine with the nitrogen to synthesis
non-essential amino acids in the body.

4. Carbohydrates and their derivatives work as
precursors of important metabolic
compounds.
 These include nucleic acids, the matrix of
connective tissue and galactosides of nerve
tissue.
5. Lactose, the milk sugar, provides galactose
needed for brain development.
It aids absorption of calcium and
phosphorus, thus helping bone growth and
maintenance.

6. Lactose forms lactic acid in the intestinal
track due to the action of the bacteria
(lactobacilli)
present there.
These lactobacilli synthesis some of the B
complex vitamins.
It aids, bacteria (lactobacilli) present to
suppress the activities of bacteria and
protects us from their undesirable effects.

8. Carbohydrates are needed for ensuring
complete normal metabolism of fats, thus
preventing acidosis.
9. Carbohydrates are needed to prevent
dehydration.
A low carbohydrate diet causes loss of water
from tissues as also electrolytes (especially
sodium and potassium) in the urine and can
lead to involuntary dehydration.

10. Dietary fibre acts like a sponge and
absorbs water.
It helps smooth movement of food waste
through the digestive tract and the soft, bulky
stools are comfortably eliminated

 Carbohydrates are synthesised by plants and
occur in several forms.
 Starch is found in plant seeds (cereals and
legumes), roots and tubers.
 These foods are the primary energy sources
in the human dietary.

 Starch is partly hydrolysed by (salivary
amylase) in the mouth to dextrose and
maltose.
 Starch and dextrin are further hydrolyzed to
maltose by amylase in the small intestine.
Maltose, sucrose and lactose are further
broken down to glucose, fructose and
galactose (simple sugar units) by the
enzymes maltase, sucrase and lactase.

 The glucose formed by the digestion of the
starch and sugar is absorbed mainly into the
blood through the walls of the intestine and
carried to the liver.
 The glucose thus absorbed helps to maintain
the glucose level in blood and the glycogen
stores in the muscle and the liver.
 Whenever we need energy, the glycogen is
broken down to glucose which is oxidized
and the energy produced is used by the body.
 Any excess glycogen is converted to fat.

END
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UNIT THREE
 LEARNING OBJECTIVES
 Utilization in the Body
 Regulation of Blood
Sugar
 Recommended Dietary
Allowances
 Clinical Problems
PART TWO
The
Nutrient
s and
Energy

 Liver glycogen is continually converted to
glucose and diffuses into the blood to replace
the blood glucose used up by the tissues.
Muscle glycogen is used for energy by the
muscles.
 Only when muscle glycogen is oxidized to
lactic acid, the lactic acid is carried to liver
and converted to glucose and glycogen.

 In normal persons, the blood sugar level is
maintained at a constant level, which is 70 to
100 mg per 100 ml, under fasting conditions.
 A number of hormones regulate the
reactions, and ensure the maintenance of
normal blood sugar level.
 These hormones are insulin, glucagon,
epinephrine,glucocorticoids, thyroxine and
growth hormones.

 A minimum of 100g carbohydrates are
needed in the diet to ensure the efficient
oxidation of fats.
 Most diets supply more than this amount.
 If the carbohydrate foods are consumed in
excess of the body’s need, the excess is
converted into fat and is stored as reserve.

 Obesity: It is very easy to take sweets, soft
drinks, etc., in excess of one’s needs.
 Most of these sweets contain a lot of fat also,
which is a concentrated source of calories.
 When the energy intake exceeds
expenditure, the excess is deposited as fat.
 Over a period of time, overweight and
obesity can occur.
 Obesity is known to be a predisposing factor
for a number of health problems.

 If sugar remains in contact with the teeth, it
tends to lead to tooth decay.
 If it is not checked, it may lead to dental
caries.
 Chewy sweets tend to remain in contact with
teeth for long periods, unless children are
taught to rinse their mouth thoroughly after
eating as also food.

 If less than required amount of carbohydrates
is consumed the body first burns its own fat
and then its tissue proteins for heat and
energy.
 To prevent this, daily diet must supply the
required amount of carbohydrates regularly.

 Lack of fibre in the diet usually makes it
difficult to eliminate food waste from the
body.
 Consistent shortage of fibre in the diet could
lead to constipation and other disturbances
of the colon.
 This condition could be corrected by
including foods containing whole grain
cereals, fruits with skins and vegetable and
fruit salads in the diet.

