NCM 105 Nutrition and Diet Therapy PDF

NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE OVERVIEW OF NUTRITION and DEFINITION OF TERMS Introduction to Basic...

NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE OVERVIEW OF NUTRITION and DEFINITION OF TERMS Introduction to Basic Nutrition ➔ Vitamins: Organic compounds required in I. FOOD small quantities for various biochemical Any substance ingested by the body that functions. They are classified as either fat- nourishes it by providing energy, building and soluble (e.g., Vitamins A, D, E, K) or water- repairing tissues, and regulating body soluble (e.g., Vitamin C, B-complex processes. vitamins). Aside from its nutritional function, food is ➔ Minerals: Inorganic elements essential for valued for its palatability and satiety effect, as various bodily functions, including the well as the emotional, social, religious, and formation of bones, teeth, and blood cells, cultural impact. and the regulation of muscle and nerve Food includes articles used as drink or food function. Examples include calcium, iron, Food is simple or complex in its chemistry and potassium, and zinc. contains nutritional and/or non-nutritional ❖ 3. Water components (food coloring, spices, ➔ Water: An inorganic compound made up preservatives) of hydrogen and oxygen. It is essential for (Reference: Food and Drug Administration – nearly every biological process, including FDA) digestion, absorption, circulation, and temperature regulation. ❖ II. NUTRIENT ❖ 4. Fibers ❖ Any chemical substance needed by the body ➔ Dietary Fibers: Mostly composed of for one or more of the following functions: complex carbohydrates (polysaccharides) (1) to provide heat/energy, that are not fully digestible by humans. (2) to build and repair tissues, and They are important for digestive health and (3) to regulate the life process. help regulate blood sugar levels. ❖ Manufactured in the body and some are ❖ According to Concentration made in the laboratory - Nutrients can also be classified based on NUTRIENT CLASSIFICATION their essentiality, which refers to whether or ❖ According to Function not they must be obtained from the diet 1. Energy Giving – carbohydrates, proteins, because the body cannot synthesize them and fats are “fuel nutrients”. Water, in sufficient quantities. Based on this minerals, and vitamins are non-caloric criterion, nutrients are categorized into: nutrients. ❖ 1.Essential Nutrients 2. Body Building – Water 2/3 of body weight; ➔ Essential Amino Acids: These are amino Protein 20%, Minerals 4%; Carbohydrates acids that the body cannot synthesize on 1%. its own, so they must be obtained from the 3. Body Regulating – Vitamins, Minerals, diet. There are nine essential amino acids: Water, and Protein. Maintains homeostasis histidine, isoleucine, leucine, lysine, of body fluids and metabolic processes methionine, phenylalanine, threonine, ❖ According to Chemical Nature tryptophan, and valine. - Nutrients are essential substances ➔ Essential Fatty Acids: These are fats that the organisms need to survive, grow, and body cannot produce, including omega-3 reproduce. They can be categorized (e.g., alpha linolenic acid) and omega-6 according to their chemical nature into the (e.g., linoleic acid) fatty acids. They are following main groups: important for maintaining cell membranes, ❖ 1. Macronutrients brain function, and the production of ➔ Carbohydrates: Organic compounds hormones. made up of carbon, hydrogen, and ➔ Vitamins: All vitamins are considered oxygen. They serve as the primary energy essential because they are necessary for source for the body. Examples include various biochemical processes, and the sugars, starches, and fibers. body cannot synthesize them in adequate ➔ Proteins: Organic compounds composed amounts (e.g., Vitamin C, Vitamin D, B of amino acids, which are made of vitamins). carbon, hydrogen, oxygen, nitrogen, and ➔ Minerals: Essential minerals are inorganic sometimes sulfur. They are crucial for elements that the body needs in small growth, repair, and maintenance of body tissues. amounts for various functions, including bone health, fluid balance, and muscle ➔ Fats (Lipids): Organic compounds function. Examples include calcium, iron, consisting mainly of carbon, hydrogen, magnesium, potassium, and zinc. and oxygen. Fats provide a concentrated ➔ Water: Water is essential for survival. It plays energy source and are vital for cell a vital role in nearly every bodily function, structure and