L6 Macro & Micro Nutrients PDF

L6: Macro & Micro Nutrients GNT Block Color Index: • • • • • • Main text Female slides Male slides Important Doctor’s notes Extra notes Editing file: Objectives: Understand the nutritional importance of dietary macro and micronutrients. Identify major dietary sources and RDAs of macro and micr...

L6: Macro & Micro Nutrients GNT Block Color Index: • • • • • • Main text Female slides Male slides Important Doctor’s notes Extra notes Editing file: Objectives: Understand the nutritional importance of dietary macro and micronutrients. Identify major dietary sources and RDAs of macro and micronutrients. Evaluate the nutritional quality of proteins, the types of dietary carbohydrates, fibers and fats and their benefits. Discuss the role of macronutrients in causing diseases or conditions such as nitrogen imbalance, diabetes, obesity, atherosclerosis and heart disease. Understand the functions of micronutrients and the diseases due to their deficiencies. Important remark: Dr. Usman said we will not ask you about sources and RDAs in the exam. Functions, deficiencies, diseases are important. Lecture presented by : Dr. Sumbul Fatma Dr. Usman Ghani Macronutrients & Micronutrients Macronutrients ● ● Nutrients needed by the body in large amounts (Proteins, carbohydrates, fats). In gram quantities They provide energy and building blocks for proteins, carbohydrates and fats. Micronutrients ● ● ● Nutrients needed by the body in small amounts (Vitamins, minerals, trace elements) e.g. Vit E, Na+, Iron Required for maintaining normal health and preventing various diseases. They do not provide energy. Not source of energy, but required for other functions (as co-enzymes/co-factors) for our normal physiology. Energy Content of Food & AMDR ◆ ◆ ◆ Body obtains energy as ATP. ATP is used for all body functions Or J The energy content of food is measured in calories (Kilocalories). One calorie is the heat required to raise the temperature of 1 gm of water by 1 C°. ◆ Proteins → 4kcal/g ◆ Carbohydrates → 4kcal/g ◆ Fat → 9kcal/g AMDR Stands for Acceptable Macronutrient Distribution Range. Adequate intake of macronutrients to prevent the risk of disease. AMDR for adults: *CHOs: 45-65% *Proteins: 10-35% *Fats: 20-35% In diseases marked with red, nutrition is playing a significant role. Macronutrients 1-Proteins Nutritional Importance of Proteins ● Proteins supply amino acids and amino nitrogen for the body. ● Essential amino acids : Body can’t synthesize, must be supplied in the diet. ● PVT TIM HALL: Phenylalanine, Valine, Tryptophan, Threonine, Isoleucine, Methionine, Histidine, Arginine, Lysine, Leucine. ● Arginine is conditionally essential (not always essential). ● Non-essential: body can synthesize. ● Under normal conditions carbs are the main source of energy, proteins are source of energy in case of carb depletion. Nutritional Quality of Proteins ● What are the factors that determine the quality of a protein ? ● A measure of a protein’s ability to provide the essential amino acids required for tissue maintenance ● Measured in PDCAAS units (Protein Digestibility-Corrected Amino Acid Scoring). ● High value indicates more digestibility and high quality (maximum score 1.0) ● Proteins from animal sources: 0.82-1.0 e.g. meat ● Proteins from plant sources: 0.4 e.g. beans ● Proteins of animal sources have higher score and this makes sense because the proteins of animal sources are similar to those our body needs. Sources Meat, poultry, fish, milk, wheat, corn, beans, nuts. Female Dr: RDA is Important Normal adult: 0.8 Athletes: 1.0 Pregnancy/Lactation: up to additional 30 g/day Children: 2.0 RDA (g/kg body weight) ● ● ● ● Macronutrients Nitrogen Balance Normal nitrogen balance In a healthy person, the nitrogen intake is equal to nitrogen loss. Negative nitrogen balance - When nitrogen loss is more than intake. - Occurs in burns, trauma, illness, metabolic stress. Positive nitrogen balance - When nitrogen intake is more than loss. - Occurs in growth, pregnancy, Lactation, Recovery from illness. Proteins Amino acids Nitrogen Dr.Usman: These are some scenarios and I want you to go over it by yourself. ‫ﺑﺎﻟﻧﺳﺑﺔ ﻟﮭذي اﻟﺻورة ﺻﺎر ﻓﯾﮫ اﺧﺗﻼف ﺑﯾن‬ ‫ دﻛﺗورة اﻟﺑﻧﺎت ﻗﺎﻟت اﻧﮫ ﻗد ﺟﺎﺑوا‬,‫اﻟدﻛﺎﺗرة‬ ‫ أﻣﺛﻠﺔ‬+ ‫اﻟﺻورة ﻣن ﻗﺑل و ﺳﺄﻟوا ﻋن