 Constipation is a common problem in large
percentage of the population.
 One of the reasons for this condition is the
intake of refined foods.
 An increase in fibre intake helps to correct
this ailment.
 Eating leafy vegetables, cluster beans, etc.,
has been found to ensure smooth, regular
elimination.

 As has already been described, these groups
of substances are not digestible and do not
contribute any nutrients to the body.
 These indigestible substance, however, do
serve a useful purpose in facilitating the
elimination of intestinal wastes.
They stimulate the peristaltic movements of
the gastrointestinal tract.

 The exact amount of fibre needed by the human body
cannot be stated.
 Some experts feel 100 mg fibre per kg or about five
to sixs grams per day is sufficient for the adult.
 An average mixed diet consisting of a raw vegetable,
fresh fruit with skins, cooked fruits and vegetables
will usually provide sufficient fibre.
 Fibre content of the diet can be increased by use of
some whole grain cereals or whole wheat bread.
 Chapatis made from whole wheat flour are also a
good source of fibre.

 Introduction
 Composition
 Sources
 Classification
Fatty Acids
Triglycerides
Fats, Oils and Other Lipids
Phospholipids
Sterols
Cholesterol
Lipoproteins
 Functions
 Essential Fatty Acids (EFAs)

 Fats are an essential part of our body, accounting for
important part of our body weight.
 The cells and tissues of our body have fat as an
integral part.
 The vital organs (brain, heart, liver) are protected by a
Fats and Other Lipids 47 sheath of fat and water,
which holds them in place and prevents injury.
The nerves are also protected by fat.
A layer of fat beneath the skin acts as a insulation
against cold.
The fat around the joints acts as a lubricant and
allows us to move these smoothly.
Thus fat is a fundamental part of the body
composition.

 Fats are the best known members of a
chemical group called, the lipids.
 They constitute an important part of our
dietary and supply 10–30 per cent of the total
energy needs.
 Food fats include solid fats, liquid oils and
related compounds such as fat-soluble
vitamins and cholesterol.

 In the middle of last century, fats were
expensive and a meal containing large
amounts of fat was
called a ‘rich meal’.
Persons consuming such meals were
thought to be healthy.

 The weight increase discourages movement,
increases pressure on the circulation, respiration
and skeletal frame. Hence it is recognized as a
risk factor for several chronic ailments.
 In this chapter, let us consider fats not only as
essential body component, nutrient and compact
storage fuel, but also as a health hazard.
 We need to achieve a realistic balance between
meeting our needs and avoid health problems
due to excessive intake.

 Lipids is an overall group, which includes all
fats and related compounds.
 The word is derived from the Greek word
(lipos) which means fat.
 It is used in combination words to name fat-
related health problems, e.g., hyperlipidemia
refers to elevated level of blood fats.
 Like carbohydrates, lipids contain the
elements carbon, hydrogen and oxygen, and
some contain
phosphorus and nitrogen.

 Lipids have fewer oxygen atoms in their
structure than carbohydrates.
 Therefore more oxygen is needed to oxidize
lipids and more energy is released per g of
lipid as compared to a g of carbohydrates.

 Lipids are an essential part of the body
structure.
 Body fat accounts for 15 to 20 per cent of
body
weight in healthy non-obese men and 18 to
25 per cent in healthy non-obese women.
The fat content of body increases in
sedentary individuals and senior citizens if
they do not have active leisure time activities.

 Lipids are widely distributed in nature.
 They are soluble in organic solvents, namely,
ether, chloroform, benzene and other fat
solvents.
 Fatty acids, fats and oils, phospholipids,
sterols and lipoproteins are some of the
groups of lipid compounds, which are
important in the study of nutrition.

 Vegetable oils, used in food preparation, are
extracts of oilseeds and nuts.
 The important sources of vegetable oils are
depicted in Butter and ghee are animal fats
extracted from milk.
 Plant oils are hydrogenated to form a almost
solid fat known as vanaspati.
 Vanaspati is usually fortified with vitamin A
and D, as it is used in place of ghee.

