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MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences CHAPTER I: BASIC CONCEPTS IN NUTRITION AND DIET This chapter provides you the foundation of nutrition and diet therapy that beg...
MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences CHAPTER I: BASIC CONCEPTS IN NUTRITION AND DIET This chapter provides you the foundation of nutrition and diet therapy that begins with the definition of related terms. It also explores the different concepts in nutrition and classification of nutrients giving emphasis on its types and functions. In your journey through the discussions and different tasks, you must have: Defined related terms in nutrition and diet therapy. Explained the basic concepts in nutrition correctly. Classified foods into groups according to their nutrients and differentiated between macronutrients and micronutrients. Listed the different sources of nutrients. Described the types and functions of carbohydrates, proteins, fats, vitamins, minerals and water. This chapter is divided into 3 topics, namely: Lesson 1 – Definition of Terms Lesson 2 – Basic Concepts in Nutrition Lesson 3 – Classification of Nutrients Carbohydrates Proteins Fats Vitamins Minerals NCM 105: NUTRITION AND DIET THERAPY 1 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Lesson 1. DEFINITION OF TERMS Food and nutrition are intimately connected aspects of our life. Let us start our study by defining the important terms which will be necessary in our lesson. After studying this lesson, you must have: Defined related terms in nutrition and diet therapy. Differentiated nutrition from diet therapy Described ways in which nutrition is related to health Direction: Choose the letter of the best answer. 1. These are organic and inorganic substances found in foods that are required for body functioning. a. nutrients b. fluid intake c. nutritive value d. water 2. Nutritional status a. is determined by heredity b. never changes c. is not reflected in one’s appearance d. can affect the body’s ability to resist disease 3. It is the result of those processes whereby the body takes in and uses food for growth, development and maintenance of health. a. respiration b. diet therapy c. nutrition NCM 105: NUTRITION AND DIET THERAPY 2 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences d. digestion 4. What must an individual do to nourish the body adequately? a. avoid all low-nutrient-density foods b. eat foods containing the six classes of nutrients c. include fats at every meal d. restrict proteins at breakfast Nutrition Nutrition has been defined as the science of food, the nutrient and other substances therein, their action, interaction and balance in relation to health and diseases, and the process by which organism ingests, absorbs, transports, utilizes and excretes food substances (Claudio). Nutrition may also be defined as the study of nutrients and the processes by which they are used by the body (Taylor). It is also defined as the science of the processes by which the body uses food for energy, maintenance and growth (Peckenpaugh). Food is any substance, when ingested, nourishes the body by building and repairing tissues, supplying heat and energy, and regulating body processes. Food may also be defined as anything eaten or drunk, which meets the needs for energy, building, regulation and protection of the body. In short, food is the raw material from which our bodies are made. Intake of the right kinds and amounts of food can ensure good nutrition and health, which may be evident in our appearance, efficiency and emotional well-being. Nutrients NCM 105: NUTRITION AND DIET THERAPY 3 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Nutrients are organic and inorganic substances found in foods that are required for body functioning. These are substances in foods required by the body for energy, growth, maintenance and repair. The six essential nutrients in human nutrition are the following: 1. Carbohydrates 2. Proteins 3. Fats 4. Vitamins 5. Minerals 6. Water Nutritive value It refers to the nutrient content of specified amount of food. Nutritional Status (Nutriture) is the condition of an individual’s health as influenced by the utilization of essential nutrients. (Good, fair, poor nutriture). The characteristics of good nutritional status are an alert, good natured personality, a well-developed body, with normal weight for height, well developed and firm muscles, healthy skin, reddish pink color of eyelids and membranes of mouth, good layer of subcutaneous fat, clear eyes, smooth and glossy hair, good appetite and excellent general health. General good health is evident by stamina for work, regular meal times, sound regular sleep, normal elimination and resistance to disease. Poor nutritional status is evidenced by a listless, apathetic or irritable personality, undersized poorly developed body, abnormal body weight (too thin or fat and flabby body), muscles small and flabby, pale or sallow skin, too little or too much subcutaneous fat, dull or reddened eyes, lusterless and rough hair, poor appetite, lack of vigour and endurance for work and susceptibility to infections. Poor nutritional status may be the NCM 105: NUTRITION AND DIET THERAPY 4 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences result of poor food selection, irregularity in schedule of meals, work, sleep and elimination. Health The WHO (World Health Organization) has defined health as the ‘state of complete physical,mental and social well-being and not merely the absence of disease or infirmity’. It refers to the condition of the body, good health not only implies freedom from disease, but physical, mental and emotional fitness as well. Nutritional Care is the application of science and art of human nutrition to help people select and obtain food for the primary purpose of nourishing the body throughout the life cycle. It is an organized group of activities allowing identification of nutritional needs and provision of care to meet these needs. Nutritional care is the use of nutritional knowledge in planning meals and the preparation of these meals in an acceptable and attractive manner to feed people. It involves assessment of the exiting meal patterns and improving these in an acceptable manner. While the nutritional plan may be general for a group of people, the actual execution is individualized to suit the person’s needs and background. Malnutrition is a dietary condition caused be deficiency or excess of one or more essential nutrients in the diet. Malnutrition means an undesirable kind of nutrition leading to ill-health. It results from a lack, excess or imbalance of nutrients in the diet. It includes undernutrition and over nutrition. We usually think of malnutrition as a condition that results when the cells do not receive an adequate supply of the essential nutrients because of poor diet or poor utilization of food (Figure 1-1). Sometimes it occurs because people do not or cannot eat enough of the foods that NCM 105: NUTRITION AND DIET THERAPY 5 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences provide the essential nutrients to satisfy body needs. At other times people may eat well-balanced diets but suffer from diseases that prevent normal usage of the nutrients. Undernutrition is a state of an insufficient supply of essential nutrients. Malnutrition can be primarily be due to insufficient supply of one or more essential nutrients; or it can be secondary, which means it results from an error in metabolism, interaction between nutrients or nutrients and drugs used in treatment. Overnutrition 1. refers to an excessive intake of one or more nutrients, which creates a stress in the bodily function. Diet 2. refers to whatever you eat and drink each day. Thus it includes the normal diet you consume and the diet people consume in groups (hostel diet). Diet may also be modified and used for ill persons as part of their therapy (therapeutic diets). Diet Therapy 3. is a method of eating to improve health for prescribed by a physician. Diet therapy involves the modification of an existing dietary lifestyle for good health. Activity # 1 WORD HUNTING. Find your answers at the box on the side of the statement. NCM 105: NUTRITION AND DIET THERAPY 6 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences 1. This refers to whatever you eat and drink each day. M D T Y X B M N FOO D 2. The extreme intake of one or more nutrients, which A H T G N M A A X I C Z produces stress in the bodily function. L E E B N C I P L M L O N D F A B M K P O G C 3. The ‘state of complete physical, mental and social well- U I U O L K B C D S V being and not merely the absence of disease or T E M T H E A L T H J infirmity. R T U O I E G X M R L B 4. Any substance, when ingested, nourishes the body by I T R Y C A R E L O B P X building and repairing tissues, supplying heat and T H ER A P Y M N N K L energy, and regulating body processes. I P A T I E N T K Q Z Y P 5. A dietary condition caused be deficiency or excess of O V E R N U T R I T I O N one or more essential nutrients in the diet. N U T R I T I O N K L M N Nutrition is directly related to health, and its effects are cumulative. Good nutrition is normally reflected by good health. Poor nutrition can result in poor health and even in disease. Poor nutrition habits contribute to atherosclerosis, osteoporosis, obesity, and some cancers. A summa ve quiz will be given by your instructor via MVLE. Just wait for further instruc ons. Good luck! Lesson 2. CONCEPTS IN NUTRITION Good nutrition is an important part of leading a healthy lifestyle. Combined with physical activity, your diet can help you to reach and maintain a healthy weight, reduce your risk of chronic diseases (like heart disease and cancer), and promote your NCM 105: NUTRITION AND DIET THERAPY 7 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences overall health. In this lesson you will study the different basic concepts in nutrition and the factors affecting nutrition. After studying this lesson, you must have: Stated the basic concepts in nutrition correctly. Explained the basic concepts in nutrition correctly. Described the factors affecting nutrition. Direction: Read and understand the statements below. Encircle the numbers of all correct statements. 