اﻟﻧوع‬ ‫ أﻓﺿل اﻧﻛم ﺗﻌرﻓوﻧﮭم ﻣن ﺑﺎب اﻻﺣﺗﯾﺎط‬, Macronutrients Malnutrition ● ● ● A condition or disease caused by not eating enough food or not eating a balanced diet. Malnutrition due to inadequate intake of proteins or energy. Two conditions: Marasmus, Kwashiorkor Kwashiorkor Marasmus Cause Inadequate intake of proteins with adequate energy intake Inadequate intake of energy with adequate protein intake Age After weaning (at about 1 year) 1-3 Years Food intake Diet mainly contains CHOs Mother’s milk is supplemented with food (cereals) deficient in calories Symptoms Edema, distended abdomen, diarrhea, dermatitis/thin hair, enlarged fatty liver, low plasma albumin Arrested growth, extreme muscle wasting, weakness, weight loss, No edema or changes in plasma proteins Important Macronutrients 2- Carbohydrates Carbohydrates ● Their major role in diet is energy production Types in the diet ● ● Simple CHOs: Sucrose, fructose, lactose, corn syrup Complex CHOs: whole grains, pasta, wheat, starch ● Complex CHOs better to be included in diet because breaking them down requires energy (chance of gaining weight when taking simple carbs) Protein sparing effect Dietary protein requirement and CHO diet are related to each other ● CHO have protein-sparing effect: - They inhibit gluconeogenesis from amino acids. - That way amino acids are used for repair and maintenance of tissue protein and not for gluconeogenesis ● RDA Female Dr: RDA is Important 130 grams/day for adults and children. CHO intake above RDA causes weight gain or obesity due to increased fat storage in adipose tissue. ● If CHO intake is less than the RDA (130 g/day): - more proteins will be metabolized. - more gluconeogenesis will take place. ● ● ● Taking enough CHO inhibits gluconeogenesis, no degradation of proteins in the muscles Macronutrients 3- Dietary fibers Dietary fibers ● The component of food that cannot be broken down by human digestive enzymes. ● Because of B(1,4) found in cellulose, it is indigestible ○ RDA (gm/day) Men: 38, Women: 25 Female Dr: RDA is Important ● Benefits - Lowers serum LDL levels - How? bile salts contains cholesterol, Fibers bind to LDL (bile salts) blocks the reabsorption, Fibers are two type : 1- soluble: helps the removal of bile salts. 2- insoluble: more contributing to bulk. - Reduces constipation - Promotes feeling of fullness - Slows gastric emptying (long-term glucose control in patients with diabetes mellitus) - It bonds to harmful agent and then get excreted with it 4- Fats in the diet Fats Female Dr: RDA is Important A concentrated source of energy (9 kcals/gram) RDA (gm/day): Total fats: 65, Saturated: 20 Excessive fat intake can cause: - Atherosclerosis/heart disease. - Obesity. ● Supply essential fatty acids such as linoleic and linolenic acids ● Provide phospholipids for membrane function ● Source of fat-soluble vitamins (A, D, E, K) and help in their absorption. ● ● ● Macronutrients 4- Fats in the diet Essential Fatty Acids Two essential fatty acids: Unsaturated - α-linolenic acid (ω-3 fatty acid). - First double bond in ω-3 fatty - linoleic acid (ω-6 fatty acid). acid is at carbon No.3 - First double bond in ω-6 fatty ● Used for eicosanoids synthesis which appear acid is ar carbon No.6 to have cardioprotective effects: - Decrease blood clotting. - Decrease blood pressure. ● Deficiency causes: scaly skin, dermatitis, reduced growth (most common in infants). ● Trans Fatty Acids ● Unsaturated fatty acids, behaving more like saturated fatty acids in the body. 1- Increase serum LDL (but not HDL). 2- Risk of CVD. ● Not found in plants (animals only in small amount) ● Formed during hydrogenation of liquid vegetable oils ● Found in baked food: cookies, cakes, deep-fried foods Essential Fatty acids Omega-3 fatty acids Source - Mainly found in cold-water ocean fish such as: albacore, mackerel, salmon, sardines, tuna, whitefish. - Plants such as spanish - Fish oil containing docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) - Nuts - Avocados - Olives - Soybeans - Oils (sesame, cottonseed, corn oil) Effects - Structural membrane lipids - Modulator of ω-6 fatty acids metabolism. - Little effect on LDL or HDL levels - Suppress cardiac arrhythmias -↓ Serum triacylglycerols -↓ Tendency to thrombosis -↓ blood pressure -↓ Risk of