function. They include including temperature regulation, nutrient triglycerides, phospholipids, and sterols. transport, and waste elimination. ❖ 2. Micronutrients ❖ 2. Non-Essential Nutrients NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE ➔ Non-Essential Amino Acids: These are - Water-Soluble Vitamins: (e.g., Vitamin C, B- amino acids that the body can synthesize complex vitamins) that must be regularly on its own from other compounds, so they replenished since they are not stored in the do not necessarily need to be obtained body. from the diet. Examples include alanine, Minerals: aspartic acid, and glutamic acid. Inorganic elements that are required in trace ➔ Non-Essential Fatty Acids: These are fatty amounts for various bodily functions. They are acids that the body can produce from classified into: other nutrients, so they are not required - Macrominerals: Required in larger amounts from dietary sources. (e.g., calcium, phosphorus, potassium, ➔ Phytochemicals: These are non-essential, sodium, magnesium). bioactive compounds found in plants that - Trace Minerals (Microminerals): Needed in may provide health benefits, such as much smaller amounts (e.g., iron, zinc, flavonoids, carotenoids, and polyphenols. copper, selenium, iodine). While beneficial, they are not required for ❖ 3. Trace Elements basic survival. Trace elements, also known as trace minerals, are ➔ Dietary Fiber: While not essential for survival, required in very small amounts but are essential dietary fiber is important for maintaining for many physiological functions. digestive health and preventing certain Iron: diseases, such as colon cancer and Essential for the production of hemoglobin and cardiovascular diseases. oxygen transport in the blood. 3. Conditionally Essential Nutrient Zinc: Conditionally Essential Nutrients: These nutrients Important for immune function, wound healing, are typically non-essential, but they become and DNA synthesis. essential under certain conditions, such as illness, Copper: stress, or certain life stages. For example, arginine Plays a role in iron metabolism and the functioning is usually non-essential but may be required in of the nervous system. higher amounts during periods of rapid growth or illness. Selenium: ❖ According to Concentration Important for antioxidant protection and thyroid Nutrients can also be classified based on their hormone metabolism. concentration in the body and their dietary Iodine: requirements. Based on this, nutrients are divided Essential for the synthesis of thyroid hormones, into: which regulate metabolism. ❖ 1. Macronutrients Manganese: Macronutrients are required by the body in large Involved in bone formation, blood clotting, and amounts because they provide energy and are metabolism. the primary building blocks of the body. ❖ 3. Ultra-Trace Elements Carbohydrates: These elements are required in extremely small Serve as the main source of energy for the body. amounts, and their precise roles are often less well They are required in relatively large quantities. understood, but they are believed to be important Proteins: for health. Necessary for growth, repair, and maintenance of Chromium: body tissues. They also play a role in enzyme and Involved in the regulation of blood sugar and hormone production. insulin function. Fats (Lipids): Molybdenum: Provide a concentrated source of energy and are Plays a role in enzyme function, particularly in the important for cell structure and the absorption of metabolism of sulfur-containing amino acids. fat-soluble vitamins. Fluoride: Water: Important for the maintenance of bone and Essential for life, water is needed in large dental health quantities to maintain bodily functions such as digestion, temperature regulation, and waste ❖ SUMMARY elimination - Macronutrients: Required in large amounts ❖ 2. Micronutrients (carbohydrates, proteins, fats, water). Micronutrients are required by the body in smaller - Micronutrients: Required in smaller amounts but are still crucial for proper functioning. amounts (vitamins and minerals). They are vital for metabolic processes, immune - Trace Elements: Needed in very small function, and overall health. quantities (iron, zinc, copper, selenium, Vitamins: iodine). Organic compounds that the body needs in small - Ultra-Trace Elements: Required in quantities for various functions. They are classified minuscule amounts (chromium, into: molybdenum, fluoride). - Fat-Soluble Vitamins: (e.g., Vitamins A, D, E, ❖ III. NUTRIENT DENSITY K) stored in body fat and used as needed. BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE - The relative ratio obtained by dividing a - Any disorder of nutrition food or beverage’s contribution to the needs of a nutrient by its contribution to - Bad or undesirable health status due to either caloric needs lack or excess of a nutrient supply - “The amount of nutrients per calorie” - State of impaired biologic activity or - High nutrient density means a large development due to discrepancy between the amount of nutrients per serving of food nutrient supply and nutrient demand of cells - Example: 8oz. (1 cup) of WHOLE MILK has higher nutrient density for minerals than - Types of Malnutrition: The condition of the body 8oz. of carbonated beverages resulting from prolonged undernutrition and ❖ IV. ENERGY overnutrition - The capacity to do work - Deficiency: Caused by an inadequate dietary - The energy in food is chemical energy; it intake of a specific nutrient can be converted to mechanical, electrical, heat, or other forms of energy in ❖ XIII. ENZYMES the body - Organic and proteinaceous catalysts of - Food energy is measured in calorie biochemical reactions ❖ V. CALORIE (CAL) - Unit of heat energy MAJOR DIGESTIVE ENZYMES - Sames as kilocalorie (kcal) - The amount of energy necessary to raise Enzyme Produced Site PH Level the temperature of a kilogram of water 1 In Release degree Celsius. Carbohydrate ❖ VI. ENERGY DENSITY Digestion A measure of the energy a food provides relative - Salivary Salivary glands Mouth Neutral to the amount of food (kcalories per gram) amylase ❖ VII. NUTRITION -Pancreatic Pancreas Small Intestine Basic The science of food, nutrients, and other amylase substances therein, their action, interaction, and -Maltase Small Intestine Small Intestine Basic balance in relation to health and disease and the process by which the organism ingests, digests, absorbs, transports, utilizes, and excretes food Protein Digestion substances. - Pepsin Gastric glands Stomach Acidic ❖ VIII. HEALTH - State of complete physical, mental, and - Trypsin Pancreas Small Intestine Basic social well-being and not merely the - Peptidases Small Intestine Small Intestine Basic absence of disease of infirmity - (WHO) - “high level health and wellness are present Nucleic Acid when an individual is actively engaged in Digestion moving towards the fulfillment of his or her -Nuclease Pancreas Small Intestine Basic potential” - Nucleosides Pancreas Small Intestine Basic ❖ IX. WELLNESS - A complex interaction and integration of Fat Digestion the seven dimensions of health (physical, - Lipase Pancreas Small Intestine Basic intellectual, emotional, social, spiritual, and occupational factors) based on a dynamic level of functioning oriented toward maximizing a human’s potential ❖ XIV. HORMONES and based on self-responsibility. - Chemical substances from the endocrine glands - A dynamic process of change and growth that can stimulate reactions in the body. that is largely determined by the decisions - Are organic substances produced by special made by a human on how to live one’s life. cells of the body that are discharged into the ❖ X. NUTRITIONAL STATUS blood to be circulated and brought to specific - Also called as “NURTRITURE” organs or tissues that are remote from the source - The condition of the body resulting from the or point of manufacture consumption utilization of nutrients - Regulate vital processes. ❖ XI. NUTRITIONAL ASSESSMENT ❖ XV. DIET - A comprehensive process identifying and - Usual pattern of food and drink intake by a evaluating a person's nutritional needs using person or animal appropriate, measurable methods. ❖ XVI. DIETETICS - Evaluation of the nutritional status - Combined science and art of human nutritional ❖ XII. MALNUTRITION care throughout life under various conditions of health and disease. BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE ❖ XVII. DIET THERAPY stimulating to peristaltic action; should be - Modification of food and drink for therapeutic used 1-2 days only. purposes Food Selection ❖ XVIII. MEDICAL NUTRITION THERAPY ➔ Food Allowed: Clear, fat-free broths, - Referred to in the past as “diet therapy” strained fruit juices, tea, black coffee, - The use of specific nutrition services to treat an salabat, plain gelatin, sugar, and hard illness, injury or condition candies. Give small amounts every 1-2 hours - 2 phases: nutrition assessment and nutrition 1. Full Liquid Diet: Post-operatively therapy → acute infections, acute inflammatory ❖ XIX. CLINICAL NUTRITION conditions of the G.I.T., - Branch of health science that deals with → for patients too ill to eat solid or semi-solid diagnosis, prevention and treatment of diseases foods; impaired chewing and swallowing caused by deficiency or excess of nutrients ability → face lifting ❖ XX. NUTRITION SUPPORT → radical mouth surgery - A variety of techniques that are available to use → tooth extraction. when the patient is unable to meet his/her needs Characteristics: Intermediate between clear liquid and soft diet; consists of liquid or strained ❖ XXI. NUTRITIONIST-DIETITIAN semi-liquid foods and foods that liquefy at room - Professional who takes leadership in the and body temperature; free from cellulose and promotion of health and nutritional well-being of irritating spices and condiments. an individual or groups ➔ 6-8 small feeding is recommended ❖ XXII. NUTRITIONIST - Is an educator, as well as counselor, who usually Food Selection works in a public health setting and who typically that at least a bachelor’s degree in nutrition ➔ Foods Allowed: Those included in the clear liquid diet plus strained meat and fish, soft HOSPITAL DIETS cooked egg, vegetable purees, and juices, A. Routine Diets strained lugao and oatmeal, strained fruit 1. Full, House, General, or Regular Diet – designed juices, plain ice cream, plain gelatin, for patients who require no special dietary custard or cornstarch pudding, milk and modifications or restrictions. milk drinks, cocoa cream in moderation, melted margarine or butter. 2. Soft Diet 2. Cold Liquid Diet 3. Liquid Diets – Clear, Full, Cold, Osterized, ➔ Sometimes referred to as T and A Diet after Blenderized or Tube Feeding Tonsillectomy and Adenectomy. B. Therapeutic Diets ➔ Tonsillectomy, Dental Extraction Adenoid Surgery, Dental Exaction, and other minor throat and mouth operations. C. Test Diets These are diets with specific food components; Characteristics: Cold fluids are given to prevent used as diagnostic aids. bleeding of the operated area; cooked soft and bland foods which have been allowed to cool CHARACTERISTICS AND INDICATIONS FOR USE OF may also be given; used only for a limited period. DIFFERENT THERAPEUTIC DIETS Food Selection: Types of Diet/Indication for use ➔ Food Allowed: Plain ice cream, cold milk, 1. Modification in Consistency iced tea, iced coffee, and soft drinks, A. Liquid Diet:Clear Liquid Diet cooked soft and bland foods which have been cooled. ➔ Illness or Surgery accompanied by marked intolerance to foods; acute inflammatory 4.Tube Feeding (blenderized or osterized) conditions of the G.I tract; in conditions ➔ Esophageal obstruction, surgery of the when it is necessary to minimize fecal mouth, gastric surgery, severe burns, coma, material. insanity, severe undernutrition, paralysis of Characteristics swallowing muscles, acute, and chronic infections, face lifting. ➔ Inadequate nutritional essentials; Food included is liquid or will become liquid at Characteristics: Composed of foods included in body temperature, leave no residue, is the soft and liquid diet, blended and liquefied non-distending, non irritating, and non diet, blended and liquefied to enable the mixture to pass thru a polyvinyl tube. Pectin or apple sauce may be included to prevent diarrhea; BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE ideally, 1cc of diluted formula provides one-kilo 3.Bland Diet calorie. ➔ Gastric and duodenal ulcers, gastritis, Food Selection ulcerative, colitis, in some cardiac cases in order to provide rest to the heart. ➔ Food Allowed: All foods included in the soft and liquid diets are easily blended. 100- Characteristics: An allowance of food and drink 200cc of diluted formula given every 2-3 which is chemically, mechanically, and thermally hours recommended. non irritating; foods likely to cause dyspepsia omitted; regularity as well as frequency of meals is B. Soft Diet advised. The modern trend of management is Patients who are unable to chew, swallow towards liberalization. or digest foods included in the full diet; mild Food Selection to moderate infection; simple G.I disturbances and convalescence. ➔ Foods Allowed: Those which are mild in flavor, no coarse fiber and tough Characteristics: Serves as a transition from full connective tissues, are non-stimulating, liquid to regular full diet; Is a nutritionally adequate and any food tolerated by the patient. diet; is a modification of the normal