Macronutrients/ Protein-Energy Malnutrition PDF

Macronutrients/ Protein- Energy malnutrition MBBS stage 1 Nutrition and Metabolism Dr Despo Papachristodoulou  Dietary Lipid (fat) Average UK diet: 88g fat 40% of total energy intake Triacylglycerols (TAGS) small amount of cholesterol (0.5-1.0 g)  Is...

Macronutrients/ Protein- Energy malnutrition MBBS stage 1 Nutrition and Metabolism Dr Despo Papachristodoulou  Dietary Lipid (fat) Average UK diet: 88g fat 40% of total energy intake Triacylglycerols (TAGS) small amount of cholesterol (0.5-1.0 g)  Is dietary fat essential? essential fatty acids – major constituents of membrane phospholipids – precursors of eicosanoids (prostaglandins, thromboxanes, prostacyclins linoleic acid (C18:2 ω6) linolenic acid (C18:3 ω3)  Requirement UK DoH recommendation 2-5 g /day UK diet 8-15g /day deficiency very rare high intakes of the ω3 series may additionally provide protection against CV disease (fish oils) also for developing brain  Fat and Cardiovascular Disease BHF UK 2022 168,000 people die in the UK from CVD every year 48,000 under the age of 75 25% of deaths in the UK Highest single cause of death in men in all countries of Europe Highest single cause of death in women in all countries of Europe except France.  Deaths from CVD in the world per100 000 population men/women 1200 / 540 Russian Federation 850/ 260 Poland 720 / 320 Hungary 430 /200 Scotland 350 / 180 USA 350 / 160 Greece 330 / 160 England/Wales 300 / 130 Netherlands 250 /110 Italy 210 / 83 Spain 210 / 74 France American Heart Foundation figures 2004  Death rates from CVD / 100,000 2022 Highest: Tajikistan 389 Azerbaijan 388 Uzbekistan 354 Ukraine 305 Oman 301 Lowest: Spain 34 Israel 34 Japan 30 France 30 South Korea 28  CVD Risk factors: – genetic susceptibility – smoking – sedentary life style – high blood pressure – high serum cholesterol (Low Density Lipoprotein) – Obesity – Diabetes – Trans fat intake?  Diet and CVD Increase in saturated fatty acids leads to increase in LDL and total cholesterol Trans fat intake? Also decrease HDL blood cholesterol can be lowered to some extent by increasing polyunsaturated fatty acids in the diet effect of mono-unsaturated fatty acids less clear (Mediterranean diet and olive oil? Is that the only factor?) cis trans saturated  Dietary fat and cancer immigrants suffer type of cancer found in the host population rather than type more common in their country of origin breast, colon, pancreas, prostate high intake of fat or obesity?  Carbohydrate 40% of total energy of diet in affluent societies 80-90% in poor populations Starch non starch polysaccharides (fibre) sugars, mainly sucrose  Carbohydrate mainly plant origin except lactose and v.small amount glycogen needed? not in theory but has protein-sparing effect low CHO diets lead to fat utilisation and ketosis  Monosaccharides Glucose -small amounts in fruit fructose –small amounts in fruit sorbitol – commercially prepared mainly in foods for diabetics (slimming?) inositol – in fibre as hexaphosphate (phytic acid) interferes with absorption of iron and calcium  Disaccharides Sucrose commonest – less than 60g/day no dental caries – UK consumption 105 g/day – frequency of consumption is more important than total amount – New advice 2014, reduce total amount lactose (milk) – no known adverse effects on health – but many non European populations – cannot tolerate lactose A comparison of current intakes (g/day) of free sugars with the 5% of total energy recommendations Public Health Average England Average intake of % of recommende % of energy intake of free free energy Age d max. free intake in sugars - sugars - intake in sugars males* females males females* intake (g/day) (g/day) (g/day) No more 4-6 years than 19g/day 51.0g 12.4% 43.5g 11.8% No more 7-10 years than 24g/day 56.9g (11- 52.7g (11-18 12.1% 12.5% 18 years) years) From 11 years, No more 55.5g (19- 44.0g (19-64 9.9% 9.9% including than 30g/day 64 years) years) adults 48.4g (65+ 36.9g (65+ 9.7% 9.2% years) years)  Polysaccharides Starch – commonest crystalline and insoluble Non-starch (NSP) term replaces ‘fibre’ – from cereals, vegetables and fruit – NSP rich foods are low in energy and high in bulk – low intakes related to constipation, diverticular disease, appendicitis, cancer of the colon  Protein 10-15% of total energy of diet. US/UK 14% developing countries 10% UK recommendations: 0.75g/kg body weight for adults and no more than 1.5g/kg/day 55g/day for men and 44g/day for women  Need for protein? ‘Essential’amino acids needed for: synthesising new protein catecholamines thyroid hormones neurotransmitters haem glutathione  Protein quality proteins of animal origin more effective in supporting growth of lab animals than those from plants ‘high quality’ proteins higher utilisation and less waste. Amino acid pattern nearer that of body protein low quality proteins deficient in certain amino acids mixtures of ‘low quality’ proteins can complement deficit. e.g. wheat and pulses important in poor countries where diet mainly vegetarian  protein requirements g/kg/day newborn 2.4 3 months 1.9 6 months 1.6 12 months 1.4 adult 0.75  recommendations infants: based on milk intake of breast fed infants showing satisfactory growth for pregnancy: compatible with protein deposition for 3.3 kg infant for lactation: based on protein content of human milk  UK status No group in the UK likely to be deficient importance of protein often overestimated excessive intake may lead to bone demineralisation or deterioration of renal function in patients with renal disease  Protein –Energy Malnutrition Growth Failure Marasmus Kwashiorkor Marasmic kwashiorkor  Incidence and Prevalence FAO and World Bank estimate: 5 million children die every year from malnutrition 300 million children have growth retardation because of malnutrition 20-75% of children under 5 suffer of have suffered from malnutrition in developing countries WHO 2008 COUNTRY UNDER-FIVE DEATHS Nigeria 858 India 824 Pakistan 399 Democratic Republic 291 of the Congo Ethiopia 178 China 132 Indonesia 115 United Republic of 103 Tanzania Angola 93 Bangladesh 90 Nutrition-related factors contribute to about 45% of deaths in children under-5 years of age. WHO 2019 Population growth in developed and developing countries (WHO)  Childhood malnutrition Stunting of growth – normal weight for height Growth Failure – low height for age Growth failure/stunting of growth  Classification of PEM by BMI BMI Weight (kg)/height2 (m) Acceptable/desirable 18.5-25 Moderate PEM 17-18.4 Moderately severe PEM 16-17 Severe PEM