Nutrition and Health PDF

NUTRITION AND HEALTH 1  INTRODUCTION ▪ The word nutrient or “food factor” is used for specific dietary constituents such as proteins, vitamins and minerals. ▪ Dietetics is the practical application of the principles of nutrition; it includes the planning...

NUTRITION AND HEALTH 1  INTRODUCTION ▪ The word nutrient or “food factor” is used for specific dietary constituents such as proteins, vitamins and minerals. ▪ Dietetics is the practical application of the principles of nutrition; it includes the planning of meals for the well and the sick. 2  INTRODUCTION ▪ Good nutrition means “maintaining a nutritional status that enables us to grow well and enjoy good health.” 3 ▪ Protein, carbohydrate and fat had been recognized early in the 19th century as energy- yielding foods and much attention was paid to their metabolism and contribution to energy requirements. 4 ▪ Nutrition is defined as the science of food and its relationship to health. ▪ It is concerned primarily with the part played by nutrients in body growth, development and maintenance. 5  ▪ Food is that which nourishes the body. ▪ Food may also be defined as anything eaten or drunk, which meets the needs for energy, building, regulation and protection of the body. ▪ Diet refers to whatever you eat and drink each day. 6  CLASSIFICATION OF FOODS ▪ Classification by origin: - Foods of animal origin - Foods of vegetable origin ▪ Classification by chemical composition: - Proteins – Fats – Carbohydrates – Vitamins – Minerals 7  CLASSIFICATION BY PREDOMINANT FUNCTION ▪ Body building foods: -meat, milk, poultry, fish, eggs, pulses etc ▪ Energy giving foods: -cereals, sugars, fats, oils etc. ▪ Protective foods: -vegetables, fruits, milk, etc 8  NUTRIENTS ▪ Organic and inorganic complexes contained in food are called nutrients. They are broadly divided in to: ▪ Macronutrients: -Proteins -Fats -Carbohydrates ▪ Micronutrients: -Vitamins -Minerals 9  PROTEINS ▪ Proteins are complex organic nitrogenous compounds. ▪ They also contain sulfur and, in some cases, phosphorous and iron. ▪ Proteins are made of monomers called amino acids. 10 ▪ Amino Acids are the building blocks of proteins. There are 100,000 types of proteins that are made up of just 20 amino acids. Some common examples of proteins are collagen, keratin, hemoglobin etc. 11  What are Essential Amino Acids? ▪. 12  What are Essential Amino Acids? There are about 20 different amino acids which are found in human body. ▪ Of this 8 AA are termed “essential” as they are not synthesized in human body and must be obtained from dietary proteins. ▪ Essential amino acids are Histidine, Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Threonine, Tryptophan and Valine. 13  Functions of Proteins ▪ Body building ▪ Repair and maintenance of body tissues ▪ Maintenance of osmotic pressure ▪ Synthesis of bioactive substances and other vital molecules ▪ Part of enzymes and hormones ▪ Transport nutrients and oxygen 14 Functions of Proteins 15  Assessment of Protein nutrition status ▪ Protein nutrition status is measured by Serum Albumin Concentration. ▪ It should be more than 3.5 g/dl. ▪ Less than 3.5 g/dl shows mild malnutrition. ▪ Less than 3.0 g/dl shows severe malnutrition. 16  Who needs more proteins? ▪ During periods of rapid growth ▪ Children ▪ Pregnant ▪ Breast-feeding moms. 17 Food rich proteins 18  What is a calorie? ▪ Are the unit used to measure energy in the body ▪ Protein contains 4 cal /gm ▪ Carb contains 4 cal / gm ▪ Fats contains 9 cal / gm 19  Calories In physical terms, one calorie (“small calorie”, symbol: cal) is defined as the amount of heat energy needed to increase the temperature of one gram of water by one degree Celsius (1°C) at a pressure of one atmosphere (101.325 kPa). 20  Calories In terms of nutrition kilocalories (“large calories”, symbol: kcal) are more commonly used to express the amount of energy value of particular foods. ▪ The total number of calories within a particular food is the sum of the amount of energy released by each of the components (protein, carbohydrates, and fats), minus the fiber content. Fiber is removed as humans are not able to fully digest it. 21 Calories 22  Energy balance ▪ A person maintains energy balance when the number of calories are eaten is the same as the number used ▪ Several factors can affect this balance as:- 1. Body size 2. Age 3. gender 4. Level of activity 5. Special factors as pregnancy, growth and breast feeding. 23  Fats Another major class of nutrients found in foods is fat. Fats have more calories than carbohydrates and proteins, and eating large amounts of fat can lead to weight gain and obesity. 24  FAT ▪ Most of the body fat (99 per cent) in the adipose tissue is in the form of triglycerides. ▪ In normal human subjects, adipose tissue constitutes between 10 and 15 per cent of body weight. 25  Fats Our bodies need fat to carry out certain essential functions, such as the absorption of vitamins A, D, E, and K. Fats are also what give our food its flavor, aroma, and texture and make us feel full. 26  Fats Fats come in three types: 1. Saturated 2. unsaturated (monounsaturated and polyunsaturated) 3. trans fats. 27  Fat requirements ▪ In developed countries dietary fats provide 30 to 40 per cent of total energy intake. ▪ The WHO Expert committee on Prevention of Coronary Heart Disease has recommended only 20 to 30 per cent of total dietary energy to be provided by fats. ▪ At least 50 per cent of fat intake should consist of vegetable oils rich in essential fatty acids. 28 Fats 29  Saturated Fats Saturated fats are the least healthy and can raise cholesterol levels in the blood. They are typically solid at room temperature. Usually come from animal sources, like meat, milk, cheese, butter, egg yolks, and cream. 30  Unsaturated Fats ▪ Are usually liquid at room temperature ▪ They almost come from plant sources ▪ Are classified as mono, poly unsaturated fats ▪ Omega 3 fats are polyunsaturated fats ▪ Main sources are cold water fish and tuna, mackerel and salmon ▪ Flaxseed and soybean and canola oil 31  Trans Fats Trans fats, also known as trans-fatty acids, are a type of unsaturated fat that occurs naturally in small amounts in some animal-based foods. These are most produced industrially by adding hydrogen to vegetable oil to make it more solid through a process called hydrogenation. 32  Trans Fats ▪ Found in French fries baked goods, cookies, and crackers. 33  Trans Fats ▪ Should be limited or avoided as, 1. It increase the risk of CVS diseases 2. Contributes to obesity 3. Negatively affect the immune system. 4. Increase the risk of other chronic diseases, such as type 2 diabetes, cancer, and other inflammatory diseases. 34  Cholesterol ▪ Waxy , fat like substances found in every cell in your body ▪ Cholesterol is not fat; it has a different chemical structure and performs different functions in our body than fats ▪ It isn’t necessary to get cholesterol in our diet because your liver makes it if you don’t eat foods containing it. 35  Cholesterol ▪ Cholesterol circulates in the blood stream in particles called lipoproteins. 36  Cholesterol ▪ Blood Cholesterol - made by your liver ▪ Dietary Cholesterol - cholesterol from food is called dietary cholesterol. ▪ Cholesterol Functions ▪ Just like oil and water, cholesterol and blood don’t mix. To help cholesterol move through your blood, it’s coated with a layer of protein, called a lipoprotein. 37 Cholesterol 38  Cholesterol ▪ Low-density lipoproteins (LDLs). ▪ High- density lipoproteins (HDLs). Both are made only in the body and are not found in foods. LDL carries most of your blood cholesterol to cells where it is used. 39  Cholesterol If too much LDL cholesterol is in the blood, it can start to build up on the walls of your arteries, increasing your risk for heart disease. We call LDL cholesterol ‘bad’ cholesterol because of its potential to increase the risk of 40 heart disease.  Cholesterol HDL, on the other hand, helps remove cholesterol from the blood and prevent fatty buildup. This reduces your risk of heart disease, which is why it’s called ‘good’ cholesterol. You can remember that HDL is the good cholesterol by thinking of the ‘H’ as ‘hero.’ 41  Dietary Cholesterol Dietary cholesterol is found only in foods from animals. High-fat foods like nuts, peanut butter, vegetable oil, and avocados contain fat, but they don’t contain cholesterol because they come from plants, not animals. Too much dietary cholesterol can raise blood cholesterol levels, increasing risk for heart disease. You don’t need to stop eating foods containing cholesterol, but just be aware of how much total cholesterol you’re taking in. 42 Dietary Cholesterol 43  Recommendations for Fat in Diet ▪ For those over two years of age: 1. Limit the total fat you eat to 20-35 percent of your total calories 2. Most fat should come from foods high in polyunsaturated and monounsaturated fats, and finally, 3. Limit saturated and trans fats in your diet. 44  Essential fatty acids are those that cannot be synthesized by humans ▪ Dietary sources of EFA Linoleic acid ▪ Sunflower oil ,Corn oil ,Soya bean oil Sesame oil ,Groundnut oil ,Mustard oil Palm oil and Coconut oil Arachidonic acid;(polyunsaturated omega 6 F A) ▪ Meat, eggs, milk Linolenic acid ▪ Soya bean oil, Leafy greens 45  Functions of fats ▪ They are high energy foods, providing as much as 9 kcal for every gram. ▪ Fats serve as vehicles for fat-soluble vitamins ▪ Fats in the body support viscera such as heart, kidney and intestine; and fat beneath the skin provides insulation against cold. 46 The “non-calorie” roles of fat ▪ vegetable fats are rich sources of essential fatty acids which are needed by the body for growth, structural integrity of the cell membrane and decreased platelet adhesiveness. ▪ Diets rich in EFA have been reported to reduce serum cholesterol and low- density lipoproteins. ▪ Polyunsaturated fatty acids are precursors of prostaglandins. 