diet in ➔ Foods Avoided: Black pepper, chili consistency and texture. powder, strong coffee, and alcohol. Food Selection 4.Mechanical Soft Diet ➔ Food Allowed: Those low in cellulose ➔ Poor dentures, lack of teeth, presence of content, low fiber, free from tough sores, and lesions in the mouth connective tissues and strong flavors, simple and easily digested. Canned or Characteristics: Food given requires little chewing. cooked fruit and vegetables without skin. Lean meat or lean protein, refined grains, Food Selection white bread. ➔ Foods Allowed: those included in the full 1.Minimum Residue Diet diet and may be given but reduced to small pieces by grinding, chopping, ➔ Disease and conditions involving the bowel mincing, etc. like dysentery, diarrhea, pre and post-op periods when it is desired to reduce fecal Types of Diet/Indication for use residue, as in colostomy, ileostomy, and Soft Diet:Low Fiber Diet Spastic constipation bowel resection. → diverticulosis, and other gastrointestinal Characteristics: Made up of foods which form the disturbances. least amount of fecal matter; inadequate in vitamins and minerals and must therefore be Characteristics: Contains a minimum of supplemented; used for a limited time only. It has indigestible carbohydrates and tough connective limited fiber. tissues. Food Selection Food Selection ➔ Food Allowed: plain and strained soups; ➔ Avoid gristle and tough connective tissues lean and tender beef, liver, chicken (no in meats; skin) fish and other sea foods, soft cooked ➔ seed and skins of fruits and vegetables, eggs; well-cooked strained vegetables whole grains cereals, course breads. and strained fruit juices only margarine and Types of Diet/Indication for use butter, in moderation; rice and other cereals, plain cakes, plain gelatin, refined Soft Diet: High Fiber Diet Atonic constipation sugars, black coffee and tea. ➔ Food Avoided: Milk and milk drinks, cheese, Atherosclerosis, diverticulosis, diabetes raw eggs, vegetables, fruits (except juices mellitus. & those strained), coarse breads & cereals, Characteristics: Normal diet with fiber increased tough meat, fried foods, and rich desserts. to more than 10g daily; concentrated foods 2. Low Residue Diet (if this diet is ordered, a soft replaced by those greater bulk. diet is given) Food Selection Food Selection ➔ Foods included: those in the full diet with ➔ Up to 2 cups of milk are allowed. emphasis on long fibered vegetables; raw fruits and vegetables, whole grain cereals, coarse breads. Types of Diet/Indication for use BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE 2. Modification in Composition noodles, sugars and sugar products, native cakes and Calorie: High Calorie ★ the like, fruits, dried beans and legumes Underweight,protein-energy malnutrition, Types of Diet/Indication for use fevers and infections, hyperthyroidism, burns, growth, pregnancy and lactation. Carbohydrates: Low CHO Characteristics Hyperinsulinism, dumping syndrome, obesity, epilepsy, celiac disease. ❖ Contains a greater amount of total energy to affect a positive energy balance Characteristics ❖ minerals and vitamins remain at or above ❖ CHO in the diet is reduced by 50% proteins ❖ gradual rather than drastic increase in the and/or fats are increased. amount of food given; 3 meals with inbetween feedings. Food Selection Food Selection ★ Foods Included: Foods in high protein; adequate to high fat foods in certain ➔ Foods Included: All foods in normal diet conditional; MCT preferred with increased amounts of cereals, breads, butter, cream and other fats and sugar. Types of Diet/Indication for use ➔ Foods Avoided: excessive amounts of bulky low calorie foods, fried foods or those Protein: High Protein which interfere with appetite. Growth, pregnancy lactation, protein- Types of Diet/Indication for use energy malnutrition, burns, surgery, fractures, fever, debilitating conditions, Calorie: Low Calorie pernicious anemia, nephrotic syndrome, renal disease without azotemia, hepatitis, Obesity and those cases where excess cirrhosis without impending coma, weight is complicating factor such as hyperinsulinism, dumpling syndrome, celiac diabetes mellitus, CVD, Renal disease, HPN, disease. Gout, Gall bladder disease, preceding surgery Characteristics Characteristics ❖ A regular diet with proteins increased by 50-100% above the normal allowance; ❖ Contains a reduced amount of total ❖ about 1/3-1/2 and ½- 2/3 of the total energy to affect a negative energy protein in diets of