cardiovascular mortality - *Omega 3 lowers triglycerides* wherase omega 6 raises triglycerides in bloodstream - ↓ Plasma cholesterol - ↓ LDL - ↓ HDL Omega-6 fatty acids Recommendations for Omega-3 Fatty Acid Intake American Heart association Guidelines Population Recommendation Patients without coronary heart disease (CHD) - Fatty fish twice a week - Include oils and foods rich in α-linolenic acid (flaxseed, canola and soybean oils; flaxseed and walnuts) Patient with CHD Patients who need to lower triglycerides (fats) - 1 gm of EPA+DHA per day from fatty fish - EPA+DHA supplements - 2 to 4 grams of EPA+DHA per day Micronutrients Minerals and trace elements Vitamins Organic compounds present in small quantities in different types of food Help in various biochemical processes in cell - Vitamins are Not required for energy but important for growth Important for growth and good health Essential, Required in very small amounts Noncaloric Vitamins - classified based on solubility Fat-soluble vitamins A, D, E, and K (stored in the body) AKED Water-soluble vitamins - Ascorbic acid (vitamin C) Thiamin (vitamin B1) Riboflavin (vitamin B2) Niacin (vitamin B3) Pantothenic acid (vitamin B5) Pyridoxine (vitamin B6) - Biton (B7) Folate (B9) - Cobalamin (vitamin B12) Vitamins Vitamin E ● ● Antioxidant: prevents oxidation of cell components by molecular oxygen and free radicals May have a role in fertility and anti-aging effect α - tocopherol is the most active form in the body Sources and RDA (mg/day) ● ● Vegetable Oil, nuts, seeds, vegetables Adults: 15, Children: 7 Deficiency ● ● (mostly observed in premature infants) Defective lipid absorption, Anemia due to oxidative damage to RBCs, Neurological problems, Male infertility ● Overview Vitamin B1 Functions Sources and RDA (mg/day) ● ● ● Active form: Thiamin pyrophosphate (TPP) Coenzyme for transketolase and oxidative decarboxylation reactions In thiamin deficiency, the activity of these two dehydrogenases is decreased Causing: Low ATP production and defective cellular function ● ● Plants, cereals, meat Adults: 1.2, Children: 0.6 ● Beriberi ○ A type of chronic peripheral neuritis due to severe thiamine deficiency causes weakness, neuropathy, disorderly thinking, paralysis ○ Thiamin has a role in nerve conduction ○ Neuropathy affects glial cells (astrocytes) of the brain and spinal cord causing neuron death Wernicke-Korsakoff syndrome ○ Common in alcoholics due to defective intestinal absorption of thiamin or dietary insufficiency ○ Causes apathy, loss of memory Disorders ● Vitamins Vitamin C Functions ● ● ● ● ● ● Sources and RDA (mg/day) ● ● ● ● ● Disorders Powerful antioxidant (prevents some cancers) Helps in dentine, intercellular matrix and collagen formation Increases iron absorption Helps in the maturation of RBCs Promotes wound healing Stimulates phagocytic action of leukocytes Reduces risk of cataract formation Citrus fruits, tomatoes, melon, peppers Men: 90, Women: 75, Children: 15-25 Scurvy ○ Abnormal collagen production ○ Gums become painful, swollen and spongy ○ The pulp is separated and the teeth are lost Female Dr: You should know 2 examples of Macro & Micro Minerals Vitamins Minerals and trace elements Macrominerals Microminerals (>100 mg/day) (<100 mg/day) - Calcium - Phosphorus - Sodium - Potassium - Chloride - Magnesium - Iron - Iodine - Copper - Manganese - Zinc - Cobalt - Molybdenum - Selenium - Fluoride - Chromium - Silicon Micronutrients Iron ● Functions ● ● Oxygen transport and metabolism Part of hemoglobin, myoglobin, cytochromes Body stores iron as ferritin, hemosiderin and transferrin Adult women have much lower iron storage than men (because of menstrual cycle) Sources and RDA (mg/day) Disorders ● ● ● Heme iron: Animal products (meat, liver),25% absorption Nonheme iron: Plants (spinach, beans), 5% absorption Men: 8, Women: 18, Children: 7-15 ● Iron deficiency anemia ○ is most common ○ Growing children, pregnant, lactating and menstruating women need more iron Hemosiderosis (iron overload disorder) ○ Due to iron excess (toxicity) excessive storage of iron ○ Hemosiderin (Iron stored in complex with ferritin protein in liver and spleen) ○ Occurs in persons receiving repeated blood transfusions ● Take home message Macro and micronutrients are essential for energy