47 Thank you 48 NUTRITION AND HEALTH lecture 2 Prof Dr. Azza Koura DR. Hagar samir 1  CARBOHYDRATE ▪ Carbohydrate is the main source of energy, providing 4 Kcals per one gram. 2  CARBOHYDRATE ▪ Carbohydrate is the main source of energy, providing 4 Kcals per one gram. ▪ Carbohydrate is also essential for the oxidation of fats and for the synthesis of certain non-essential amino acids 3 CARBOHYDRATE 4  CARBOHYDRATE ▪ Best fuel – provide energy quickly and efficiently ▪ Two types – Simple sugars ▪ Glucose (monosaccharide) – most common form ▪ Fructose (monosaccharide) – found in fruits and berries ▪ Sucrose (disaccharide) – sources include granulated sugar, milk and milk products – Complex carbohydrates (polysaccharides) ▪ Starches – from flour, pasta, potatoes –Stored in the body as glycogen ▪ Fiber 5 CARBOHYDRATE 6  Sugars ▪ Some come naturally in foods, like apples, and some have added sugars, like chocolates. ▪ Either way, the body can’t tell the difference between the two types. It treats all sugars basically the same way. 7  Sugars Empty Calorie Foods Empty calories are calories from foods that contain very few healthy nutrients. These foods typically contain a lot of sugar as candy, cakes, Doughnut and cookies. 8 Sugars 9 Sugars 10  Starch ▪ Another type of carbohydrate is starch, mainly found in grains such as wheat, rice, corn, and oats, also legumes, dry beans, peas, potatoes and yams. ▪ High-starch foods usually have more vitamins, minerals, and fiber than high- sugar foods. 11  Starch Hidden Starches ▪ they are Less obvious. ▪ These starches are added to foods during cooking. ▪ Some examples are adding flour to gravy to thicken it, and breading on meats and poultry, such as fried chicken or nuggets. 12  Starch Hidden Starches 13  Fibers The final type of carbohydrate is fiber. Our bodies don’t have the enzymes needed to break fiber down into smaller units for absorption. This means fiber cannot be used for energy. ❖There are two types of fiber: Insoluble Fiber (or roughage) Soluble Fiber 14  Fibers Insoluble Fiber Doesn’t dissolve in water, but it does absorb water. Creating bulkier, softer stool makes it easier for small intestine and colon to push waste through. This extra bulk reduces constipation and may help prevent diseases, such as colorectal cancer. Whole-wheat flour, nuts and many vegetables are good sources of insoluble fiber. Soluble Fiber Soluble fiber dissolves in water to form a gel-like, gummy material It can help lower blood cholesterol and glucose levels. Soluble fiber is found in oats, peas, beans, apples, citrus fruits, and carrots. 15 Fibers 16  Fibers Offers many health protections Colon and rectal cancer Breast cancer Constipation Heart Disease Diabetes Obesity Recommended is 20-30 grams and average is 12 grams 17  Fibers ▪ Functions of fibers – Maintain healthy skin – Insulate body organs – Maintain body temperature – Promote healthy cell function – Carry fat-soluble vitamins A, D, E, and K – Are a concentrated form of energy 18 Fibers 19  Obtaining Essential Nutrients ▪ Avoiding trans fatty acids – Created by process of making liquid oil into a solid – Increase LDL levels while lowering HDL levels ▪ Higher risk of coronary and heart disease, sudden cardiac death – Found in many margarines, baked goods and restaurant deep-fried foods – Food labels listing no trans fasts can still contain less than 500 milligrams/serving 20  Dietary fiber ▪ It is final type of carbohydrates ▪ Dietary fiber is mainly non-starch polysaccharide. ▪ It is found in vegetables, fruits and grains. It may be divided broadly into cellulose and non-cellulose polysaccharides ▪ These are all degraded to a greater of lesser extend by the micro flora in the human colon 21  Dietary fiber ▪ Increasing Fiber Intake, Use these strategies: 1. Eat a variety of plant-based foods. 2. Eat plenty of fruits and vegetables. 3. Look for ‘bran’, ‘whole grain’, or ‘whole wheat flour’ on food labels. 4. Choose whole grains for at least half of your grain. 5. Eat beans and legumes often. 6. Eat brown rice rather than white rice. 7. Leave the skins on your fruit and vegetables. 8. Choose whole fruit over juice. 9. Substitute higher fiber ingredients in cooking (such as adding bran or oatmeal). 22  VITAMINS ▪ Vitamins are essential nutrients that your body needs in very small amounts. ▪ All the vitamins that our bodies need can be found in the different types of foods we eat. 23  VITAMINS ▪ Vitamin supplements can be taken when it is not possible to consume enough of one or more of these essential vitamins in the typical diet. ▪ Partner with other nutrients to build, maintain and repair our body tissue and regulate body processes 24  Vitamins don’t provide energy themselves, but they do help you get energy from carbohydrates, fats, and proteins. ▪ 13 essential vitamins your body needs to remain healthy. 25 Two Categories of Vitamins 26  Two Categories of Vitamins ▪ Fat Soluble ▪ Dissolve in fat, not water, and then are stored in body. ▪ They include vitamins A, D, E and K. ▪ Fat soluble vitamins are stored in body and consuming too much can have toxic effects. ▪ Water Soluble ▪ Dissolve in water and are not stored in significant amounts in your body. ▪ Water-soluble vitamins include vitamin C and eight B-complex vitamins. 27 Vitamins 28  VITAMIN A ▪ «Vitamin A» covers retinol, and a pro-vitamin, beta carotene. ▪ The international unit (IU) of vitamin A is equivalent to 0,2 microgram of retinol (or 0,55 microgram of retinal palmitate). 29  Functions of Vitamin A ▪ It is indispensable for normal vision. ▪ It contributes to the production of retinal pigments which are needed for vision lights. ▪ It is necessary for maintaining the integrity and the normal functioning of glandular and epithelial issue which lines intestinal , respiratory and urinary tracts as well as the skin and eyes. ▪ It supports growth, especially skeletal growth. ▪ It may protect against some epithelial cancers such as bronchial cancers. 30 Deficiency of vitamin A ▪ The signs of vitamin A deficiency are predominantly ocular. They are: ▪ Nightblindness ▪ Conjunctival xerosis ▪ Bitot's spots (KERATIN ON CONJUCTIVA) ▪ Corneal xerosis (DRY HAZY CORNEA) ▪ Keratomalacia (DRYNESS AND CLOUDING OF THE CORNEA) 31  VITAMIN D ▪ The nutritionally important forms of Vitamin D in man are Calciferol (Vitamin D2) and Cholecalciferol (Vitamin D3). 32  Functions of vitamin D and its metabolites ▪ Intestine: Promotes intestinal absorption of calcium and phosphorus ▪ Bone: Stimulates normal mineralization, Enhances bone reabsorption, Affects collagen maturation ▪ Kidney: Increases tubular reabsorption of phosphate 33 Deficiency of vitamin D Deficiency of vitamin D leads to: ▪ Rickets ▪ Osteomalacia 34  THIAMINE(B1) ▪ Thiamine (vitamin B1) is a water soluble vitamin. ▪ It is essential for the utilization of carbohydrates. It is involved in the direct oxidative pathway for glucose. 35  VITAMIN B12 ▪ Vitamin B12 is a complex organo-metallic compound with a cobalt atom. The preparation which is therapeutically used is cyanocobalamine. ▪ Vitamin B 12 cooperates with foliate in the synthesis of DNA. ▪ Vitamin B 12 has a separate biochemical role, in synthesis of fatty acids. 36  Vitamin B12 deficiency ▪ Vitamin B12 deficiency is associated with (pernicous anaemia), demyelinating neurological lesions in the spinal cord and infertility (in animal species). ▪ Dietary deficiency of B12 may arise the subjects who are strict vegetarians and eat no animal product. 37  VITAMIN C ▪ Vitamin C (ascorbic acid) is a water- soluble vitamin. It is the most sensitive of all vitamins to heat. ▪ Man are one of the only species known to require vitamin C in their diet. ▪ Vitamin C has an important role to play in tissue oxidation it is needed for the formation of collagen, which accounts for 25 per cent of total body protein. 38  Deficiency of vitamin C ▪ Deficiency of vitamin C results in scurvy:- the signs are swollen and bleeding gums, subcutaneous bruising or bleeding into the skin or joints, delayed wound healing, anemia and weakness. ▪ Scurvy is an important deficiency disease 39  Vitamin Supplements A well-balanced and varied diet provides all the vitamins most people need to stay healthy. 40  Vitamin Supplements ▪ There are reasons to take vitamin supplements such as: ▪ During rapid growth in infants and teens. ▪ Stress to the body. ▪ Pregnancy or breastfeeding. ▪ Those recovering from illness. ▪ Those on a weight-loss diet. ▪ In Oregon, where sunshine is not a dependable source for our bodies to make vitamin D, so use of a supplement is recommended. 41  WIC Special Vitamins ▪ While all 13 vitamins are important, the WIC- women, infants and children - program focuses more on vitamin A, vitamin C, and folic acid. ▪ Many people don’t get enough of the key vitamins that are crucial to the growth of healthy tissue. ▪ Important to pregnant and breastfeeding women, infants, and adults. 42  Minerals ▪ Minerals are micronutrients, so like vitamins, only small amounts are needed to accomplish a great deal. ▪ 43  Minerals Minerals do not contain calories. ▪ Unlike vitamins, they aren’t destroyed by heat, so cooking doesn’t affect the content. When food is burned down to ash, the ash remaining is the food’s mineral content. 44  Multitasking Minerals ▪ Minerals are part of the cells in the body including red blood cells, bones, teeth, nails, and muscle structure. 1. Minerals regulate chemical reactions in the body 2. maintaining water levels inside and outside the cells, keeping a regular heartbeat 3. helping nerves respond normally 4. allowing blood clotting in wounds 5. and regulating the release of energy from food. 45  Types of Minerals ▪ Major minerals – calcium, phosphorus, potassium, magnesium, sodium, chlorine and sulfur. ▪ Trace minerals – iron, iodine, fluoride, zinc, manganese, chromium, molybdenum, copper and selenium. 46  WIC Special Minerals ▪ Important Minerals for WIC women, infants and children ▪ While all minerals are important for body functions, WIC is especially interested in focusing on four minerals important : calcium, iron, fluoride and sodium. 