1. An individual’s health status greatly affects eating habits and nutritional status. 2. A balanced diet results when you do not consume one nutrient at the expense of another, but rather get appropriate amounts of all nutrients. 3. Food is a fundamental human need that influences both psychological and emotional states. 4. Nutrition process is a multidisciplinary process and forms the bridge between the educator and the consumer in the transport of nutritional principles and application. 5. Roman Catholic faiths prohibit meat, tea, coffee or alcohol. 6. Protestants observe kosher custom, eating certain foods prepared according to dietary laws. 7. Men differ from women in their nutrient requirements due to their differences in body composition and reproductive function. 8. Chemotherapy and radiation adversely affect eating patterns and nutrition. 9. Anorexia and weight loss can indicate severe stress or depression. 10. Childhood malnutrition is not just due to lack of nutrients, it can also be caused by enteric infections leading to intestinal inflammation and malabsorption of nutrients. BASIC CONCEPTS IN NUTRITION NCM 105: NUTRITION AND DIET THERAPY 8 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences The following are the basic concepts in nutrition you need to know. 1. An adequate diet is the foundation of good nutrition. A diet must be adequate, by providing sufficient amounts of each essential nutrient, as well as fiber and calories. A balanced diet results when you do not consume one nutrient at the expense of another, but rather get appropriate amounts of all nutrients. It should consist a wide variety of food. Foods are our best source of nutrients; synthetic forms like pills, purified diets are reserved for research purposes and therapeutic uses (supplements for deficiencies.) 2. Adequate nutrition is essential to good health. An adequate nutrition contributes to achieve or maintain a good state of health. Good nutrition gives a picture of a person with normal height and weight and body frame of his age. With firm, strong muscles that are well- formed and clear, pinkish skin, and healthy gowing hair. Has good appetite and digestion, ability to concentrate, mental alertness, emotional stability, vitality and vigor, endurance to certain stresses, efficient work performance, resistance to infection and wholesome personality- all reflects good health and proper nutrition. 3. The nutrients in the body is in dynamic equilibrium. They must be in metabolic balance, a disturbance of one nutrient will affects the others. Example, the glucose levels in your body remain relatively the same. Over the course of a day however, your body uses enormous amounts of glucose and NCM 105: NUTRITION AND DIET THERAPY 9 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences must replace it. Each cell in your body requires glucose to function. As the cells use this glucose, the liver and your digestive system work quickly to replace it. Glucose from the food you eat is moved from the stomach and intestines into the bloodstream. The liver stores glucose as glycogen, and must break this large molecule down to release glucose into the blood. In your body, glucose is in dynamic equilibrium. While glucose has periods of high and low concentration, it is relatively stable. If glucose levels in your body fall out of dynamic equilibrium, or you cannot replace the glucose you use, you would eventually die. (https://biologydictionary.net/dynamic-equilibrium/) 4. Nutrient content in food is variable. Whatever is present in the natural food should be conserved by scientific preparation and service. Ex. the nutrient content of rice suggests that the nutritional value of rice varies based on a number of factors. The nutritional content also depends on the color of the grain. Scientists have found that the color of rice is basically due to the compounds it contains as in purple rice, hydrophilic antioxidants represent a greater portion than the lipophilic antioxidants. (https://www.sciencedirect.com/topics/medicine-and-dentistry/nutrient-content) Wherever is feasible and under supervision of technical expertise, enrichment and fortification may be done on certain food products. 5. In addition to its nutritional importance, food has more meanings: psychological, emotional, social, cultural aesthetics. Food is a fundamental human need that influences both psychological and emotional states. As such, the search for and consumption of food has shaped human behavior. People feel strongly about their individual food preferences and the food culture they were raised in. Eating behavior goes beyond nutrition and alleviating hunger; family, friends, and cultural heritage shape individual food preferences. NCM 105: NUTRITION AND DIET THERAPY 10 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Food offering can be used to show affection to loved ones, to show hospitality to strangers, or to adhere to or express religious beliefs. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907771/) 6. Dietary intake and nutrient need should be individualized. Dietary intake refers to the daily eating patterns of an individual, including specific foods and calories consumed and relative quantities. Nutrition needs vary among individuals because of these factors: age, body size, state of health, physiologic stresses like growth, pregnancy and lactation, pathological disorders, convalescence, surgery etc. 7. Malnutrition is brought about by faulty diet and/or by conditioning factors like heredity, infections, ingestion of certain drugs and parasitism. “Nutritional deficiencies often occur together (multiple deficiency disease)”. Disease-related malnutrition arises due to reduced dietary intake, malabsorption, increased nutrient losses or altered metabolic demands. Childhood malnutrition is not just due to lack of nutrients, it can also be caused by enteric infections leading to intestinal inflammation and malabsorption of nutrients. 8. Various resources and other allied arts and sciences to which the study of nutrition is interrelated, are needed to improve the nutritional status of the population. The study of nutrition is interrelated with allied arts and sciences: food science and technology, nursing and medical fields, behavioral sciences, chemistry, biology, medicine, etc. 9. Nutrition education, abundant food supply and the use of various resources are needed to improve the nutritional status of the population. Nutrition education is a multidisciplinary process and forms the bridge between the educator and the consumer in the transport of nutritional NCM 105: NUTRITION AND DIET THERAPY 11 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences principles and application. There is no single approach in nutrition education and to motivate learning and change food habits, various techniques of communication have to be employed. This make nutrition an art. Activity #2. Fill in the tables with the following factors affecting nutrition. 1. Bereavement 2. Metabolic disorder 3. Work environment 4. Marriage status 5. Food price 6. Diet cost 7. Infant 8. Lactating mother 9. Asian 10. Roman Catholic 11. American 12. Eating habit 13. Cooking skills 14. Lack of teeth 15. Difficulty swallowing Development Religion, Lifestyle General Economic Psychological Ethnicity, Health Culture Status FACTORS AFFECTING NUTRITION The following are major elements that could influence nutrition. 1. Development NCM 105: NUTRITION AND DIET THERAPY 12 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Throughout the life cycle, nutrient needs change in relation to growth, development, activity, and age related changes in metabolism and body composition. Periods of intense growth and development (infancy, adolescence, pregnancy, lactation) cause an increase in nutrient needs. Stabilizes during adulthood, although older people may need more or less of some nutrients. Age influences not only nutrient requirements but also food intake. The consistency of food, eating patterns and the significance of food change with physical and psychosocial development. 