 The animal foods, milk, egg, meat and liver,
which contain fat, are sources of hidden fat in the
diet.
 Nuts, oilseeds, milk, eggs and meat supply not
only fat but also protein , minerals and vitamins
of the B-complex group.
 Ghee, butter, eggs and liver are good sources of
vitamin A.
 Some distinguished oils and vanaspati are
fortified with vitamin A.
 Use of ghee, butter, fortified refined oil or
vanaspati helps to meet a part of the day’s need
for vitamin A.

 Lipids are classified into three groups on the
basis of their chemical structure:
 1. Simple lipids, which include fats and oils,
 2. Compound lipids, which comprise of
phospholipids and lipoproteins, and
 3. Derived lipids such as fatty acids and
sterols

 There is no precise definition of the word
‘fat’.
 The term is applied to foods which are fatty,
immiscible in water and fatty in texture.
 Every fat molecule has glycerol at its core and
three fatty acids attached to it.
 The nature of the fat or the oil depends on
the kind of fatty acids linked to the glycerol.

 The hardness, melting-point and the flavour
of the fat is related to the length of the
carbon chain and the level of the saturation
of the
fatty acid.
If the substance is a liquid at 20°C it is
called an oil, if solid at that temperature, it is
known
as fat.

 Saturated fatty acids are found in solid fats
whereas most of the oils contain unsaturated
fatty acids.
 The unsaturated fatty acids can be converted
to saturated ones, thus changing the physical
and
chemical characteristics of the oil, by a
process known as hydrogenation in which
hydrogen is added on to the oils, in the
presence of a catalyst.

 Fatty acids are the main building blocks of
fats. Fatty acids have a methyl group (CH3) at
one end
and a carboxyl group (COOH) at the other
end with a chain of carbon and hydrogen
atoms in the
middle.
 About twenty fatty acids are found in foods
and body tissues.

 Saturated fatty acid has a single bond between
its carbon atoms, thus the molecule is saturated
with hydrogen. Stearic acid is an example of a
saturated fatty acid.
 Unsaturated fatty acids have one or more double
bonds in their molecule and are thus not
saturated with hydrogen.
 Further monounsaturated fatty acids (MUFA) have
only one double bond in the molecules.
 Oleic acid, found in olive oil, is a
monounsaturated fatty acid.

 Polyunsaturated fatty acids (PUFA) have two or
more double bonds in the molecules.
 Corn oil contains polyunsaturated fatty acids.
 The methyl end of the fatty acid molecule is
called the omega end.
 If the first double bond in the fatty acid is in the
third carbon atom from the methyl end, it is
called omega-3 fatty acid.
 if it is in the sixth carbon from the methyl end, it
is called omega-6- fatty acid and when it is in
the ninth carbon, it
is called omega-9 fatty acid.

 Examples of these are:
 Oleic acid — Omega-9-fatty acid, which is a
MUFA.
 Linoleic acid, omega-6-fatty acid, which is a
PUFA.
 Linolenic acid, omega-3-fatty acid, which is
also a PUFA.
 Fatty acids are found in all simple and
compound lipids.

 Cholesterol is an essential part of each cell and
every type of human cell makes cholesterol.
 Each day our liver makes about 800 mg of
cholesterol, which circulates through the blood
stream and is used wherever it is needed.
 It is a precursor of vitamin D, hormones and bile
acids.
 The hormones made from cholesterol include
corticosteroids, estrogens, testosterone and
calcitriol (the active vit. D hormone).
 Bile acids needed for fat digestion, are formed
from cholesterol.

 Lipoproteins are synthesized in the liver.
 They are composed of three-fourth to two-third
lipids
and the remainder protein.
These serve as the major vehicle for fat transport
in the blood stream.
The blood is mainly water and fat needs a water
soluble cover of protein to permit it to be carried
by blood.
 The lipoproteins contain triglycerides, cholesterol
and other substances such as fat soluble
vitamins.

 The density of lipoproteins is dependent on
the amounts of fat and protein in it.
 The higher the fat content, the lower the
density.
Four groups of, lipoproteins that have been
identified are chylomicrons, low density
lipoproteins (LDL), high density lipoproteins
(HDL), and very low density lipoproteins
(VLDL). The LDLs carry fat and cholesterol to
cells.

 The HDLs carry free cholesterol from body
tissues to the liver for breakdown and
excretion.
 Like cholesterol, there is much interest now
in these lipoproteins because their
concentration
in the blood plasma needs to be maintained
within certain limits for good health.
Their levels in blood plasma are routinely
tested to detect lipid disorders, which are
related to heart ailments.