47 Thank you 48 Guidelines and Standards To Nutrition 10/16/2024 1  FOOD PYRAMID A Visual Guide to Healthy Eating  3 FOOD PYRAMID The food pyramid is a graphical representation, in the form of a triangle, of nutritional standards. It indicates the quantities and types of food needed daily to maintain the health status and to prevent or reduce the risk of development of eating disorders Sample Footer Text Element 10/16/2024  The food pyramid is designed to make healthy eating easier. Healthy eating is about getting the right amount of nutrients - proteins, fats, carbohydrates, vitamins and minerals that you need to maintain your good health. Because different foods have different nutritional values, it is not possible to get all the nutrients we need from a single food  KEY COMPONENTS OF FOOD PYRAMIDS: 1. Base: Typically, the base of the pyramid is composed of grains, such as bread, pasta, rice, and cereals. Grains are a primary source of carbohydrates, providing energy for the body. 2. Mid-Sections: The middle sections of the pyramid often include vegetables and fruits. These food groups are rich in vitamins, minerals, and fiber, essential for overall health and well-being. 3. Top Sections: The top sections of the pyramid usually feature dairy products and protein foods, such as meat, poultry, fish, beans, eggs, and nuts. These foods provide essential nutrients like calcium, protein, and iron. New Food Pyramid 2023  KEY COMPONENTS OF FOOD PYRAMIDS: Oils and Fats: Oils and fats are often represented as a separate section or incorporated into other food groups. They are essential for nutrient absorption and energy, but should be consumed in moderation due to their high calorie content. New Food Pyramid 2023  EVOLUTION OF FOOD PYRAMIDS: Original Pyramid: The traditional pyramid shape, often associated with the USDA's Dietary Guidelines, has been criticized for its simplicity and potential for misinterpretation. Plate Model: More recent models, like the MyPlate in the United States, have adopted a plate-shaped design to emphasize the importance of portion control and the balance of different food groups. Personalized Pyramids: Some organizations and individuals have developed personalized food pyramids tailored to specific dietary needs or cultural preferences.  Old food pyramid The major change is the division of the pyramid into separate food groups. Earlier versions of the pyramid separated food into 3 layers: ‘Eat Most’, ‘Eat Moderately’ and ‘Eat in Small amounts’. Recent food pyramid There are six vertical categories in the Food Pyramid: 1. the bread, cereal, rice, and pasta group (grains) 2. the fruit group 3. the vegetable group, 4. the meat, poultry, fish, dry beans, eggs, and nuts group (protein), 5. the milk, yogurt, and cheese group (dairy), 6. the fats, oils, and sweets group.  The bottom layer is unprocessed plant foods – vegetables, legumes and fruit – as current evidence suggest that 70% of our diet should come from these foods.  THE BASE LAYERS It include the three plant-based food groups: vegetables and legumes fruits grains Plant foods contain a wide variety of nutrients like vitamins, minerals and antioxidants. They are also the main source of carbohydrates and fiber in our diet. Older children, teens and adults should aim to have at least 2 serves of fruit and 5 serves of vegetables or legumes each day. From the grains group, choose mostly whole grains (such as brown rice, oats), and whole meal/wholegrain varieties of bread, pasta, crisp breads and cereal foods (over highly processed, refined varieties).  THE MIDDLE LAYER It includes the milk, yoghurt, cheese & alternatives and the lean meat, poultry, fish, eggs, nuts, seeds, legumes food groups. Foods in the milk, yoghurt, cheese & alternatives group primarily provide us with calcium and protein, plus other vitamins and minerals. This food group also refers to non-dairy options such as soy, rice or cereal milks which have at least 100mg per 100ml of added calcium. Choose reduced fat options of these foods to limit excess kilojoules from saturated fat. Foods in the lean meat, poultry, fish, eggs, nuts, seeds, legumes section are our main sources of protein. But each food also provides a unique mix of nutrients, including iodine, iron, zinc, B12 vitamins and healthy fats. We should aim to have a variety of meat and non-meat options from this food group.  THE TOP LAYER refers to healthy fats because we need small amounts every day to support heart health and brain function. We should choose foods that contain healthy fats instead of foods that contain saturated fats and trans fats. Choose unrefined polyunsaturated and monounsaturated fats from plant sources, such as extra virgin olive oil, nut and seed oils. Limit the amount of saturated fat you consume and avoid trans fats. We also get healthy fats from foods in the other food groups, such as avocados, nuts, seeds and fish, so we only need a little bit extra from oils and spreads each day.  In the food pyramid, Fats, salts, and sweets should be consumed maximum once or twice a week. The size of each category on the pyramid corresponds with the amount of food, or number of servings, that we need to eat every day. The way we measure a serving depends on the food group. For example, one serving from the grains group would be a slice of bread. One serving from the fruit group would be an apple. The groups at the bottom of the pyramid take up more space, which means that we need more servings of these foods. The group at the top of the pyramid is for foods that consist primarily of fat and sugar, demonstrating that you should only eat a small amount of these foods. SERVING SIZE CARD  MODERN VARIANT OF THE FOOD PYRAMID The USDA food pyramid was created in 1992 and divided into six horizontal sections containing depictions of foods from each section's food group. It was updated in 2005 with black and white vertical wedges replacing the horizontal sections and renamed MyPyramid. MyPyramid was often displayed with the food images absent, creating a more abstract design. In an effort to restructure food nutrition guidelines, the USDA rolled out its new MyPlate program in June 2011. My Plate is divided into four slightly different sized quadrants, with fruits and vegetables taking up half the space, and grains and protein making up the other half. The vegetables and grains portions are the largest of the four. MODERN VARIANT OF THE FOOD PYRAMID  PORTION SIZE IS A KEY DIFFERENCE BETWEEN THE NEW AND OLD FOOD PYRAMIDS The old food pyramid provided an estimated range of each food category; the new food pyramid provides more specific serving sizes. Whole Grains……recommends that half of all grains eaten come from whole grain sources.  MYPYRAMID The icon stresses activity and moderation along with a proper mix of food groups in one's diet. MyPyramid contained eight divisions. From left to right on the pyramid are a person and six food groups. physical activity, At least 30 minutes on most, and if possible, every day for adults and at least 60 minutes each day for children and teenagers. MYPYRAMID MYPYRAMID  Grains, recommending that at least half of grains consumed be as whole grains (27%) Grains are the most type of the food groups we should eat. Vegetables, emphasizing dark green vegetables, orange vegetables, and dry beans and peas (23%) Fruits, emphasizing variety and deemphasizing fruit juices (15%)  Oils, recommending fish, nut, and vegetables sources (2%) Dairy, a category that includes fluid milk and many other milk-based products (23%) Proteins, emphasizing low-fat and lean meats such as fish as well as more beans, peas, nuts, and seeds (10%) Discretionary calories, represented by the narrow tip of each colored band, including items such as candy, alcohol, or additional food from any other group.  MYPLATE MyPlate is the current nutrition guide published by the United States Department of Agriculture, form a place setting with a plate and glass divided into five food groups. It replaced the USDA's MyPyramid guide on June 2, 2011, concluding 19 years of USDA food pyramid diagrams.  MYPLATE The plate is split into four sections, for fruit, vegetables, grains and protein. A smaller circle sits beside it for dairy products. BALANCED DIET  THE MEDITERRANEAN DIET PYRAMID The Mediterranean Diet Pyramid is based on the traditional dietary patterns of countries bordering the Mediterranean Sea. It emphasizes whole, unprocessed foods, fruits, vegetables, grains, legumes, fish, nuts, and olive oil.  Low carb diet is better than low fat diets  THE HARVARD HEALTHY EATING PLATE The Harvard Healthy Eating Plate is similar to the MyPlate but includes some additional recommendations, such as limiting added sugars, unhealthy fats, and sodium. It also emphasizes the importance of physical activity.  FOR WEIGHT LOSS: Caloric deficit: Consume fewer calories than you burn. Balanced diet: Prioritize whole, unprocessed foods. Portion control: Be mindful of portion sizes. Regular physical activity: Exercise regularly to boost metabolism.  Diabetes low carbohydrate intake: Maintain a consistent daily carbohydrate intake. Glycemic index: Choose low-glycemic index foods to manage blood sugar levels. Healthy fats: Incorporate healthy fats into your diet. Regular physical activity: Exercise regularly to improve insulin sensitivity. Cardiovascular Health Healthy fats: Choose unsaturated fats over saturated and trans fats. Fruits, vegetables, and whole grains: Consume plenty of fiber-rich foods. Limit sodium: Reduce your intake of processed foods high in sodium. Regular physical activity: Engage in regular aerobic exercise.  HIGH BLOOD PRESSURE DASH diet: Follow the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains, and low-fat dairy. Limit sodium: Reduce your intake of processed foods high in sodium. Healthy fats: Choose unsaturated fats over saturated and trans fats. Regular physical activity: Engage in regular aerobic exercise.  DEFINITIONS Overweight – having extra body weight from muscle, bone, fat or water. Obese – having a high amount of extra body fat. Morbidly obese – having such a high amount of extra body fat that it’s life-threatening.  BODY MASS INDEX (BMI) ❖It is one way of measuring whether a person's weight or body fat is higher than what is considered a healthy weight for a given height. ❖This is measured by: calculating a person's weight in kilograms, then dividing that number by the person’s height in meters squared (kg/m2). ❖If the resulting ratio is high, then it can be an indicator of high body fat.  