2. Gender Men differ from women in their nutrient requirements due to their differences in body composition and reproductive function. Three large muscle mass of men translates to a greater need for calories and protein. Women require more iron than men do prior to menopause because they are menstruating. 3. Religion, ethnicity and culture Religion practice also affects diet - Roman Catholics avoid meat on certain days (Lenten season, Ash Wednesday and Good Friday) - Protestants faiths prohibit meat, tea, coffee or alcohol - Orthodox Jews observe kosher custom, eating certain foods prepared according to dietary laws. Ethnicity and Culture - Often determines food preferences Asians – rice Italians - pasta Indians – curry NCM 105: NUTRITION AND DIET THERAPY 13 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Philippines – region Ilocos – pinakbet Bicol – foods with gata - Nurses should not use good food/ bad approach rather, should realize that variations of intake are acceptable under different circumstances. - The only universally accepted guidelines are: a. To eat a wide variety of foods, to furnish adequate nutrients. b. To eat moderately to maintain correct body weight. 4. Lifestyle, personal preferences a. Lifestyle Certain lifestyles are linked to food related behavior - People are always in a hurry probably buy convenience grocery items or eat restaurant meals. Individual differences also influence lifestyle patterns. - Cooking skills, concern about health Some people work at different times, such as evening or night shifts. - They might need to adapt their eating habits and also make changes in their medication schedules if they are related to food intake. Muscular activity affects metabolic rate more than any other factors. - The more strenuous the activity, the greater the stimulation of the metabolism. Mental activity provides very little metabolic situation b. Personal Preferences Likes and dislikes can be related to familiarity Prefer to eat the same foods repeatedly Preferences in the tastes, smells, flavors, temperature, colors, shapes and sizes of food influence a person’s food choices NCM 105: NUTRITION AND DIET THERAPY 14 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Sweet and sour taste/ bitter or salty taste, texture also play a great role in food preferences (crisp food, firm to soft, tender to tough, smooth, dry). c. Alcohol consumption/ abuse Can alter body’s use of nutrients Toxic effect of alcohol on the intestinal mucosa interferes with normal nutrient absorption, thus require increase as the efficiency of absorption decreases. Can influence nutrient metabolism by impairing nutrient storage, increasing nutrient absorption, thus require as the efficiency of absorption decreases. Liver damage has profound effects on the body’s nutrient metabolism and requirement. Need of Vitamin B vitamins increases because they are used to metabolize alcohol. 5. Medication and therapy a. Medication May alter appetite, disturb taste perception, or interfere with nutrient absorption or excretion. Some nutrients decrease drug absorption or enhance absorption. Example: Ca in milk hinders absorption of the antibiotic tetracycline but enhances the absorption of antibiotic erythromycin. b. Therapy Chemotherapy and radiation adversely affect eating patterns and nutrition. Normal cells of the one marrow and the gastrointestinal mucosa are naturally very active and particularly susceptible to antineoplastic agents. Oral ulcers, intestinal bleeding, diarrhea resulting from the toxicity of antineoplastic agents used in chemotherapy can seriously diminish a person’s nutritional status. Radiation therapy: the effects depend on the area that is treated. NCM 105: NUTRITION AND DIET THERAPY 15 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences - Radiotherapy of the head and neck may cause decreased salivation, taste distortion, and swallowing difficulties. - Radiotherapy of the abdomen and pelvis may cause malabsorption, nausea, vomiting, diarrhea, feel profound fatigue and anorexia. 6. General Health Status/ State of Health An individual’s health status greatly affects eating habits and nutritional status. The alteration in nutrient requirements that results from illness and trauma varies with the intensity and duration of the illness. Example: - Fever increases the need for calories and water - Trauma (major surgery, burns, and crash injuries) is followed by hormonal changes that profoundly affect the body’s use of nutrients. To preserve and replenish body nutrient stores and to promote healing and recovery, nutrient requirements increase dramatically in the adaptive phase after stress. - Chronic disorders (DM, renal disease, hypertension, heart disease. GI disorders, and cancer) can affect / alter nutrient intake, digestion, absorption, metabolism, utilization, or excretion of essential nutrients. - Gastrointestinal and other diseases also create nausea, vomiting, diarrhea, all of which can adversely affect a person’s appetite and nutritional status. - Gallstones which can affect the flow of bile are a common cause of impaired lipid digestion. - Metabolic processes can be impaired by disease of the liver. - Diseases of the pancreas can affect glucose metabolism. - Lack of teeth, ill-fitting dentures, or a sore mouth makes chewing food difficult. NCM 105: NUTRITION AND DIET THERAPY 16 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences - Difficulty of swallowing (dysphagia) due to a painful, inflamed throat or a structure of the esophagus can prevent person from obtaining adequate nourishment. 7. Advertising Food producers try to persuade to change from the product they currently use to the brand of the producer. Popular actors/ actresses are often used to influence television viewers or radio listener’s choices. Alcoholic beverages, coffee, frozen foods, and soft drinks are more heavily advertised than such products as bread, vegetables and fruits. - Convenience foods – frozen, packaged, easy to prepare. - Take out/ to go fast foods are heavily advertised. - Elders – use of herbs and supplements 8. Psychological factors Some people over eat when stressed, depressed or lonely. Others eat very little under the same condition. Anorexia and weight loss can indicate severe stress or depression 9. Economic Factors What, how much and how often a person eats are frequently affected by socio- economic status. A person with limited income may not be able to afford meat and fresh vegetables. People with higher income may purchase more proteins, fats and fewer complex carbohydrates. Not all persons have financial resources for extensive food preparation and storage facilities. NCM 105: NUTRITION AND DIET THERAPY 17 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Nutrition is how food affects the body. Adequate diet is the foundation of good nutrition, which is essential to good health. Food is essential, thus it has more meanings in other aspects. Multiple factors affect nutrition like development, age, culture, lifestyle, medication, state of health, development, psychological and economic factors. A summa ve quiz will be given by your instructor via MVLE. Good luck! Lesson 3. CLASSIFICATION OF NUTRIENTS Which nutrients are the cornerstones of health and disease prevention? What do they do to make them so important? In this lesson, you will learn about each nutrient in more detail. You will learn about the major categories of nutrients, the main sources of these, their function, and how our body uses each of these nutrients for healthy growth and development. After you study this lesson, you must have: Classified foods into groups according to their nutrients and differentiate between macronutrients and micronutrients. Listed the sources and functions of the nutrients. Described vitamins and their classification. Explained the functions of the common minerals that people require in their diet. 1. What are the two categories of nutrients? 2. What are the two classification of carbohydrates? NCM 105: NUTRITION AND DIET THERAPY 18 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences 3. What are the classifications of protein? 4. What are the classifications of vitamins according to solubility? 