Protein is a chain of amino acids joined by peptide
bonds in a specific sequence.
Protein is an essential nutrient.
There is no life without protein. Protein is contained in
every part of your body, the skin, muscles, hair, blood, body
organs, eyes, even fingernails and bone.
Next to water, protein is the most plentiful substance in
your body.

Globular proteins usually do not serve a
structural function — they act as transporters, like
hemoglobin, and are often enzymes. They are
usually water-soluble

Protein has a critical physiological function. Protein
is primarily used in the body to build, maintain, and
repair body tissues.
In the event that protein intake is greater than that
required by the body for this primary function, excessive
protein is converted to energy for immediate use or
stored in the body as fat.
Protein energy will be used only after other energy
sources (carbohydrate and fat) are exhausted or
unavailable.

 Protein is vital in the maintenance of body tissue,
including development and repair.
 Protein is the major source of energy.
 Protein is involved in the creation of some
hormones, help control body functions that involve
the interaction of several organs and help regulate
cell growth.
 Protein produces enzymes that increase the rate
of chemical reactions in the body.

 Proteins transport small molecules through the
organism. Hemoglobin is the protein that
transports oxygen to the cells and it is called as
transport protein.
 Proteins called antibodies help rid the body of
foreign protein and help prevent infections,
illnesses and diseases.
 protein help store other substance in the organism.
For example, iron is stored in the liver in a
complex with the protein ferritin.

 Proteins help mediate cell responses, such as the
protein rhodopsin, found in the eye and involved in
the vision process.
 Proteins make up a large protein of muscle fiber
and help in the movement of various parts of our
bodies.
 Skin and bone contain collagen, a fibrous protein

Proteins are composed of small units. These
units are the amino acids which are called the building
blocks of protein. There are about 20 different amino
acids which are commonly known.
Each different protein is composed of various
amino acids put together in varying order with almost
limitless combinations. Most proteins are large
molecules that may contain several hundred amino
acids arranged in branches and chains.

Biochemists have distinguished several levels of
structural organization of proteins. They are:
1. Primary structure
2. Secondary structure
3. Tertiary structure
4. Quaternary structure

Course nutrition
UNIT: FIVE PART TWO .
LECTURER: HAMDI HASSAN HASHI

 MALNUTRITION
WHO defines Malnutrition as "the cellular imbalance
between the supply of nutrients and energy and the
body's demand for them to ensure growth,
maintenance, and specific functions.“
Malnutrition is the condition that develops when the
body does not get the right amount of the vitamins,
minerals, and other nutrients it needs to maintain healthy
tissues and organ function.

 PROTEIN ENERGY MALNUTRITION
It is a group of body depletion disorders which
include kwashiorkor, marasmus and the intermediate
stages
 MARASMUS
Represents simple starvation . The body adapts to a
chronic state of insufficient caloric intake
 KWASHIORKOR
It is the body’s response to insufficient protein intake
but usually sufficient calories for energy


 PEM is also referred to as
protein-calorie malnutrition.
 It is considered as the primary
nutritional problem in world
wide.
Also called the 1st National
Nutritional Disorder.
 The term protein-energy
malnutrition (PEM) applies to
a group of related disorders
that
include marasmus, kwashiork
or, and intermediate states of
marasmus-kwashiorkor.
 PEM is due to “food gap”
between the intake and
requirement.

AETIOLOGY:
Different combinations of many aetiological
factors can lead to PEM in children. They are:
Social and Economic Factors
Biological factors
Environmental factors
Age of the Host

 Lack of breast feeding and giving diluted formula
 Improper complementary feeding
 Over crowding in family
 Ignorance
 Illiteracy
 Lack of health education
 Poverty
 Infection
 Familial disharmony

 Age Of Host :
 Frequent in Infants & young children whose rapid
growth increases nutritional requirement.
 PEM in pregnant and lactating women can affect the
growth, nutritional status & survival rates of their
fetuses, new born and infants.
 Elderly can also suffer from PEM due to alteration of
GI System

Primary PEM:
Protein + energy intakes below requirement for normal growth.
Secondary PEM:
 the need for growth is greater than can be supplied.
 decreased nutrient absorption
 increase nutrient losses
Linear growth ceases
Static weight
Weight loss
Wasting
Malnutrition and its signs
AETIOLOGY of PEM:

1. Kwashiorkor
2. Marasmic-kwashiorkor
3. Marasmus
4. Nutritional dwarfing
5. Underweight child

 The term kwashiorkor is taken from the Ga language of
Ghana and means "the sickness of the weaning”.
 Williams first used the term in 1933, and it refers to an
inadequate protein intake with reasonable caloric
(energy) intake.
 Kwashiorkor, also called wet protein-energy
malnutrition, is a form of PEM characterized primarily by
protein deficiency.
 This condition usually appears at the age of about 12
months when breastfeeding is discontinued, but it can
develop at any time during a child's formative years.
 It causes fluid retention (edema); dry, peeling skin; and
hair discoloration.

 Kwashiorkor was thought to be caused by
insufficient protein consumption but with
sufficient calorie intake, distinguishing it
from marasmus.
 More recently, micronutrient and
antioxidant deficiencies have come to be
recognized as contributory.
 Victims of kwashiorkor fail to
produce antibodies following vaccination against
diseases, including diphtheria and typhoid.
 Generally, the disease can be treated by
adding food energy and protein to the diet;
however, it can have a long-term impact on a
child's physical and mental development, and in
severe cases may lead to death.


 Changes in skin pigment.
 Decreased muscle mass
 Diarrhea
 Failure to gain weight and
grow
 Fatigue
 Hair changes (change in
color or texture)
 Increased and more severe
infections due to damaged
immune system
 Irritability
 Large belly that sticks out
(protrudes)
 Lethargy or apathy
 Loss of muscle mass
 Rash (dermatitis)
 Shock (late stage)
 Swelling (edema)

 The term marasmus is derived from the Greek
word marasmos, which means withering or wasting.
 Marasmus is a form of severe protein-energy
malnutrition characterized by energy deficiency and
emaciation.
 Primarily caused by energy deficiency, marasmus is
characterized by stunted growth and wasting of muscle and
tissue.
 Marasmus usually develops between the ages of six
months and one year in children who have been weaned
from breast milk or who suffer from weakening conditions
like chronic diarrhea.


Severe muscle wasting
 Severe growth retardation
 Loss of subcutaneous fat

 The child looks appallingly thin and
 Shriveled body
 Wrinkled skin
 Bony prominence
 Associated vitamin deficiencies
 Failure to thrive
 Irritability, fretfulness and apathy
 Frequent watery diarrhoea and acid
stools
 Mostly hungry but some are
anoretic
 Dehydration
 Temperature is subnormal
 Muscles are weak
 Oedema and fatty infiltration are
absent

DIFFERENCE IN CLINICAL FEATURES
BETWEEN MARASMUS AND
KWASHIORKOR

St.Ann's Degree College for Women

A severely malnourished child
with features of both
marasmus and Kwashiorkor.
 The features of
Kwashiorkor are severe
oedema of feet and legs and
also hands, lower arms,
abdomen and face. Also
there is pale skin and hair,
and the child is unhappy.
 There are also signs of
marasmus, wasting of the
muscles of the upper arms,
shoulders and chest so that
you can see the ribs.

 Some children adapt to prolonged insufficiency of
food-energy and protein by a marked retardation of
growth.
 Weight and height are both reduced and in the same
proportion, so they appear superficially normal.

 Children with sub-
clinical PEM can be
detected by their weight
for age or weight for
height, which are
significantly below
normal. They may have
reduced plasma albumin.
They are at risk for
respiratory and gastric
infections


Treatment strategy can be divided into three stages.
 .
 There are three stages of treatment.
1. Hospital Treatment
 The following conditions should be corrected.
 Hypothermia, hypoglycemia, infection, dehydration, electrolyte imbalance, anaemia
and other vitamin and mineral deficiencies.
2. Dietary Management
 The diet should be from locally available staple foods - inexpensive, easily digestible, evenly
distributed throughout the day and increased number of feedings to increase the quantity of food.
3. Rehabilitation
 The concept of nutritional rehabilitation is based on practical nutritional training for mothers in which th
learn by feeding their children back to health under supervision and using local foods.

 Promotion of breast feeding
 Development of low cost weaning
 Nutrition education and promotion of correct
feeding practices
 Family planning and spacing of births
 Immunization
 Food fortification
 Early diagnosis and treatment

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