BODY MASS INDEX (BMI) Measures weight in relation to height. Gives a general estimate of body fat. Gauges for risk of disease. (higher the BMI, the higher the risk for disease). BMI Limitations ✓While BMI is a less accurate guideline for estimating body fat, it has its limitations. ✓Sometimes overestimates body fat in very muscular athletes. ✓Underestimates body fat in older people with loss of muscle mass. ✓Since we’re not alike, the link between BMI and body fat tends to vary with age, gender, and ethnicity.  BODY MASS INDEX (BMI) How to Calculate Your BMI For those who use the metric system, it's your weight in kilograms divided by your height in meters squared, Formula Your weight (kg) / height (m)2 Example For a person who is 1.7 meters tall and weighs 68 kg: 68 / (1.7 x 1.7) = 23.5 BMI. BODY MASS INDEX (BMI)  FACTORS AFFECTING WEIGHT Family Genetics. Environment. history. Behavior. Habits. Metabolism.  WAYS TO PREVENT OBESITY While some factors such as family history can’t be changed, there are steps you can take to help prevent obesity for yourself or for your family. Make sure to follow a healthy diet. Monitor calories and fats in foods. Increase physical activity. Limit sedentary activities such as surfing the Internet, playing video games, or watching TV.  LIMIT SALT AND ADDED SUGAR The Pyramid reminds us to limit our intake of salt and added sugar. This means avoiding adding salt or sugar to food when we’re cooking or eating, and avoiding packaged foods and drinks that have salt or added sugar in the ingredients. Disadvantage of consuming too much salt and added sugar and this is linked to increased risk of diseases, such as heart disease, type 2 diabetes and some cancers. Cooking your own meals at home, and choosing whole foods or minimally- processed foods will also help to limit how much salt and added sugar we consume.  ADDED SUGAR Consuming a lot of added sugars, especially from foods like lollies, chocolate, cakes, biscuits, desserts and soft drink, can add extra kilojoules to your diet. This can lead to weight gain and increase your risk of developing type 2 diabetes, cardiovascular disease and some cancers. Too much sugar can also cause dental cavities. Most fruits, vegetables, legumes and unsweetened dairy foods contain small amounts of naturally-occurring sugars which are not harmful. Choose fresh or minimally-processed varieties of these foods and check the ingredients on all packaged foods and drinks to see if sugar has been added.  MAIN TAKE HOME MESSAGE Through all of this scientific research we must be able to articulate a take home message, something that we can apply to our lives straight away. These are: To make the majority of our diet plant based on whole vegetables, fruit and legumes, To moderately include dairy, meat, seafood and eggs, Include a small serve of healthy fats and oils is important each day, Limit added sugar and salt.  Presented by: DR. Hagar Samir Lecturer Of Oral Biology Oral Biology Departement Faculty Of Dentistry-Alexandria University Nutrition and Oral Health Course 2023-2024  Contents Essential Minerals: (defintion, functions, types) Major Minerals (Macrominerals): (defintion,types) Trace Minerals (Microminerals): (defintion, types) WHO classification of trace elements. Source, biological and oral function of Major Minerals as: (Sodium, Potassium, Calcium, Phosphorus, Magnesium, Sulphur ) Source, biological and oral function of Trace Minerals as: (Iron, Copper, zinc, cobalt, chromium,fluride, selenium )  Essential Minerals Minerals are inorganic elements required by the body in small amounts for a variety of functions. Minerals are vital for our body to keep it healthy.  Essential Minerals Their functions including; ✓ keeping our brain, heart, bones, and muscles functioning optimally. ✓ They’re also vital for the production of hormones and enzymes. ✓They’re of great importance to general and oral health. “Your body can affect your ❖The amounts needed in the body are mouth and, likewise, your mouth can affect your body” not an indication of their importance.  The manifestations of undernutrition and overnutrition of micronutrients on the oral health are numerous and can result in defects of the dental hard tissues as well as oral mucosa. Essential minerals are:  They’re called macrominerals because we need to consume more than 100 mg/day for each macromineral. They account for 96% of the total body weight.  Trace elements are chemical micronutrients which are required in minute quantity, less than 100 mg/day of each micromineral. They account for only 0.02% of the total body weight.  As each trace element act as a co-factor to many enzymes, deficiency of one trace element is not associated with any specific clinical presentation, but rather presents as a combination.  WHO classification of trace elements: ✓There are 19 trace elements divided into three groups (WHO classification): Essential elements: include zinc (Zn), copper (Cu), selenium (Se), chromium (Cr), cobalt (Co), iodine (I), manganese (Mn), and molybdenum (Mo). Probably essential elements Potentially toxic elements as lead. Types of Trace minerals : Iron Copper Zinc Cobalt Chromium Fluride Selenium Iodine  Major Major minerals minerals  Major minerals Calcium Sources Milk and milk products canned fish with bones (salmon, sardines) greens (broccoli, mustard greens) legumes  Major minerals Calcium Function Important for healthy bones and teeth helps muscles relax and contract Important in nerve functioning, blood clotting, blood pressure regulation, immune system health ✓It is found in the osseous tissue in the form of hydroxyapatite, an inorganic crystal made up of calcium and phosphorus. ✓Calcium is essential for bone growth and tooth developments. ✓Enhance enamel remineralization. Clues for deficiency& Overdose: ❖Calcium deficiency can lead to fatigue, muscle cramps, increased risk of fractures (Osteoporosis). ❖Overdose of calcium leads to bone pain, constipation, and calculus deposition on teeth.  Major minerals Phosphorus Sources Meat, chicken,fish, eggs, milk, processed foods, almonds  Major minerals Phosphorus Function Important for healthy bones and teeth Found in every cell. ✓Phosphorus combine with calcium for strengthening of bones and teeth. ✓Without phosphorous, the calcium in our body goes waste. ✓Lack of phosphorus in the body makes our bones weak and can cause oral diseases, gingival bleeding, arthritis. ✓Overdose of phosphorous leads to calcium being drawn to blood from bones leading to weak and brittle bones.  Major minerals Sodium Sources Table salt soy sauce processed foods small amounts in milk, breads, vegetables, and fruites.  Major minerals Sodium Function Needed for 1. proper fluid balance 2. nerve transmission 3. muscle contraction. 4. Improve brain function.  Sodium Major minerals ✓A high sodium intake increase the amount of calcium excreated through urine, which can lead to osteoporosis and tooth loss. ✓In extreme situations, there is a risk for dry mouth syndrome that could cause gum disease and tooth decay. low sodium in blood ( as in severe vomiting or diarrhea) leads to weakness, fatigue, headache,, vomiting, and loss of consciousness.  Major minerals Potassium Sources Meats Milk Fresh fruits (esp. Bananas and avocados) and vegetables, Whole grains, legumes  Major minerals Potassium Function Needed for proper fluid balance, nerve transmission, and muscle contraction. Deficiency: Muscle cramps and spasms Palpitations (heart beats faster and harder) Weakness, numbness Tingling sensations in hands and feet (called paraesthesia) Constipation.  Major minerals Potassium Role in Oral Health Potassium mouthrinse used with toothbrushing. It reduce dentinal hypersensitivity.  Major minerals Magnesium Sources Legumes Leafy green vegetables Nuts and seeds Chocolate Seafood.  Major minerals Magnesium Function They are responsible for over 600 enzymatic reactions. Found in bones and teeth. Needed for making protein, muscle contraction, nerve transmission, immune system health. Clues for deficiency: Weakness, tiredness, loss of appetite, Painful muscle spasms, Muscle cramps  Magnesium is a fantastic mineral for overall health, and it plays a critical role in building strong teeth and bones. Magnesium helps the body absorb calcium, which is critical to building strong teeth and tooth enamel.  You COULD BE AT RISK FOR A MAGNESIUM DEFICIENCY IF: You drink carbonated beverages,this adds large amounts of phosphates to your system. Phosphates bind to the magnesium in your digestive tract and flush it out of your body. You drink caffeinated or alcoholic beverages daily, which stimulates your kidneys to excrete extra magnesium. You eat refined sugars and sweets regularly, which causes your body to excrete magnesium through the kidneys.  Presented by: DR. Hagar Samir Lecturer Of Oral Biology Oral Biology Departement Faculty Of Dentistry-Alexandria University Nutrition and Oral Health Course Part II  Trace Major minerals minerals  Trace minerals Iron ✓Iron is the most abundant essential trace element in the human body. Sources Red meats; fish; shellfish Egg yolks Legumes Dark, leafy greens as spinach Cereals  Trace minerals Iron Function Part of a molecule (hemoglobin) found in red blood cells that carries oxygen in the body Needed for energy metabolism  Iron Trace minerals The manifestation of low serum levels are: 1) Iron deficiency anemia (most common): The oral manifestations angular cheilitis, atrophic glossitis, generalised oral mucosal atrophy, candidal infections. 2) Tumor progression in head and neck carcinomas.  Copper Trace minerals ✓Copper in its many forms is the most abundant mineral in the body. Sources Nuts and seeds Legumes Whole grains Drinking water Meats.  Trace minerals Copper Function It is involved in the release process of energy inside the cell It has antioxidant properties It is also essential in vitamin C and iron metabolism.  Trace minerals Copper Caries-promoting effect of Copper Copper is defined as a material which increases caries through demineralization of the outer layer of enamel. In decayed teeth, a higher level of copper is found compared to healthy teeth.  Trace minerals Zinc ✓Zinc is a mineral with a wide application in human health. ✓In the oral cavity, it is naturally present at various sites such as dental plaque, dental hard tissues and saliva. Sources Liver, meat Fish milk wheat germ, whole-grain products fortified cereals.  