5. FOOD NUTRIENTS are compounds in foods essential to life and health, providing us with energy, the building blocks for repair and growth and substances necessary to regulate chemical processes. These are classified according to their functions, chemical nature, and essentiality. Nutrients have one or more of three basic functions: they provide energy, contribute to body structure, and/or regulate chemical processes in the body. Nutrients may be organic or inorganic. Organic compounds include most compounds containing carbon, while all other chemicals are inorganic. Two categories of Nutrients: 1. Macronutrients are the nutrients our body needs in larger amounts, namely: a. carbohydrates b. protein c. fat 2. Micronutrients are the nutrients our body needs in smaller amounts, which are commonly referred to as a. vitamins b. Minerals CARBOHYDRATES NCM 105: NUTRITION AND DIET THERAPY 19 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Carbohydrates (CHO) are a group of organic compound that contains the elements carbon (C), hydrogen (H) and oxygen (O). It contribute at least 50% of total energy needs and provide preventive health benefits Classification of Carbohydrates: According to Complexity of Molecules 1. Simple Carbohydrates a. Monosaccharide b. Disaccharide 2. Complex CHO a. Starch b. Glycogen c. Fiber Simple carbohydrates are made up of just one or two sugar units and sometimes called "sugars" or "simple sugars." a. Monosaccharides contain just one sugar unit, so they're the smallest of the carbohydrates. The small size of monosaccharides gives them a special role in digestion and metabolism. Food carbohydrates have to be broken down to monosaccharides before they can be absorbed in the gastrointestinal tract, and they also circulate in blood in monosaccharide form. Three types of monosaccharides: i. Glucose - is called the blood sugar, a simple carbohydrate that circulates in the blood, the main source of energy for the central nervous system and the brain, and rapidly absorbed from the intestines but needs insulin to be taken into the cells where energy is released NCM 105: NUTRITION AND DIET THERAPY 20 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences ii. Fructose – is the sweetest of all sugars which provides characteristics taste of fruits and honey and it is also called as Levulose. It is absorbed in the intestine but it is converted to glucose in the liver iii. Galactose - rarely found in nature by itself but is part of the dissacharide lactose (sugar in milk). It is absorbed and converted to glucose like fructose b. Disaccharides (also called a double sugar or bivose) is the sugar formed when two monosaccharides (simple sugars) are joined by glycosidic linkage. Like monosaccharides, disaccharides are soluble in water. Three examples of disaccharides: i. Sucrose (glucose + fructose) - is made of a glucose molecule bonded to a fructose molecule. It's made by plants for the same reason as fructose -- to attract animals to eat it and thereby spread the seeds. The sucrose found in sweet potato is chemically identical to the sucrose found in table sugar. ii. Maltose (glucose + glucose) - it is available when cereal grains are about to germinate and the plant starch is broken down in the small intestines. When maltose is fermented, alcohol is formed ( used in the production of beer and malted beverages) iii. Lactose (glucose + galactose) - it is sometimes called "milk sugar" as it is found in dairy products like milk, yogurt, and cheese. These are the only animal foods that have significant amounts of carbohydrate. Most of our carbohydrates come from plant foods. Complex carbohydrates NCM 105: NUTRITION AND DIET THERAPY 21 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Complex carbohydrates are also called polysaccharides, because they contain many sugars. (The prefix "poly-" means "many.") Three main polysaccharides: a. Starch - is the storage form of carbohydrate in plants. Plants make starch in order to store glucose. For example, starch is in seeds to give the seedling energy to sprout, and we eat those seeds in the form of grains, legumes (soybeans, lentils, pinto and kidney beans, for example), nuts, and seeds. Sources: Grains – provide more CHO than other food category Eg: wheat, oats, barley, rice, corn, rye Legumes – source of starch as well as dietary fiber and protein Eg: dried beans and peas Vegetables eg: potatoes, yams, parsnips, carrots and some varieties of squash (acorn) and butternu b. Glycogen - the storage form of carbohydrate in animals, humans included. It's made up of highly branched chains of glucose, and it's stored in the liver and skeletal muscle. The branched structure of glycogen makes it easier to break down quickly to release glucose to serve as fuel when needed on short notice. i. liver glycogen * glycogenolysis - the conversion of glycogen to glucose in the liver ii. muscle glycogen - used directly to supply the muscle tissues of energy during exercise and work c. Fiber - roughage or residue, consist of strings of simple sugars, indigestible parts of plants. It absorbs water in the large intestine, helping to create a soft, bulky stool. NCM 105: NUTRITION AND DIET THERAPY 22 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Classification based on solubility in fluids 1. Soluble dietary fibers dissolved in fluids and thicken substances (hold water and form gels) Examples: Pectin – found inside fruits (apples, peaches, plums, bananas) and vegetables (carrot, cabbage, broccoli) 2. Insoluble dietary fibers do not dissolve in fluids and therefore provide structure and protection for plants Examples: Cellulose –primary source of dietary fiber -found in the skin of fruits (apples, grapes); leaves and stem of vegetables Hemicelluloses- dietary fiber found in whole grains (brown rice, wheat bran, whole grain in crackers) Functions of dietary fibers 1. Fibers act as broom in the digestive tract *Fibers prevent the following: a. Constipation - adequate fiber assures larger, softer stool (holds water) thus easier elimination b. Diverticular diseases - a disorder on the walls of large intestine where pockets are developed. Pressures are created because of decreased bulk of fibers that push the feces; Pressure weakens the walls on the large intestines NCM 105: NUTRITION AND DIET THERAPY 23 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences c. Colon Cancer - may develop due to high intake and exposure to carcinogens. Fiber replaces foods that are high in fat d. Heart diseases /Obesity - soluble fibers bind with lipids and cholesterol and eliminated in the intestinal tract, thus helping elimination of cholesterol e. Diabetes mellitus - fibers decrease glucose absorption, lowering blood glucose level 2. Dietary fibers (pectin) were found to retard gastric emptying. Benefits are the following: a. Increased satiety, thus less food is eaten and energy intake is kept within the requirement b. Slower absorption of glucose, hence decrease insulin secretion 3. Fibers increase motility of colon and decrease transitional tissues less time for exposure of mucosa to harmful toxins. FUNCTIONS OF CARBOHYDRATES 1. Chief source of energy Body cells require a constant and steady supply of energy mainly as glucose and its intermediate product Glycogen stored in muscles for immediate use Only about 10 gm of glucose is circulating in the blood. 70-100 mg of glucose /100 ml of blood is adequate to maintain homeostasis (must be kept constant and ready for utilization Sole energy source for brain and nerve tissue NCM 105: NUTRITION AND DIET THERAPY 24 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences 2. Protein sparer Energy needs of the body are given priority over body building. CHO are always the frontlines in providing energy, thereby sparing or saving the CHON to be used for specific protein functions 3. Regulator of intestinal peristalsis and bulk provider Cellulose aids in normal elimination by stimulating peristaltic movement and absorption of water 4. Detoxifier of harmful agents Glucuronic acid – a glucose metabolite found in the liver, which combines with chemical and bacterial toxins making them easy to be eliminated. 4. CHO and CHON products are used in different fields of study and some serve as precursors for other compounds Examples: a. Glycosides – when hydrolyzed yields sugar and related substances; gain importance in drug therapies. b. Insulin – used in medicine for insulin clearance – to test for kidney function. IMBALANCES IN CARBOHYDRATES Disorders in carbohydrates occur in many forms. There are disorders which arise when there is deficiency and excess in carbohydrates. Deficiency a. PEM- protein energy malnutrition is composed of a spectrum of biological disorders caused by the lack of food. Despite the name, it is not necessary for affected individuals to be experiencing a lack of protein, but rather a deficiency of total energy. (https://www.sciencedirect.com/topics/food-science/protein-energy- malnutrition) b. Hypoglycemia NCM 105: NUTRITION AND DIET THERAPY 25 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Low blood sugar (also known as hypoglycemia) is when your blood sugar levels have fallen low enough that you need to take action to bring them back to your target range. This is usually when your blood sugar is less than 70 mg/dL. Each person's reaction to low blood sugar is different. From milder, more common indicators to most severE, signs and symptoms of low blood sugar include: Feeling shaky Feeling Sleepy Being nervous or anxious Feeling weak or having no energy Blurred/impaired vision Sweating, chills and clamminess Tingling or numbness in the lips, Irritability or impatience tongue, or cheeks Headaches Confusion Coordination problems, clumsiness Fast heartbeat Nightmares or crying out during sleep Seizures Feeling lightheaded or dizzy (https://www.diabetes.org/diabetes/med Hunger ication-management/blood-glucose- Nausea testing-and-control/hypoglycemia) Color draining from the skin (pallor) Excess: a. Obesity has traditionally been defined as an excess accumulation of body energy, in the form of fat or adipose tissue. Thus, obesity is a disease of positive energy balance, which arises as a result of dysregulation in the energy balance system – a failure of the regulatory systems to make appropriate adjustments