and maintaining good health Various diseases are associated either with malnutrition or excessive intake of these nutrients Summary Macronutrients Amazing summary from 439 Proteins Carbohydrates Function: energy production. Types: - Simple CHOs: sucrose, fructose, lactose, corn syrup. - Complex CHOs: whole grains, pasta, wheat, starch. RDA: 130 grams/day for adults and children. Dietary fibers RDA (gm/day): Men: 38, Women: 25. Benefits: - Lowers serum LDL levels. - Reduces constipation. - Promotes feeling of fullness. - Slows gastric emptying (long-term glucose control in patients with diabetes mellitus). - Reduces exposure of gut to carcinogens Fats Micronutrients Function: Proteins supply amino acids and amino nitrogen for the body. Sources: Meat, poultry, fish, milk, wheat, corn, beans, nuts. RDA: - Normal adults: 0.8. - Athletes: 1.0. - Pregnancy / lactation: upto 30. - Children: 2. Function: A concentrated source of energy (9 kcals/gram). - Supply essential fatty acids such as linoleic and linolenic acids. - Provide phospholipids for membrane function. - Source of fat-soluble vitamins (A, D, E, K) and help in their absorption. RDA (gm/day): Total fats: 65, Saturated: 20. E Vitamins B1 C Mineral & Trace elements IRON Function: - Antioxidant - May have a role in fertility and anti-aging effect. Source: Vegetable Oil, nuts, seeds, vegetables. RDA: Adults: 15, Children: 7. Deficiency: (mostly observed in premature infants) - Defective lipid absorption. - Anemia due to oxidative damage to RBCs. - Neurological problems. - Male infertility. Function: - Coenzyme for transketolase and oxidative decarboxylation reactions. Source: Plants, cereals, meat. RDA: Adults: 1.2, Children: 0.6. Deficiency: - Beriberi - Wernicke-Korsakoff syndrome Function: - Powerful antioxidant (prevents some cancers). - Helps in dentine, intercellular matrix and collagen formation. - Increases iron absorption. - Helps in the maturation of RBCs. - Promotes wound healing. - Stimulates phagocytic action of leukocytes. - Reduces risk of cataract formation. Source: Citrus fruits, tomatoes, melon, peppers. RDA: Men: 90, Women: 75, Children: 15-25. Deficiency: - Scurvy. Function: - Oxygen transport and metabolism. - Part of hemoglobin, myoglobin, cytochromes. - Body stores iron as ferritin, hemosiderin and transferrin.. Source: - Heme iron: Animal products (meat, liver), 25% absorption. - Nonheme iron: Plants (spinach, beans), 5% absorption. RDA: Men: 8, Women: 18, Children: 7-15. Deficiency: - Iron deficiency anemia. - Hemosiderosis (iron overload disorder). Quiz MCQs A- Stroke B- Heart Disease C- Malignancy D- Pneumonia Q2:A 2 year old child came to the clinic complaining of arrested growth, extreme muscle wasting and weight loss. After history taking, his parents informed the physician that his diet is normal with adequate protein intake. What is the diagnosis ? A- Kwashiorkor B- Marasmus C- Scurvy D- Beriberi Q3: Which of the following represents a negative nitrogen balance? Q4: Scurvy is caused due to the deficiency of? A- Growth B- Pregnancy C- Lactation D- Burns A- Vitamin A B- Vitamin C C- Vitamin D D- Vitamin K Q5: Which one of the following macronutrients makes you feel full for long time and controls long-term glucose in diabetic patients? Q6:Transketolase has the coenzyme? Q1: Which one of the following diseases that associated with high death rate is strongly correlated with diet that is deviated from ADMR? A- Proteins B- Carbohydrates C- Fats D- Dietary fibers SAQ A- Vitamin C B- Vitamin E C- Thiamine D- Pyridoxal phosphate Answers: 1-B, 2-B, 3-D, 4-B, 5-D, 6-C Q: Write one function, source, effect of deficiency for each vitamin? A- Slide 11-12 Function Vitamin E Vitamin B1 Vitamin C source Deficiency Effect Members board Team Leaders Raghad Alhamid Remas Aljeaidi Mohammed Alqutub Team Members Leen Alduaij Zeyad Alotaibi Sultan Almishrafi Wafa Alakeel Mohammed Alarfaj Juwan Al Musma Madawi Alhussain Nazmi A Alqutub Wasan Alanazi Leen K Althunayan Faisal Alshowier Aishah boureggah Dana A Alkheliwi Osama Almashjari Mansour Alotaibi Aldanah Abdullah Nazmi M Alqutub Salma Alsaadoun Layan Al-Ruwaili Fahad Mobeirek Abdulrahman Alosleb Areej Alquraini Sarah Alajaji Waad alqahtani Special Thanks to Aleen Alkulyah for the Design! [email protected]