Trace minerals Zinc Function It is important for smell and taste sensation, as Zinc is essential for the taste buds to get stimulated. Act as Co-factor of many enzymes. Needed for synthesis of protein and collagen. It has antioxidant properties. It boosts immune system, and aids to regulate appetite.  Trace minerals Zinc Zinc deficiency is well known to cause anosmia and taste dysfunction. This is because one of the enzymes critical to maintain taste and smell function is a zinc dependent enzyme. Sneezing may be an indicator of local Zn deficiency. Acute viral infection of the nasopharyngeal mucosa may lead to a decrease in local Zn level.  Trace minerals Zinc Zinc & COVID-19: zinc may help to combat against corona virus symptoms. zinc strengthens the immune system of the body, and inhibits viral replication. zinc-containing metalloenzymes (enzymes containing metal ions) promotes cell division in basal stem cells, thus replacing the dead cells.  Zinc Corona virus also causes anosmia. Trace minerals Virus enters the basal stem cells and structural support cells that have an involvement in odorant transformation of the olfactory epithelium. Inside these cells, virus replicates and causes cellular injury. These cells support the receptors and neurons of the olfactory epithelium. The possible explanation of this role is that 1. Zinc strengthens the immune system of the body 2. Inhibits viral genome replication. 3. Zinc-containing metalloenzymes (enzymes containing metal ions) promotes cell division in basal stem cells, thus replacing the dead cells. In this manner, zinc may help to combat against corona virus symptoms.  Zinc Trace minerals Role in Oral Health and Diseases: It is effective against common oral health problems such as dental caries, gingivitis, periodontitis and malodour. It is used in oral health care products (the mouth rinses and toothpastes) to inhibiting the formation of dental calculus. promote remineralization under caries.  Trace minerals Cobalt ✓Cobalt is an essential trace element for the human body ✓it forms an integral part of vitamin B12 Function It has a substantial role in the formation of Sources amino acids and neurotransmitters.  Trace minerals Cobalt Clues for deficiency: Deficiency related to vitamin B12 can occur after feeding a cobalt-deficient diet, as cobalt is a component of vitamin B12. The manifestation of cobalt deficiency in oral cavity is pernicious anemia which is characterized by glossitis, burning sensation, red tongue.  Trace minerals Chromium ✓The word “chrome” is a Greek word which means “color.” ✓Chromium is an important mineral for obese people Function Sources Unrefined foods, especially plays an important role liver in glucose metabolism by serving as a cofactor Yeast for insulin action. whole grains regulate blood sugar nuts (glucose) levels cheeses  Chromium is one of insulin’s closest friends chromium helps insulin in reducing the blood glucose, by stimulating glucose uptake from the muscles and other tissues. When the chromium levels are less, the insulin is less effective in reducing blood sugar.  Trace minerals Chromium Clues for deficiency: Hyperglycemic status of diabetic patients may lead to oral manifestations noted in diabetics such as: delayed wound healing, periodontitis, various oral fungal infections.  Trace minerals Fluoride ✓Fluorine makes negligible part of body weight Sources Drinking water (either fluoridated or naturally containing fluoride) fish.  Trace minerals Fluoride Function Involved in formation of bones and teeth, is found in the form of fluorapatite. Helps prevent tooth decay. Promote remineralization of enamel Xylitol is a natural sugar alcohol found in plants as fruits and vegetables Role in Oral Health : Xylitol is another nutrient against caries Used in chewing gum to prevent caries  Trace minerals Selenium ✓Selenium is a vital trace element which is an essential component of antioxidant enzymes. Sources Liver, kidneys, meat Sea products Grains Milk products Fruits, and vegetables.  Trace minerals Selenium Function: 1. Acts as a powerful antioxidant. 2. Reduce risk of certain cancers. 3. Protect against heart disease. 4. Important for thyroid health (for the production of thyroid hormones). 5. Helps prevent mental decline (alzheimer’s disease). 6. Improve immune system (as in influenza, tuberculosis, and hepatitis c) 7. Reduce the symptoms of asthma  Trace minerals Selenium Function: Increase in dental caries It is settled in the micro-crystal structure of the enamel at the initial caries and made it more sensitive toward dissolution.  Trace minerals Selenium Clues for deficiency: Selenium deficiency associated with an increased risk of disease progression as in HIV. Increased risk of autoimmune thyroiditis and hypothyroidism  Trace minerals Selenium  Trace minerals Iodine ✓Iodine is a vital trace element required at all stages of life especially during formative years. Function Iodine plays an important Sources role in general growth and development of the body. Iodine is essential for thyroid gland in order to make thyroid hormones  Trace minerals Iodine Function: 1. Iodine plays an imperative role in oral mucosa and in salivary glands physiology. 2. Oral immune defense mechanism. 3. Iodine rich zones of the world showed greater attrition, and lesser dental caries.  Trace minerals Iodine Deficincy: It is the most common cause of thyroid gland disesese Hypothyroidism (UNDERACTIVE THYROID) It can cause symptoms including 1. severe tiredness 2. Enlarged thyroid (Goitre) 3. Feeling cold 4. Weight gain ✓Deficiency can developed in people who are pregnant or breast feeding, and new born babies.  References 1. Kulkarni N, Kalele K, Kulkarni M, Kathariya R. Trace elements in oral health and disease: An updated review. J Dent Res Rev 2014;1:100-4. 2. Fatima T, Haji Abdul Rahim ZB, Lin CW, Qamar Z. Zinc: A precious trace element for oral health care? J Pak Med Assoc. 2016 Aug;66(8):1019-23. PMID: 27524540. Relation between Obesity and oral health Prof. Hagar Samir  content Introduction Definition Causes Consequences Molecular biology in obesity Obesity and Oral health Treatment prevention 11/23/2024 PRESENTATION TITLE 2 PRESENTATION TITLE  Oral health behaviors are Introduction related to other health conditions, such as obesity. Primary preventive strategies should be established considering the oral health status of adults in treatment for obesity and weight control programs. 11/23/2024 PRESENTATION TITLE 4 Obesity What is Obesity ?  Obesity Obesity is defined as an abnormal or excessive fat accumulation that presents a risk to the health. The main cause of weight gain and obesity is the imbalance between the number of calories you take in and the calories you burn. 11/23/2024 PRESENTATION TITLE 6  Obesity It is now considered the sixth biggest dangerous factor contributing to diseases worldwide. It has been suggested that decreased life expectancy in the future may be the result of increased levels of obesity Obesity, which is considered a large-scale 11/23/2024 public health dilemma. PRESENTATION TITLE 7  Causes of Obesity: 1. Family history of obesity. 2. Unhealthy food habits followed by the individual or the family. 3. Inactivity or inadequate physical exercise. 4. Certain diseases, such as Cushing's syndrome, hypothyroidism, and Prader-Willi syndrome. Medical problems, such as arthritis, can also lead to decreased activity, which may result in weight gain. 11/23/2024 PRESENTATION TITLE 8  Causes of Obesity: 5. Certain medications: some medications can lead to weight gain. These include some antidepressants, anti- seizure drugs, and diabetes medications, as well as certain types of contraceptives. 6. Changes in sleeping habits: not getting enough sleep or getting too much sleep can cause hormonal changes that can increase your appetite. 7. Advanced age. 8. Pregnancy. 11/23/2024 PRESENTATION TITLE 9  Consequences of overweight 1. Fatigue and lack of energy. 2. Shortness of breath. 3. Obstructive sleep apnea. 4. Back and joint pain. 5. Type 2 diabetes. 6. Hyperlipidemia. 7. High blood pressure. 8. Cardiovascular disease. 11/23/2024 PRESENTATION TITLE 10  Consequences of overweight 9. Osteoarthritis. 10. Chronic kidney disease. 11. Psychological problems: low self- esteem, lack of confidence, and feeling isolated, which may lead to depression. 12. Cancer: colon, breast, uterine, pancreatic, prostate, esophageal, liver, and kidney cancers. 11/23/2024 PRESENTATION TITLE 11  Diagnosis: 1. Health history: the doctor may review weight history, weight loss efforts, exercise habits, eating patterns, medications, stress levels, and other issues about health. The doctor may also review the family's health history. 2. Initial diagnosis: weight, height, heart rate, blood pressure, and temperature. 12  Diagnosis: 3. Body Mass Index (BMI). 4. Measuring waist circumference. 5. Blood tests: Tests may include a cholesterol test, liver function tests, a thyroid test, and others. 13  As advocated by the WHO, body mass index (BMI) can be used to measure obesity and categorize it for all adult age groups. 11/23/2024 PRESENTATION TITLE 14  Excess gain of fat in early life, that is often associated with increased stress levels, may play a role in promoting periodontal disease. 11/23/2024 Obesity& oral health 15  Molecular biology in obesity 1 Bioactive molecules known as adipokines are secreted by adipose cells in obese participants. The adipokines comprise hormone-like proteins (adipocytokines, adiponectin, and leptin) and classical cytokines (TNF α and IL-6). The increased adipocytes and macrophages lead to the creation of pro-inflammatory cytokines such as TNF-α, IL-1 β, and IL-6. 11/23/2024 PRESENTATION TITLE 16  Molecular biology in obesity 11/23/2024 PRESENTATION TITLE 17  Molecular biology in obesity 1 As the release of inflammatory cytokines is linked closely to a higher vulnerability to bacterial infection, increased production of these pro-inflammatory cytokines increases the host susceptibility for the evolution and advancement of periodontal disease. 