between intake and expenditure. b. Dental caries Dental caries are cavities formed by the destruction of the hard tissues of the teeth. They occur when bacteria on your teeth metabolize carbohydrates. This leaves behind an acid, which sits on your teeth, slowly destroying the hard enamel covering and underlying structures of the tooth, much like acid rain chips away at a statue over time. NCM 105: NUTRITION AND DIET THERAPY 26 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Dental caries is commonly associated with the overconsumption of refined carbs and added sugar because these are the easiest carbs for the bacteria to break down into acids. (https://study.com/academy/lesson/health-effects-of-the-excessive- consumption-of-carbohydrates.html) c. Galactosemia is an an inherited disease in which the transformation of galactose to glucose is blocked, allowing galactose to increase to toxic levels in the body. If untreated, high level of galactose causes vomiting, diarrhea, lethargy, low blood sugar, brain damage, jaundice, liver enlargement, cataracts, susceptibility to infection, and death. d. Ketosis is the abnormal accumulation of ketones in the body as a result of excessive breakdown of fats caused by a deficiency or inadequate use of carbohydrates. Fatty acids are metabolized instead, and the end products, ketones, begin to accumulate. This condition is seen in starvation, occasionally in pregnancy if the intake of protein and carbohydrates is inadequate, and most frequently in diabetes mellitus. It is characterized by ketonuria, loss of potassium in the urine, and a fruity odor of acetone on the breath. Untreated, ketosis may progress to ketoacidosis, coma, and death. ACTIVITY #3: Fill in the missing boxes to complete the diagram. CARBOHYDRATES (CHO) NCM 105: NUTRITION AND DIET THERAPY 27 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences The body of a healthy lean man is composed of roughly 62 percent water, 16 percent fat, 16 percent protein, 6 percent minerals, and less than 1 percent carbohydrate, along with very small amounts of vitamins and other miscellaneous substances. Tthe Dietary Guidelines for Americans recommends that carbohydrates make up 45 to 65 percent of your total daily calories. PROTEINS A protein is a chain of amino acids connected together. You can think of this like a beaded necklace. The beads (amino acids) are connected together by a string (bond), which forms a long chain (protein) Protein comes from the Greek word “proteios”, meaning "primary" or "holding the first place." A Dutch chemist Gerard Johann Mulder, coined the word protein in 1838. Proteins are organic compounds which contain carbon, hydrogen, oxygen, nitrogen (CHON) and usually sulfur and are composed of chains of alpha-amino acids. They are composed of chemical compounds called amino acids (building blocks of CHON). They are essential macromolecules which without, the human body would be unable to repair, regulate, or protect itself. The human body is about 45% protein. They can be obtained from foods such as meat, fish, eggs, milk, and legumes. CLASSIFICATION of PROTEINS 1. According to physiological properties: a. Simple proteins. On hydrolysis they yield only the amino acids and occasional small carbohydrate compounds. Examples are: albumins, globulins, glutelins, albuminoids, histones and protamines. These proteins are made up of amino acids only. Seafood. White-Meat Poultry. Milk, Cheese, and Yogurt. Eggs. Beans. Pork Tenderloin. Soy. Lean Beef. NCM 105: NUTRITION AND DIET THERAPY 28 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Albumin is a protein made by your liver. Albumin helps keep fluid in your bloodstream so it doesn't leak into other tissues. It is also carries various substances throughout your body, including hormones, vitamins, and enzymes. Low albumin levels can indicate a problem with your liver or kidneys The globulins are a family of globular proteins that have higher molecular weights than albumins and are insoluble in pure water but dissolve in dilute salt solutions. Some globulins are produced in the liver, while others are made by the immune system. Any of a class of simple proteins that are found in cereal grains and are soluble in dilute acids or bases. Glutelins are a major component of gluten in wheat. ALBUMINOID- a class of simple proteins, as keratin, gelatin, or collagen, that are insoluble in all neutral solvents; A histone is a protein that provides structural support to a chromosome Protamines are small, arginine-rich, nuclear proteins that replace histones late in the haploid phase of spermatogenesis and are believed essential for sperm head condensation and DNA stabilization. Protamine sulfate is a medication that is used to reverse the effects of heparin. It is specifically used in heparin overdose, in low molecular weight heparin overdose, and to reverse the effects of heparin during delivery and heart surgery. It is given by injection into a vein. b. Conjugated proteins. These are simple proteins combined with some non-protein material in the body. Examples are: nucleoproteins, glycoproteins, phosphoproteins, haemoglobins, lecithoproteins and enzymes. The non-amino part of a conjugated protein is usually called its prosthetic group. Most prosthetic groups are formed from vitamins.. The nonprotein portion is called the prosthetic group. c. Derived proteins. These are proteins derived from simple or conjugated proteins by physical or chemical means. Examples are: denatured proteins and peptides. Denaturation refers to the physical changes that take place in a protein exposed to abnormal conditions in the environment. Heat, acid, high salt concentrations, alcohol, and mechanical agitation can cause proteins to denature Peptides are short strings of amino acids, typically comprising 2–50 amino acids. Peptides act as structural components of cells and tissues, hormones, toxins, antibiotics, and enzymes. Examples of peptides include the hormone oxytocin, glutathione (stimulates tissue growth), melittin (honey bee venom), the pancreatic hormone insulin, and glucagon (a hyperglycemic factor) AMINO ACIDS Amino acids are organic compounds that combine to form proteins. Amino acids and proteins are the building blocks of life. When proteins are digested or broken down, amino acids are left. The human body uses amino acids to make proteins to help the body: Break down food Grow Repair body tissue NCM 105: NUTRITION AND DIET THERAPY 29 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Perform many other body functions Amino acids can also be used as a source of energy by the body. Amino acids are classified into three groups: a. Essential amino acids Essential amino acids cannot be made by the body. As a result, they must come from food. b. Nonessential amino acids Nonessential means that your bodies produce an amino acid, even if you do not get it from the food we eat. c. Conditional amino acids Conditional amino acids are usually not essential, except in times of illness and stress. Conditionally Essential Non-essential Arginine Alanine Cysteine Asparagine Glutamine Aspartic Acid or Aspartate Glycine Glutamic Acid or Glutamate Proline Serine Tyrosone NCM 105: NUTRITION AND DIET THERAPY 30 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences ACTIVITY #4 Please complete the table as to the number which is being requested. ESSENTIAL AMINO ACIDS (9) NON-ESSENTIAL AMINO CONDITIONAL AMINO ACIDS ACIDS (11) (8) Functions of Protein 1. Growth and maintenance the amino acids are needed to make the proteins required to support muscle, tissue, bone formation, and the cells themselves. 2. Creation of communicators and catalysts Many vital substances produced by the bodies are made-up of proteins Examples: hormones, enzymes 3. Immune System Response NCM 105: NUTRITION AND DIET THERAPY 31 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Amino acids are necessary for the formation of antibodies. 4. Fluid and Electrolyte Regulation Proteins help in the proper distribution of fluids in the different fluid compartments. 5. Acid Base Balance Proteins have buffering effect. Proteins assist with intracellular pH regulation 6. Transportation Some proteins act as carrier protein. A transport protein (variously referred to as a transmembrane pump, transporter, escort protein, acid transport protein, cation transport protein, or anion transport protein) is a protein that serves the function of moving other materials within an organism. Carrier proteins are used in both passive and active transport and change shape as they move their particular molecule across the membrane Protein Deficiency Conditions: 1. Marasmus a disease caused by a severe deficiency of protein and calories that affect infants and very young children, often resulting in weight loss and dehydration. can develop into starvation and can cause fatality due to lack of essential nutrients. 2. Kwashiorkor a disease caused by a severe deficiency of protein in diets that contain calories mostly from carbohydrates such as yams, rice and bananas. It usually affects older children. People with kwashiorkor appear puffy in the abdomen area from retention of fluid. Common symptoms include fatigue, irritability, diarrhea, stunted growth and impairment of cognition and mental health. 