11/23/2024 PRESENTATION TITLE 18  Molecular biology in obesity 2 Another probable mechanism associated with obesity and periodontal disease is insulin resistance. Insulin resistance also contributes to a generalized hyperinflammatory state, including periodontal tissue. 11/23/2024 PRESENTATION TITLE 19  Molecular biology in obesity 3 Obesity & Bone Metabolism Because both adipocytes and osteoblasts are derived from a common multipotential mesenchymal stem cell, obesity may increase adipocyte differentiation and fat accumulation while decreasing osteoblast differentiation and bone formation. 11/23/2024 PRESENTATION TITLE 20  Obesity affects bone metabolism through 1. Increased tissue proinflammatory cytokines in obesity promote osteoclast activity and bone resorption through modifying the receptor activator of NF-κB (RANK)/RANK ligand/osteoprotegerin pathway. 2. Excessive secretion of leptin and decreased production of adiponectin by adipocytes in obesity may either directly affect bone formation or indirectly affect bone resorption through up- regulated proinflammatory cytokine production. 11/23/2024 PRESENTATION TITLE 21  Obesity affects bone metabolism through 3. Finally, high-fat intake interferes with intestinal calcium absorption and therefore decrease calcium availability for bone formation. 11/23/2024 PRESENTATION TITLE 22  Obesity and Oral health 11/23/2024 PRESENTATION TITLE 23  1. Periodontitis ✓ periodontitis is defined as the presence of one or more periodontal sites with both an attachment loss of > 3mm and a probing depth of > 4mm. ✓ Several recent studies suggest that periodontitis occurs more frequently in obese individuals than in a normal body weight. 11/23/2024 PRESENTATION TITLE 24  1. Periodontitis ✓ The obese individuals exhibited significantly greater pocket depth and a higher percentage of sites exhibiting visible plaque. 11/23/2024 PRESENTATION TITLE 25  1. Periodontitis The location of fat accumulation also plays a role, since the increase in visceral fat is more important for the increase in attachment loss and probing depth than the increase in BMI. 11/23/2024 PRESENTATION TITLE 26  1. Periodontitis & Gender The relationship between obesity and periodontitis seems affected by both gender and age. The association between obesity and alveolar bone loss was stronger among females than males. i.e., Obese females showed an 80% higher chance of having periodontitis than females of normal weight. No significant association was found between periodontitis and obesity among males. 11/23/2024 PRESENTATION TITLE 27  2. Caries The possible relation between obesity and dental caries seems related to age. Several studies suggest that the primary dentition of obese children has a reduced caries risk. DMFT is the sum of the number of Decayed, Missing due to caries, and Filled Teeth in the permanent teeth. 11/23/2024 PRESENTATION TITLE 28  2. Caries In permanent dentition, the obese children had a higher DMFT than the normal children. 11/23/2024 PRESENTATION TITLE 29  2. Caries With increasing BMI, the number of DMFT increased rapidly. This suggests that the increased risk of caries is related to accumulation of visceral fat, just like the increased risk of periodontitis. 11/23/2024 PRESENTATION TITLE 30  2. Caries Children among 6 to 12-year-olds showed that the DMFT not only correlated with the degree of obesity, but also with the consumption of fried foods, potato chips, cookies and fruits. The DMFT was related to the intake of sugar and chocolate, cookies, ice cream and instant noodles. 11/23/2024 PRESENTATION TITLE 31  Dietary habits probably play a role in the development of both caries and obesity. 11/23/2024 PRESENTATION TITLE 32  Maternal obesity A possible association between maternal obesity and the risk of early childhood caries in their offspring has been explored. 11/23/2024 PRESENTATION TITLE 33  3. Loss of teeth The increased risk of developing caries and periodontitis, could lead to premature loss of teeth in obese individuals. 11/23/2024 PRESENTATION TITLE 34  3. Loss of teeth The severely obese women have more dental anxiety than the normal women. This may explain the decrease in dental care utilization of severely obese women compared to women with normal weight. 11/23/2024 PRESENTATION TITLE 35  3. Loss of teeth Edentulous men and women have on average higher BMI than dentate men and women. Dentures were found significantly more often in overweight and obese women in comparison to those with normal weight. 11/23/2024 PRESENTATION TITLE 36  To sum up, a higher BMI is associated with a lower number of teeth. 11/23/2024 PRESENTATION TITLE 37  4. Xerostomia The pharmacological treatment of obesity may have oral side-effects. The obsolete appetite-suppressive drugs inhibited salivary flow, especially in middle-aged and elderly individuals. Complications of the mouth dryness are speech, swallowing difficulty and rampant caries with oral mucosal inflammation. 11/23/2024 PRESENTATION TITLE 38  5. Osteoporosis The association between the bone and adipose tissue is complex. The two tissues, both highly active metabolically, interplay through adipokines, estrogens and bone-derived metabolic factors. 11/23/2024 PRESENTATION TITLE 39  5. Osteoporosis The cross-talk between them is complicated with feedback mechanisms, which affect bone remodelling, body weight control, adipogenesis, glucose homeostasis and muscle adjustment. 11/23/2024 PRESENTATION TITLE 40  Obesity Osteoporosis 11/23/2024 PRESENTATION TITLE 41  5. Osteoporosis Mechanical loading has positive effects on bone health, but this may not suffice in obese individuals. Obesity has a negative impact on bone health. Low- grade systemic inflammation is probably harmful to the bone due to up-regulation of pro-inflammatory cytokines and/or increased leptin production, observed in obesity. 11/23/2024 PRESENTATION TITLE 42  5. Osteoporosis 11/23/2024 PRESENTATION TITLE 43  5. Osteoporosis The effects of obesity on skeletal health seem to differ depending on the age. Obese children and adolescents may have a higher likelihood to experience adverse effects on bone health. 11/23/2024 PRESENTATION TITLE 44  6. Other oral aspects Obese children have a higher risk of obstructive sleep apnea than children with a normal body weight. Obstructive sleep apnea is also more prevalent in obese adults, especially men and postmenopausal women. 11/23/2024 PRESENTATION TITLE 45  6. Other oral aspects The background of the relation between obesity and sleep apnea is as a result of narrower pharyngeal airway and progressive adipose tissue accumulation in the upper part of the body could interfere with respiration. 11/23/2024 PRESENTATION TITLE 46  Treatment ✓ The goal of obesity treatment is to help obese individuals reach and stay at a healthy weight, limit their risks of developing other serious health issues, and improve their overall quality of life. ✓ This may require the help of a team of health professionals, including a dietitian, to help patients suffering from obesity understand their situation and make the necessary changes in their eating and activity habits; start exercising and eating a healthy diet. 11/23/2024 PRESENTATION TITLE 47 11/23/2024 PRESENTATION TITLE 48  Treatment ✓ The doctor sets a goal weight for the patient and explains how it can be achieved. Initially, the goal may be to lose 5 to 10 percent of their body weight within six months. ✓ The patient may start feeling better upon losing a small amount of weight, about 5 to 15 percent of their total weight. ✓ That is, if the patient weighs 91 kg and is obese by BMI standards, then this patient may need a lose between 4.5 to 13.6 kg for their health to begin to improve. 11/23/2024 PRESENTATION TITLE 49 Treatment 11/23/2024 PRESENTATION TITLE 50  Treatment ✓These treatment methods include: 1. Dietary changes. 2. Regular exercise and activity. 3. Behavior modification. 4. Prescription weight-loss medications. 5. Weight-loss surgery: for those with a BMI of 40 or higher. 11/23/2024 PRESENTATION TITLE 51  Prevention: ✓ Whether you're at risk of becoming obese, currently overweight, or at a healthy weight, you can take steps to prevent unhealthy weight gain and related health problems. ✓ The steps to prevent weight gain are the same as the steps to lose weight, and these include: 1. Daily exercise: according to the American College of Sports Medicine, you need to get 150 to 300 minutes of moderate-intensity activity a week to prevent weight gain. Moderately intense physical activities include fast walking and swimming. 11/23/2024 PRESENTATION TITLE 52  Prevention: 2. Maintaining a healthy well- balanced diet: this can be achieved by focusing on low-calorie, nutrient- dense foods, such as: fruits, vegetables, and whole grains, as well as avoiding saturated fat, sweets and alcohol. It is important to choose foods that promote a healthy weight and good health. 3. Closely monitoring what you eat or drink on a long-term basis. 11/23/2024 PRESENTATION TITLE 53  Thank you 11/23/2024 PRESENTATION TITLE 54 Role of vitamins in integrity of Oro-facial tissue Oral Biology Department Faculty of Dentistry AIU “ 5 Important vitamins and minerals for healthy teeth ” Effect of vitamins on oral health. 1-Calcium It is one of the most abundant minerals in the body and it aids in a number of processes, including building and maintaining strong teeth and bones. Calcium can be found in dairy products like milk and cheese, and we strongly suggest getting calcium from cheese. That’s because cheese has a protein called casein, which is vital for building strong tooth enamel. 2-Vitamin C It is a strong antioxidant that helps fight gingivitis. It does this by helping the body produce more collagen, which aids in cell repair and healing process. You can find vitamin C in citrus fruit like oranges, grapefruit and kiwi. However, all of the fruits are very acidic, so be sure to rinse your mouth out with water after enjoying them. 3-Magnesium It is an important mineral for overall health, and it plays a critical role in building strong teeth and bones. Magnesium helps the body absorb calcium, which is critical to building strong teeth and tooth enamel. You can find magnesium in nuts, whole grains, beans, seeds and dark leafy vegetables. 4- Vitamin A One of the best vitamins for overall oral health is vitamin A. Because it helps keep saliva flowing, which naturally cleans teeth of damaging acids and prevents dry mouth. It also promotes the healthy mucous in the mouth that coats cheeks and gums, which makes them less susceptible to infection and disease. Foods that are rich in vitamin A are carrots, eggs, sweet potatoes and fish. 5- Vitamin D Without adequate vitamin D, the healthy power of calcium is severely diminished. Vitamin D acts as a communicator, and signals the intestines to absorb calcium into the bloodstream. Adequate vitamin D and calcium make bones and teeth denser and far stronger, which helps prevent fractures and cracks. It is found in eggs, fish and dairy products like cheese and milk.  Content Definition Vitamin A Vitamin D Vitamin E Vitamin K Vitamin B Vitamin C  What are Vitamins? Vitamins are defined as organic substance required in small amount for the maintenance and growth of living organisms.  Vitamins Deficiency Over-dose certain specific diseases hypervitaminosis can be cured by the administration of that specific vitamin. Vitamins can be classified based on their solubility: Fat-soluble Vitamins: Water-soluble Vitamins: Vitamins A, D, E and K Vitamins B and C  Fat-soluble Vitamins (A, D, E and K) ✓ Absorbed in the presence of fats ✓ Stored by the body for longer than the water-soluble vitamins ✓ So avoid overdose  Content Definition Vitamin A Vitamin D Vitamin E Vitamin K Vitamin B Vitamin C  K E D A ✓ Chemical nature and properties of vitamin A ✓ Sources of vitamin A in food ✓ Importance for oral health Chemical nature and properties of vitamin A Natural form A1 (Retinol), A2 (3-dehydro-retinol ) Active form Retinol, Retinal, Retinoic acid Provitamin A β-carotene Storage Liver, Adipose tissue of the body  Sources of vitamin A in food β-carotene  like dark leafy green vegetables, spinach, broccoli, carrots, cabbage, sweet potato, deep orange fruits, mangoes, apricots,  Sources of vitamin A in food Retinols like milk, butter, cheese, cream, eggs, kidney, tomatoes and water melon. Health benefits of vitamin A  The active form of vitamin A, retinoic acid, is essential for: 1. Maintaining the integrity of mucosal tissues. 2. proper differentiation of cells, including cells of the immune system. ✓maintaining some bacteria in adequate level ✓prevention of massive inflammation  against oxidation 3- It has antioxidant activity Free radicals Oxidative stress Superoxide dismutase:- it catalyzes oxygen (O2-) anion into normal O2 molecule. Function:- An important antioxidant (enzyme) defense in all living cells exposed to oxygen. Hydrogen peroxide is damaging to cells and is degraded by other enzymes e.g. Catalase enzyme Antioxidants are man-made or natural substances that may prevent or delay some types of cell damage. Application of antioxidant vitamin therapy (vitamins A, E and K) improves the status of the periodontium. Vitamin A deficiency results in: 1- Epithelial proliferation and maturation defects. Epithelium Connective tissue 2- Night blindness  enamel 3- Irregular tubular dentin formation crown dentin root cementum  4- Enamel hypoplasia. 5- Xerostomia (dry mouth) marked increase in risk for caries. 6- Decreased taste sensitivity.  inflammation 7- gingivitis & periodontitis  Content Definition Vitamin A Vitamin D Vitamin E Vitamin K Vitamin B Vitamin C  Vitamin D is one of the fat-soluble vitamins known for treatment of rickets. Vitamin D also known as the sunshine vitamin, because the sterols resent in the skin can be converted to vitamin D with the help of UV rays emitted from the sun  So far 7 different types of vitamin D have been discovered. only D1, D2 and D3 are important. Vitamin D2 is ergocalciferol, derived from ergosterol. Vitamin D3 is cholecalciferol and obtained form 7- dehydrochloesterol.  Natural source include cod liver oil, mackerel, salmon, sardines, tuna and mushrooms  Vitamin D2 is of plant origin  Vitamin D3 is obtained from animal sources only, by irradiation with UV light of a Provitamin to give Previtamin D, which will be Vit D3 by body heat  Vit D3 will be transported to the liver by the blood, where will be converted to 25 hydroxy vitamin D  Function  Vitamin D maintains the homeostasis of calcium and phosphorus in the tissues and body fluids. Effect of vitamin D on oral health Dr. Nesma Khalil  enamel 1- It has a critical role in enamel, dentin, and alveolar bone formation as ameloblasts, odontoblasts and osteoblasts are target cells for vitamin D. Oral vitamin D3 has a significant potential in motivating remineralization of early lesions on the enamel surfaces representing improved surface microhardness and minerals content (Ca and P weight %) of demineralized tooth surfaces Effect of Vitamin D3 on dental tissues  Vitamin D3 plays a major role in the regulation of calcium and phosphorus absorption and in maintaining skeletal and dental tissues.  Deficiency of vitamin D3 causes the delay of teeth eruption and abnormal calcification of enamel and dentin. Since vitamin D has a major function in teeth development, any defect in tooth enamel surfaces induced by such vitamin deficiency makes the tooth more susceptible to caries 2- Therefore, deficiency in vitamin D during periods of tooth development may also result in developmental defects including enamel hypoplasia. Recent studies said that deficiency in vitamin D3 has been linked to major changes in tooth tissues. Enamel and dentin abnormalities have been considered in children as caries risk factors. Optimum Vitamin D3 levels in children are required as a secondary preventive intervention for dental cavities in the permanent dentition 3- Vitamin D deficiency is associated with caries.  4- Its deficiency may be a potential risk factor for aggressive periodontitis Vitamin D intake was associated with lower severity of periodontal disease. Calcium and vitamin D supplementation has a positive effect on periodontal health, and consistent dental care improves clinical parameters of periodontal disease. There is a raise possibility that vitamin D, at higher doses, may positively impact on periodontal disease severity.  Content Definition Vitamin A Vitamin D Vitamin E Vitamin K Vitamin B Vitamin C  Vitamin E can be found in fortified cereals, seeds and seed oils like sunflower and green leafy vegetables like spinach, tomato products, sweet potato, mangoes & broccoli.  Found in high quantity in Liver of cattle.  Small quantities found in the muscles of heart, kidneys, eggs, kiwi fruit and blue berries. Health benefits of vitamin E  1- Being as an anti-oxidant Vitamin E plays an important role to protect the body cells from the damage caused by free radicals which are highly reactive and destructive compounds.  Anticarcinogenic effects of Vitamin E are its ability to inhibit formation of the carcinogenic chemicals in some foods, and its ability to promote immune system function. 2- Vitamin-E is an essential nutrient that is receiving growth attention in the prevention of precancerous lesions because of its anti oxidant properties 3- Topical application of Vitamin E had performed better on oral mucositis induced by Cancer Chemo/Radiotherapy than Vitamin E systemic administration The efficacy of Vitamin A topical treatment also showed reduction in severity of oral mucositis similar to vitamin E. Thank you  Content Definition Vitamin A Vitamin D Vitamin E Vitamin K Vitamin B Vitamin C  The term originated from the German word Koagulation (clotting of blood). So, it is also known as the clotting vitamin.  It is found primarily in leafy green vegetables.  The dietary requirement is low because the vitamin is naturally produced by the bacteria in the intestines.  Two natural forms exist: vitamins K1 and K2. It's a multifunctional vitamin (have a role in a wide range of biological activities) 1- cell growth and proliferation 2- regulation of calcium metabolism in tissues 3-Vitamin K2 has been shown to have an antioxidant potential. antioxidant 4- plays an essential role in normal blood clotting, 5- promoting bone strength  In bone, vitamin K exerts its anabolic effect as promoting osteoblast differentiation 6- Vitamin K has been tested as possible anticaries agent in vitrue by its enzyme inhibiting activity in the carbohydrate degradation cycle. Demineralization of tooth structure  Content Definition Vitamin A Vitamin D Vitamin E Vitamin K Vitamin B Water soluble vitamins Vitamin C  They include vitamin B1 (thiamine) vitamin B2 (riboflavin) vitamin B3 (niacin) vitamin B5 (pantothenic acid) vitamin B6 (pyridoxine) vitamin B7 or B8 (biotin) vitamin B9 (folic acid) vitamin B12 (cobalamin)  Vitamin B-complex is important for cell growth and metabolism.  Each member of the B-complex has a unique structure and performs unique functions. Vitamins B1, B2, B3, and biotin (B7 & B8) participate in different aspects of energy production.  building blocks of proteins  Vitamin B6 (pyridoxine) is essential for amino acid metabolism.  Vitamin B12 and folic acid facilitate steps required for cell division.  Vitamin B12 is one of the important micronutrients for brain development and function. Effect of vitamin B-complex on oral health 1- Vitamin B12 deficiency may cause an increase in prevalence of dental caries and gingival diseases in children. 2- Subjects suffering from cobalamin (B12) deficiency may exhibit some oral signs and symptoms, including glossitis angular cheilitis recurrent oral ulcer  oral candidiasis pale oral mucosa. diffuse erythematous mucositis 3- Folic acid (B9) is required for essential biochemical reactions for the synthesis of amino acids, purines, and deoxyribonucleic acid (DNA) & integrity of gingival tissues. 4- Insufficient intake of folic acid during the pregnancy has been suggested to increase the risk for cleft lip & palate. 5- Vitamin B-complex supplementation has also demonstrated positive effects on wound healing after periodontal surgery and enhance wound repair.  Content Definition Vitamin A Vitamin D Vitamin E Vitamin K Vitamin B Water soluble vitamins Vitamin C  Vitamin C (also known as ascorbic acid) is naturally found in citrus fruits (oranges, lemons, limes, grapefruits) and vegetables (potatoes, broccoli, spinach, red peppers).  Additionally, vitamin C is heat sensitive so, boiling or cooking has removed the nutritional value.  