3. PKU (Phenylketonuria) a genetic disorder with a protein link. characterized by the inability to use or break down excess phenylalanine, an essential amino acid Phenylketonuria is a genetic disorder inherited from a person's parents. It is due to mutations in the PAH gene, which results in low levels of the enzyme phenylalanine hydroxylase. This results in the buildup of dietary phenylalanine to potentially toxic levels. Phenylalanine is an amino acid found in many foods and used by your body to produce proteins and other important molecules NCM 105: NUTRITION AND DIET THERAPY 32 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Newborns with PKU initially don't have any symptoms. However, without treatment, babies usually develop signs of PKU within a few months. PKU signs and symptoms can be mild or severe and may include: A musty odor in the breath, skin or urine, caused by too much phenylalanine in the body Neurological problems that may include seizures Skin rashes (eczema) Fair skin and blue eyes, because phenylalanine can't transform into melanin — the pigment responsible for hair and skin tone Abnormally small head (microcephaly) Hyperactivity Intellectual disability Delayed development Behavioral, emotional and social problems Psychiatric disorders The main way to treat PKU is to eat a special diet that limits foods containing phenylalanine. Infants with PKU may be fed breast milk. They usually also need to consume a special formula known as Lofenalac. When your baby is old enough to eat solid foods, you need to avoid letting them eat foods high in protein 4. Sickle cell disease or anemia a genetic protein disorder which affects the shape of red blood cells. Because of the abnormalities of the hemoglobin molecule, the RBC is curved or sickle shaped rather than round, causing these blood cells to clog small blood vessels. This could be painful, may cause damage to internal organs such as the kidneys and heart and may lead to frequent infections throughout the body. Sickle cell anemia is an inherited red blood cell disorder in which there aren't enough healthy red blood cells to carry oxygen throughout your body. Normally, the flexible, round red blood cells move easily through blood vessels. NCM 105: NUTRITION AND DIET THERAPY 33 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Sickle cell anemia results from a mutation in a gene called HBB, which contains the blueprint for cells to make part of a protein called hemoglobin. The hemoglobin protein is made up of two alpha chains and two beta chains. Each chain includes an iron-containing “heme” portion. n sickle cell anemia, the red blood are shaped like sickles or crescent moons. These rigid, sticky cells can get stuck in small blood vessels, which can slow or block blood flow and oxygen to parts of the body. Episodes of pain.... Swelling of hands and feet.... Frequent infections.... Delayed growth or puberty.... Vision problems. Manage acute crises. During an acute crisis, comfort measures, use of analgesics, and complementary approaches such as massage and distraction are key. Healthcare providers focus on hydration, prevention of infections, and early recognition of complications. NCM 105: NUTRITION AND DIET THERAPY 34 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences FATS AND FATTY ACIDS FATS any of various soft, solid, or semisolid organic compounds constituting the esters of glycerol and fatty acids and their associated organic groups. A mixture of such compounds occurring widely in organic tissue, especially in the adipose tissue of animals and in the seeds, nuts, and fruits of plants. LIPIDS organic compounds not soluble in water, but soluble in fat solvents such as alcohol stored in the body as energy reserves and are also important components of cell membranes. FATTY ACIDS any of a large group of long-chain monobasic organic acids hydrolytically derived from fats. CLASSIFICATIONS OF FATTY ACIDS A. According to degree of saturation 1. Saturated- each of carbon atoms has two hydrogens attached to it. 2. Unsaturated – one of hydrogen atom is missing which necessitates double bond between the two carbon atoms B. According to complexity of molecules and chemical compositions 1. Simple lipids a. Triglycerides NCM 105: NUTRITION AND DIET THERAPY 35 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences b. Esters 2. Compound lipids a. Phospholipids b. Glycolipids c. Aminolipids 3. Derived lipids C. According to physical appearance 1. Visible fats 2. Invisible fats FUNCTIONS OF FATS 1. Energy giving nutrient body fat cells contain nearly pure fat in the form of triglycerides. a pound of adipose tissue, the storage depot of body fat could produce 3500 kcalories as energy. adipose tissue provides important fuel during illness or times of food restriction and is a major energy source for muscle work. 2. Act as pad and give support to organs stored fat safely cushions and protects body organs during bumpy activities. 3. Protein, thiamin, niacin sparer 4. Supplier of essential fatty acids fats contain the essential fatty acids of linoleic and linolenic fatty acids which are necessary materials for making compounds, such as prostaglandins, that regulate many body functions such as blood pressure, blood clotting thru platelet aggregation, gastric acid secretions and muscle secretions 5.Serve as carrier of fat-soluble Vitamins transport the fat-soluble nutrients of vitamins A, D, E and K 6. Other special functions: a. dietary lubricant helps facilitate ease of movement of food particles along the GIT b. high satiety value fat helps prevent hunger between meals fat slows down digestion because of the hormones released in response to its presence in the GIT causing to the feeling of fullness and satiety NCM 105: NUTRITION AND DIET THERAPY 36 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences d. emulsifying agents Lecithin, a phospholipid, is an important part of all cell membrane structure and serves as an emulsifier to keep fats dispersed in body fluids e. insulation myelin, a substance composed largely of fatty tissue, covers nerve cells; this covering provides electrical insulation that allows the transmission of nerve impulses. SOURCES 1. visible fats - butter, margarine, fish liver oils, cooking oils, pork fat, chicken fat 2. invisible fats - avocado, lean meats, egg yolk, milk and pastries, cream/ cheese, yogurt 3. polyunsaturated - corn, sesame, soybean oil, salmon, tuna, beef and poultry fats 4. saturated - butter fats, ice cream, chocolates, bacon, sausage FAT MALNUTRITION 1. Reduced calorie supply in the body 2. Reduced growth 3. Cardiovascular diseases- deposition of fats in the blood vessels We have tackled the different macronutrients which are carbohydrates, proteins and fats. Moving on, we are now on the micronutrients which will be our focus on this session. VITAMINS Vitamins are organic compounds that are essential in small amounts for body processes. Organic Compounds All contain the elements carbon, hydrogen and oxygen Only water-soluble vitamins contain nitrogen Some water soluble have sulfur/cobalt in their composition NCM 105: NUTRITION AND DIET THERAPY 37 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences They are potent organic compounds of unrelated chemical composition which occur in minute quantities in foods and are needed in small amount for specific regulatory functions for the maintenance of life and normal growth. The body requires vitamins only in minute amounts, but proper growth and development and optimal health are impossible without them. Some vitamins may be synthesized by the body, but the most part they must be supplied in the daily diet of normal healthy persons. Vitamins, although organic in nature, do not provide energy (kcal). However, they do help in the metabolism of the kcal containing macronutrients: CHO, CHON and fat. In this role, vitamins are thought to act as catalysts. Provitamins compounds that can be changed to achieve vitamins Precursor something from which the body can synthesize the specific vitamin Avitaminosis without vitamins Hypervitaminosis is the condition caused by excessive ingestion of one or more vitamins Antivitamin / Vitamin antagonist these are substances that interfere with the normal function of a vitamin. Examples: dicumarol against Vit. K; avidin against Biotin Synthetic Vitamins man-made/synthesized vitamin made in the laboratory Are frequently added to foods during processing (described as enriched or fortified). Examples of these foods are enriched bread and cereals to which thiamin, niacin, riboflavin folate and the mineral iron have been added. Vit. A and D are added to milk and fortified margarine Beside solubility proper es, fat soluble vitamins differ from water soluble vitamins based on the following criteria: General Properties of Fat Soluble Vitamins: 1. Fat soluble vitamins generally have precursors/provitamins. 2. Because they can be stored in the body, deficiencies are slow to develop. 3. They are not absolutely needed daily from food sources 4. They are generally stable, especially in ordinary cooking methods. NCM 105: NUTRITION AND DIET THERAPY 38 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences General Properties of Water Soluble Vitamins: 1. They must be supplied every day in the diet 2. They do not have precursors 3. They are not stored significantly in the body and any excess is secreted in the urine 4. Deficiency symptom develop relatively fast 5. Being water-soluble, they are most likely to be destroyed in ordinary cooking Preserving vitamin content in food 1. Buy the freshest, unbruised vegetables and fruits and using them raw whenever possible. 2. Prepare fresh fruits and vegetables just before serving. 3. Follow package directions when using frozen vegetables and fruits. 4. Use as little water as possible when cooking. 5. Cover the pan and cook as short a time as possible. 6. Save the cooking liquid for later use (in soup, stews and gravies). 7. Store fresh vegetables and fruits in a cool, dark place. Activity #4. What are the two (2) Classification of Vitamins according to solubility? (Fill in the blanks below) A. ________________ ___________ ___________ ___________ ___________ ___________ B. _________________ ________________ ________________ ______________ ______________ ______________ ______________ Folate/ Folic acid FAT SOLUBLE VITAMINS 1. Vitamin A (Retinol) consists of 2 basic dietary forms: Preformed Vit. A, also called retinol, which is the active form of Vit.A; and Carotenoids, the inactive form of Vit. A, which are found in plants Functions: NCM 105: NUTRITION AND DIET THERAPY 39 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences a. Maintain stability of cell membranes b. For normal bone ad skeletal growth Food Sources: a. preformed vitamin A- fish, oil, egg yolk, milk, cream, butter and cheese b. provitamin A- dark green and yellow vegetables, yellow fruits, cream, butter RDA- 4,000- 5000 IU for normal adult Vitamin A Malnutri on: a. Deficiency symptoms: night blindness, rough skin, eye lesions, retarded growth, risk for infection. b. Hypervitaminosis 2. VITAMIN D anti-rachitic, sunshine vitamin exists in 2 forms: D2 (ergocalciferol) and D3 (cholecalciferol) Functions: - for the regulation of Calcium and Phosphorus metabolism Food Sources: Utilization: - absorbed through the lymphatic system and enters the blood to be carried to the liver. RDA : 1 mg Vit D=40,000 IU ; 400 IU for normal adults Vitamin D Malnutrition: a. Tetany - is a disorder of increased neuronal excitability usually associated with hypocalcemia. b. Rickets - is the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D deficiency. c. Osteomalacia - is a weakening of the bones that can lead to serious health NCM 105: NUTRITION AND DIET THERAPY 40 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences complications, such as fractures and severe deformity, if it's not treated. d. Osteoporosis - is a disease characterized by low bone mass and deterioration of bone tissue, which can lead to increased risk of fracture. e. Hypervitaminosis - is a condition of abnormally high storage levels of vitamins, which can lead to toxic symptoms. 3. VITAMIN E antisterility vitamin, tocopherols deteriorates when exposed to light and bleach Func ons: a. essentials for normal reproduction b. protects cell structure c. has antioxidant properties Food Sources: a. plants- good sources b. wheat germ, vegetables and seed oils, egg yolk, milk, leafy vegetables Utilization: similar to other fat-soluble vitamins RDA: 10-15 or 10-30 mg/ day Vitamin E Malnutrition: - Deficiency: increased hemolysis of RBC, signs of muscle loss 4. VITAMIN K has antihemorrhagic factors found naturally in 2 forms:K1 (phylloquinone) and K2 (menaquinones); synthetic forms include: menadione and phytomenadione resistant to heat and air exposure, but destroyed by light, alkalis and strong acids Func ons: a. for proper clotting b. for phosphorylation Food Sources: NCM 105: NUTRITION AND DIET THERAPY 41 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences a. green leafy vegetables, liver, vegetable oils b. poorest sources are animal sources U liza on: a. similar to other fat-soluble vitamins b. intestinal synthesis by bacteria in the large intestines RDA: 2 mcg/ kg BW Vitamin K Malnutrition: a. Hemorrhagic diseases in newborns b. Delayed blood clotting time in adults c. Hypervitaminosis: liver and kidney damage, kernicterus B. WATER SOLUBLE VITAMINS 1. VITAMIN C (Ascorbic acid) ascorbic acid, “fresh food” vitamin, antiscorbutic acid has antioxidant properties but is the most unstable and readily destroyed by heat, air, light and alkalis. Func ons: a. for normal functioning of all cellular units b. necessary for metabolism of iron Food Sources: citrus fruits U liza on: almost completely absorbed in the small intestines RDA: 70 mg for women and 75 mg for men Vitamin C Malnutrition: a. Deficiency signs: b. Scurvy c. Excess: diarrhea, nausea, cramps 2. VITAMIN B1 (Thiamine) also anti-beriberi, antineuritic factors artially destroyed by heat and alkalis, lost in cooking Func ons: a. essential for CHO metabolism b. helps maintain good muscles tone and normal functioning of nerves Food Sources: lean pork, whole/ enriched grains and flours, legumes, seeds and nuts U liza on: almost completely absorbed in the duodenum, excess is excreted in the urine RDA:.2 mg per 1000 caloric intake; allowances are at least twice the minimum needs. NCM 105: NUTRITION AND DIET THERAPY 42 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Vitamin B1 malnutri on: a. Deficiency signs: b. Beriberi - two types of the disease: wet beriberi and dry beriberi. - Wet beriberi affects the heart and circulatory system. In extreme cases, wet beriberi can cause heart failure. Dry beriberi damages the nerves and can lead to decreased muscle strength and eventually, muscle paralysis. Beriberi can be life-threatening if it isn’t treated. 3. VITAMIN B2 (Riboflavin) name denoted a ribose content (ribo) and yellow pigment (flavin) easily destroyed by light, irradiation, and alkalis Func ons: a. essential for CHO, CHON and fat metabolism b. for tissue maintenance Food Sources: eggs, organ meats, vegetables (brocolli, asparagus, cabbage) Utilization: absorbed through the small intestines, excess is excreted in the urine; stored in limited amount RDA:.025 mg per gram of protein intake;.4 mg per 1000 cal Vitamin B2 Malnutri on: a. Cheilosis - an abnormal condition of the lips characterized by scaling of the surface and by the formation of fissures in the corners of the mouth. b. Ariflavinosis - a deficiency disease due to inadequate intake of riboflavin and characterized by sores on the mouth. 4. VITAMIN B3 (Niacin) Antipelagra factor 2 biologically active forms: Nicotinic Acid, and Nicotinamide most stable of the water-soluble vitamins Func ons: NCM 105: NUTRITION AND DIET THERAPY 43 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences a. helps to converts carbohydrates into glucose, metabolize fats and protein b. helps the body to make sex and stress related hormones and improves circulation Food Sources: a. outstanding sources are animal sources b. foods that are good sources of tryptophan: U liza on: absorbed and circulated in the blood both in acid and amide form; stored in limited amount RDA: 1NE=1 mg niacin or 60 mg tryptophan; 4.4 mg per 1000 Kcal or 13-16 mg/day Niacin Malnutri on: a. Deficiency symptoms: scaly pigmented rash on skin, swollen mouth and bright red tongue , vomiting and diarrhea b. Pellagra- caused by low levels of niacin, also known as vitamin B-3. It’s marked by dementia, diarrhea, and dermatitis, also known as “the three Ds”. If left untreated, pellagra can be fatal. c. Toxicity: flushing, pruritus (severe itching of the skin), skin rashes 5. VITAMIN B5 (Pantothenic acid) Func ons: a. essential for CHON, CHO and fat metabolism b. maintenance of growth U liza on: readily absorbed in the small intestines through bacterial synthesis; stored to a limited extent in the liver and kidney RDA: at least 5 mg/day is sufficient Pantothenic Acid Malnutri on: a. Deficiency symptoms: insomia, muscle cramps, tingling sensation of Extremities 6. VITAMIN B6 (Pyrodixine) group name for 3 forms: pyridoxine (aldehyde) pyridoxal (alcohol) pyrodoxamine (amine) stable to heat, but sensitive to light Func ons: in the form of pyridoxal phosphate, it acts as coenzyme in the metabolism of amino acids and proteins and serves as a coenzyme for fatty acid NCM 105: NUTRITION AND DIET THERAPY 44 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences and carbohydrate metabolism. Food sources: whole grains, cereals, legumes, chicken, fish, pork and eggs Utilization: absorbed through the small intestines and circulated in the blood as active coenzyme pyridoxal phosphate; stored in limited amount RDA:.02 mg per gram of dietary protein;.4 mg per 1000 Cal Vitamin B6 malnutrition: a. Deficiency symptoms: dermatitis, altered nerve function, weakness, poor growth, convulsions, and microcytic anemia b. Toxicity: ataxia and sensory neuropathy 7. VITAMIN B12 (Cobalamins) generic group of B vitamins with cobalt exist in several forms: hydroxyl- and nitroso-cobalamin fairly stable but can be destroyed by extreme heat Func ons: has a role in folate metabolism by modifying folate coenzymes to active forms to support metabolic functions, including the synthesis DNA and RNA. Food sources: meat, fish poultry, eggs and dairy products U liza on: absorbed through the small intestines with the aid of intrinsic factor; stored in the liver for several years RDA: 3 mcg per day for adults Vitamin B12 Malnutri on: a. Deficiency symptoms: sore mouth and tongue, amenorrhea b. Pernicious Anemia - cause of vitamin B-12 deficiency anemia. It’s thought mainly to be caused by an autoimmune process that makes a person unable to produce a substance in the stomach called intrinsic factor. 