Ascorbic acid is absorbed from the intestinal tract and has a biological half-life of approximately 30 minutes.  There is no storage site in the body; however, some tissues carry higher concentrations (white blood cells, adrenal glands, pituitary gland) 1- Ascorbic acid plays an essential role in the hydroxylation of collagen. This crucial biochemical pathway enables each collagen fibril to form a uniform and flexible triple helix configuration in the body’s connective tissues.  Some tissues such as skin, gums, mucus membranes, and bones contain a greater concentration of collagen and thus are more susceptible to deficiencies. 2- Ascorbic acid is also needed in the synthesis of dopamine, norepinephrine & epinephrine. 3- It has antioxidant properties 4- It can enhance iron absorption from the intestinal tract.  8 to 12 weeks of irregular or inadequate intake of vitamin C. Scurvy anemia, myalgia, bone pain, easy bruising, swelling, gum disease 5- Vitamin C associate positively with periodontal health and using vitamin C supplementation improves postoperative healing following dental implant surgery in patients with chronic periodontitis 6- It is evident that serum and salivary vitamin C level decreases with increase in caries activity suggesting the powerful antioxidant property of vitamin C. 7- Deficiency of Vitamin C is well recognized as producing severe changes in the periodontal tissue and pulps of the teeth.  Content Definition Vitamin A Vitamin D Vitamin E Vitamin K Vitamin B Water soluble vitamins Vitamin C  Take home messages ✓ Vitamins are essential for general growth, health ✓ Required in small amounts ✓ Act as antioxidants ✓ Your diet should contain vegetables & fruits as they are natural sources of vitamins ✓ Sun shine vitamin (Vitamin D) ✓ Supplements (deficiency, old age, pregnancy) ✓ Avoid hypervitaminosis especially fat soluble vitamins NUTRITION AND ORAL HEALTH IN CHILDREN Presented by: DR. Hagar Samir Lecturer Of Oral Biology Oral Biology Departement Faculty Of Dentistry-Alexandria University [email protected] Nutrition and Oral Health Course Contents ▪ Children malnutrition ▪ Nutrition and development of the oral cavity ▪ Nutrition and diseases of the oral cavity ▪ Brest feeding ▪ Recommendations to prevent caries Children and nutrition ▪ Oral and systemic health is conditioned by proper nutrition. ▪ This lecture highlights the consequences of inadequate nutrition on oral health in children and how certain vitamin or nutrient deficiencies can condition the occurrence of different diseases at this level.  Diet influences the health of the oral cavity, it conditions the onset of caries, the development of enamel, the onset of dental erosion, periodontal health and oral mucosa in general. Diseases of the oral cavity can be prevented both by proper and balanced nutrition, and by proper hygiene. Nutritional habits and, oral and systemic health should be considered, as children's oral health is a predictor for the oral health of the future adults.  Pediatrics malnutrition and diseases of the oral cavity ▪ Oral care programs include oral hygiene, fluoride prophylaxis, regular check-ups, professional oral hygiene sessions and secondary prevention programs, and finally, healthy eating. ▪ A correct diet means a balanced diet so that the body can get the nutrients needed for proper general health and, thus, oral health (periodontal tissue, saliva quality and quantity, dental elements). ▪ Unhealthy eating can affect the integrity of the oral cavity and can cause disease progression at this level.  Due to the high prevalence of malnutrition, 5.6 million children under the age of 5 in developing countries contribute to the country's death rate, i.e. 10 children per minute (UNICEF 2006). Malnutrition not only causes scurvy but also dental development impairments (late tooth eruption), exacerbates infection and periodontal disease.  Nutrition and Development of the Oral Cavity  A deficiency of vitamins and minerals in the intrauterine phase influences the development of the future embryo, influencing the dental organogenesis, the development of the skull and jaw. In infants, the pre-teething phase is influenced by the nutritional condition. Deficiencies of vitamins A, B, C, D and protein are associated with disorders of oral structures.  Malnutrition occurs when there are deficiencies in protein and/or energy foods. An insufficient amount of protein can cause 1) Lingual papillary atrophy 2) Dentinogenesis modification 3) Cementogenesis alteration 4) Changes in jaw development 5) Malocclusion 6) Linear enamel hypoplasia.  An insufficient lipid intake can cause 1) Inflammatory and degenerative pathologies 2) Hyposalivation 3) Degeneration of the glandular parenchyma 4) Alteration of mucosal lining. An insufficient amount of carbohydrates can lead to 1) Altered organogenesis 2) The influence of metabolism on dental plaque, caries, periodontal disease.  Folate associated with deficiency Neural tube defects, (vitamin B9) Cleft lip with or without cleft palate. Angular cheilitis Vitamin B12. Gingival bleeding deficiency. Painful mouth ulcers Cleft palate Dental anomalies Vitamin A Tooth fragility, Salivary gland degeneration deficiency Caries ✓ Vitamin C is essential for collagen synthesis. Deficiency of vitamin C is associated with irregular dentine formation, gingival bleeding, and delayed healing of lesions ✓ Vitamin D plays an important role in the absorption of calcium and phosphorus, allowing proper mineralization of bones and teeth. A deficiency of vitamin D will cause 1. Dental hypo mineralization 2. Delay in dental eruption 3. Absence of lamina dura 4. Development of dental caries. The American Academy all infants (naturally or artificially fed) receive a daily supplement of 400 IU of vitamin D Breast feeding versus Bottle feeding  Breastfeeding is ideal because of its overall health benefits. American Pediatric Association have shown that breastfeeding influences swallowing, jaw growth, correct teeth alignment and hard palate modeling. Artificial feeding may cause the occurrence of arterial hypertension, obesity, cardiovascular disease and inflammation of the oral mucosa. Nursing bottle caries  It is a type of caries characterized by rapid onset and extensive destruction of most of the deciduous teeth in infants who hold nursing bottles and pacifiers in their mouths over long periods of time. e.g., falling asleep with the nipple of the bottle or pacifier in the mouth. In this situation, there is direct contact of the teeth with water, juice, or milk sweetened with sugar, syrup, or honey.  Some Pedodontics have even seen this type of rampant caries in children who drink unsweetened milk from their nursing bottles. Usually, the nursing bottles are used as pacifiers at bedtime for children who are much beyond the bottle-feeding age Nutrition and Risk of the Dental Caries ▪ The risk of developing caries in children is directly related to the frequency and type of the meals. ▪ Frequent intake of high carbohydrate foods results in lower pH in the dental plaque, increased acid production by microorganisms, and demineralization of dental tissues. ▪ The type and consistency of carbohydrates consumed also determines the caries risk. ▪ Some foods are more retentive to the dental surfaces and facilitate the formation of a plaque. ▪ Foods and beverages such as milk, dairy products, and fluoridated water have caries-protective effects. ▪ These products increase the amount of calcium, phosphorus, and fluorine in the plaque, stimulate salivation, reduce the harmful effects of carbohydrates, and contribute to the remineralization process of acid-attacked tooth surfaces. ▪A daily habit of three meals and three snacks, every 30 minutes in length with an additional 30 minutes for the plaque pH to return to normal, theoretically supports 6 hours of demineralization and 18 hours of remineralization. ▪ Rapidly growing children and adolescents require frequent opportunities to consume energy to support growth, restrictive meal patterns (e.g., three meals, no snacks) are inappropriate It has been defined as ‘‘the presence of one or more Early decayed (non cavitated or childhood cavitated lesions), missing (due caries (ECC) to caries), or filled tooth surfaces in any primary tooth’’ in children from birth through 71 months of age. Severe ECC is characterized by the presence of Early 1) One or more decayed, missing, or filled childhood smooth surfaces in children less than 36 months. caries (ECC) 2) Cavitated, filled, or missing (due to caries) smooth surfaces in the primary maxillary anterior teeth. 3) Multiple decayed, missing, or filled surfaces in children aged 36 to 71 months. The etiology of ECC is Early multifactorial, the presence of childhood oral bacteria and fermentable carbohydrates are necessary, caries (ECC) yet proper oral hygiene and regular fluoride exposure reduce the risk of caries  Pediatrics Nutritional Needs at Different Stages  Infancy The mother should be advised to continue breastfeeding. The pediatrician should promote the breastfeeding beyond 6 months. It is recommended that all infants who are breastfed be given a liquid vitamin D supplement of 400 IU (10 μg) every day. A small amount of water can be offered from an open cup. Parents should avoid delaying the introduction of solid foods beyond about 6 months of age to reduce the risk of iron deficiency, solid foods can be offered before or after breast milk Do not introduce juice during the first 6 months of life.  Toddlers 1) It is the role of the parent to provide age-appropriate foods with scheduled meals and snacks in a consistent place (e.g., at the table versus in front of the TV). 2) It is the role of the child to determine whether or not to eat the provided food.  Preschoolers and School-aged children 1) Depending on the degree of snacking and the nature of foods consumed, snacking may lead to inadequate energy intake with weight loss, or excessive energy intake with weight gain. 2) Parents are responsible for providing access to appropriate food. 3) Frequent intake of energy-containing beverages increases risk of dental carries and may blunt the appetite. Recommendations for the prevention of oral cavity diseases ▪ Poornutrition, especially con