8. FOLACIN (Folic Acid) sensitive to light and heat especially in an acid medium Functions: it is required for the synthesis of amino acids Food Sources: green leafy vegetables, liver, kidney, fish, nuts, legumes, whole grain cereals Utilization: absorbed through the small intestines and synthesized by intestinal bacteria; circulated as protein conjugated, excess is excreted in urine and feces NCM 105: NUTRITION AND DIET THERAPY 45 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences RDA:.4 mg/day for adults Folacin Malnutrition: a. Deficiency signs: glossitis, GI disturbance b. Megaloblastic anemia 9. Biotin Member of the B vitamin complex, in tiny amounts Func on: assists in the transfer of carbon dioxide from one compound to another, playin an important role in carbohydrate, fat and protein metabolism. Food sources: liver, kidney, peanut butter, egg yolks, yeast U liza on: synthesized in the lower GI tract by bacterial microorganisms. RDA: 30 mcg Bio n Malnutri on: a. Deficiency signs: scaly red skin, hair loss, loss of appetite, depression and Glossitis MINERALS inorganic compounds that comprise 4 -6 % of total body weight found in water and nature (they can be positively/negatively charged) they are essential for various body functions such as: maintenance of acid-base balance serving as catalyst for biological reactions transmission of nerve impulses regulations of contractility of muscles provision of structural components of body tissues CLASSIFICATIONS A. MACRONUTRIENTS/ MAJOR MINERALS 1. CALCIUM (Ca) Func ons: a. Normal development and maintenance of bones and teeth b. Blood clotting c. For normal nerve and muscle actions, heart function and cell metabolism Sources: a. Milk and milk products – best sources b. Dark green leafy vegetables (except vegetables containing oxalic acid) RDA – 800-1200mg (500 mg) NCM 105: NUTRITION AND DIET THERAPY 46 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Deficiency: a. Retarded growth b. Osteoporosis c. Rickets/ Osteomalasia d. Tetany e. Slow clotting Excess: a. Constipation b. Kidney stones c. Inhibition of iron and other minerals 2. PHOSPHOROUS (P) Func ons: a. Normal development and maintenance of bones and teeth b. Regulation of acid-base balance of blood c. Essential for the effective action of Vit B Sources: a. Protein-rich foods (best source) b. Legumes, whole grain cereals and nuts (substantial source) RDA – 800-1200 mg Deficiencies: (caused by antacids) a. General malaise b. Anorexia c. Retarded growth d. Poor bone and tooth formation 3. MAGNESIUM (Mg) Func ons: a. Vital for both hard/soft body tissues b. regulates nerve and muscle functions c. plays a role in blood and clotting process and immune system Sources: a. Plant foods (primary source) b. Milk RDA: Men – 420 mg; Women- 320 mg Deficiencies : (related to secondary causes) a. Unusual heart action b. Mental, emotional and muscle disorders 4. SODIUM (Na) major cation in the extracellular fluid compartment Func ons: a. regulates fluid and acid –base balance(primary function) NCM 105: NUTRITION AND DIET THERAPY 47 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences b. regulates muscle and nerve activity c. helps in glucose absorption Sources: a. Table salt (Primary source) b. Animal food (natural source) c. Commercially prepared foods RDA : 500 mg/ day (minimum requirements) Deficiency : a. Dehydration b. Alkalosis/acidosis Excess a. Edema 5. POTASSIUM (K) Electrolyte found primarily in intracellular fluid compartment Func ons: a. Maintenance of fluid balance and osmosis b. Promotion of muscle contraction c. Transmission of nerve impulses Sources: Meat, vegetables, Fruits RDA : 1875-5625 mg Deficiency: Hypokalemia- muscle weakness, confusion, loss of appetite, cardiac arrythmias Excess: Hyperkalemia – muscle weakness, vomiting, cardiac arrest 6. CHLORIDE (Cl) Func ons: a. Maintenance of fluid, electrolyte and acid-base balance b. Carrying of CO2 to lungs c. Formation of HCl Sources: Table salt (NaCl), Meat, Milk, Eggs RDA : 750 mg/ day Malnutri on: a. Nausea b. Exhaustion 7. SULFUR (S) NCM 105: NUTRITION AND DIET THERAPY 48 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Functions: For building of all body tissues Sources: Protein foods B. MICRONUTRIENTS/ TRACE MINERALS 1. IRON (Fe) Functions: a. For the formation of hemoglobin – delivers oxygen to body tissues b. Constituent of cellular enzymes involved in making amino acids, hormones, and neurotransmitters c. Component of myoglobin - Protein compound in muscles that provides oxygen to cells Sources: a. Heme iron: muscle meat, poultry, liver and fish; absorbed more than twice as efficiently as non- heme iron b. Nonheme iron: Whole-grain cereals, enriched grain products, vegetables, fruits c. dark green leafy vegetables RDA: 0-18 mg doubles during pregnancy Difficult to meet by diet alone Iron supplement commonly prescribed Increased requirements during infancy and teenage years Vitamin C enhances absorption Deficiency a. Anemia - Fatigue, weakness, irritability, shortness of breath, pale skin, and spoon-shaped fingernails Excess a. Hemochromatosis - results from inborn error of metabolism that causes excessive absorption of iron NCM 105: NUTRITION AND DIET THERAPY 49 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Untreated, can damage liver, spleen, and heart To control iron buildup, must give blood on regular basis 2. COPPER (Cu) In all tissues - heaviest concentration in liver, kidneys, muscles, and brain Functions: a. Formation of hemoglobin b. Energy production c. Transport of iron to bone marrow Sources: Organ meats, Oyster/ shellfish, nuts, whole grain cereals, cocoa, human milk RDA: 2-3 mg Malnutrition: a. Anemia b. Bone disease 3. IODINE (I) Functions: For the formation of hormones in the thyroid glands Sources: Sea foods, Iodized salt, foods grown in soil bordering salt water RDA: 100-150 mg/ day Deficiencies a. Goiter b. Hypothyroidism c. Myxedema d. Cretinoin Excess: a. Thyrotoxicosis 4. MANGANESE (Mn) Functions: a. Constituent of enzyme involved in metabolism b. Important in bone formation NCM 105: NUTRITION AND DIET THERAPY 50 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences c. Glucose utilization Sources: Whole grains and tea, fruits and vegetables RDA: 2.3 mg (men) 3.8 mg (women) 5. ZINC (Zn) Functions: a. Taste acuity b. Essential for growth c. Wound healing d. Glucose tolerance e. Mobilization of Vit. A in the body Sources: Protein foods RDA: 11 mg (men); 8 mg (women) Deficiencies: a. Decreased appetite b. Dwarfism c. Hypogonadism d. Poor wound healing, anemia, acne-like rash, and impaired immune response 6. FLOURIDE Functions: Increase resistance to tooth decay Sources: Fluoridated water RDA: 1.5- 4mg Deficiency: Tooth decay 7. COBALT Functions: Component of Vit B12 Sources: Supplied in Vit B12 NCM 105: NUTRITION AND DIET THERAPY 51 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Deficiency: B12 deficiency 8. CHROMIUM Functions: a. Glucose metabolism b. Influence fat and CHON metabolism Sources: Meat, cheese, whole grain RDA 0.05- 0.2 mg Deficiency: Metabolism disturbance 9. MOLYBDENUM Function: Constituent of all body tissues Sources: meat, poultry, cereals, legumes RDA 0.15-0.5 mg 10. SELENIUM (Se) Function: Component of enzyme that act as antioxidant Sources: Seafood, kidney, liver and muscle meat RDA: 55µg Excess/ toxicity: vomiting, loss of hair and nails, skin lesion WATER Principal constituent of the body: ½ to ¾ of body weight is water Most water is intracellular; the remainder is found in blood, in lymph, in various secretions and excretions and in the interstitial spaces. Water is found in varying quantities in foods; it is formed in the body’s metabolic processes and is an end-product of oxidation Water intake recommendations: NCM 105: NUTRITION AND DIET THERAPY 52 MARIANO MARCOS STATE UNIVERSITY College of HealthUNIVERSITY Sciences Adults-1ml/kcal and for infants 1.5ml/kcal or 1 ounce/kg of body weight or ½ oz/lb of body weight (1 ounce=30ml) or 8 glasses/day Structure: 2 hydrogen atoms bonded to one oxygen atom (H20) This allows water to provide a base for biochemical reactions in the body and to easily move through the various compartments of cells and body systems. As the basis of body fluids, water can host other substances of different electrical charges and characteristics. INTRACELLULAR FLUID EXTRACELLULAR FLUID PROTEINS MINERALS MINERALS PROTEIN Enzymes Potassium Sodium Blood proteins Hemoglobin Magnesium Chloride Antibodies Phosphorus Bicarbonate ions CARBOHYDRATES LIPIDS Glucose Lipoproteins Total = 60% of body water Total = 35 % of body water Functions: a. Provides shape and rigidity to cells b. Helps to regulate body temperature c. Acts as a lubricant d. Cushions body tissues e. Transports nutrients and