adults and children, balance; ❖ respectively, should come from proteins ❖ protein, minerals and vitamins remain at HBV; enough CHO and fats should be above recommended levels; distribution of provided for the protein-sparing effect. CHO and fats may allow a normal pattern as long as total calories are reduced; Food Selection drastic reduction should be avoided. ★ Food Included: All foods in the regular diet Food selection with emphasis on milk, eggs, cheese, meat, poultry, and fish. ★ Foods Included: protective foods are emphasized; sufficient bulk, and low in Types of Diet/Indication for use calories for a satisfied feeling. ★ Foods Restricted or avoided: High fat foods, Protein: Low Protein high CHO foods. Acute glomerulonephritis, uremia; hepatic Types of Diet/Indication for use coma; chronic glomerulonephritis with nitrogen retention. Carbohydrate: High CHO Characteristics Renal and liver disturbances, toxemia of pregnancy, Addison’s disease, ❖ Protein restricted to 50% below the normal preparation for surgery, hyperthyroidism allowance or about 20-30gm per day; ❖ about 2/3 of the total protein prescribed Characteristics should come from HBV proteins; sodium and potassium may be restricted. ❖ CHO in the diet is increased by 50% above the normal Food Selection Food Selection ★ Foods avoided: Protein foods in excess of the prescribed amount. ★ Foods Included: rice and other cereals, breads and bakery products, root crops, ★ Food Limited: Legumes, nuts, cereals, and vegetables BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE Types of Diet/Indication for use The diet is relatively high in CHO and low in fat since CHO favors uric acid excretion Protein: Protein Free and Zero Protein while fats tend to favor retention. Fluid Hepatic coma, acute anuria intake of at least 2qt/day or more is encouraged to help eliminate uric acid Characteristics preventing renal calculi and retarding ❖ Use only as an emergency measure; high progressive involvement of the kidney. Restriction CHO and fats to prevent tissue breakdown. of alcohol intake is also advised. Food Selection Food Selection ★ Foods included: Fruit juices if potassium is Foods limited: Protein foods not restricted; sugar, butter balls, butter soup pudding etc. Types of Diet/Indication for use Types of Diet/Indication for use Phenylalanine Restricted Protein: 20 gm Protein (GiordanoGiovanetti Diet) (Phenylketonuria (PKU) Chronic Renal Failure, acute Characteristics glomerulonephritis A diet rich in which the intake of the amino Characteristics acid phenylalanine is limited to a prescribed level governed by patient ❖ Contains a limited amount of protein with intolerances usually 200-500 mg at least ½ - 2/3 from HBV sources. Phenylalanine/day. Food Selection Food Selection ★ Food included: Sugars, fats, and fruits (If Same as Purine Restricted potassium is not restricted) are used Types of Diet/Indication for use generously to meet caloric needs. ★ Food limited: Meat, fish, egg, milk, nuts, Gluten Restricted, Gliadin Free Diet beans, cereals. Celiac Disease; non tropical sprue, Types of Diet/Indication for use dermatitis herpetiformis Protein: 40gm Protein (Modified Giordano- Characteristics Giovanetti Diet) ★ A diet that is free of toxic gluten. High Chronic uremia, chronic calorie, high protein, low fat, high glomerulonephritis, maintenance diet in carbohydrates (simple, easily digested between dialysis. ★ sugars), supplements of B Foods limited: Characteristics wheat, rye, oats, and barley, protein or other derivatives, e.g. malt from barley. ❖ More capable than 20 gm PRO, more vitamins, Vitamins A and C, Iron variety of foods can be included in Supplement if anemia is present. planning, at least ½ - 1/3 should come from Food Selection HBV sources. Food Selection ★ Foods limited: wheat, rye, oats, and barley, protein or other derivatives, e.g. malt from ★ Foods included: Same as 20 gm PRO barley. ★ Food Limited: Foods high in purine; Types of Diet/Indication for use glandular meats, dried legumes, lentils, and meat extracts. D. Fats and Lipids: low fat Types of Diet/Indication for use Malabsorption with steatorrhea, acute attacks of pancreatitis and cholecystitis, in Protein Constituents: Purine Restricted type I hyperlipoproteinemia, celiac Gout, uric acid, calculi disease. Characteristics Characteristics A diet in which uric acid and its precursors, Severely restricted fat diet allows from 10 - specifically, sources of purines such as 15% of TER as fat calories or approximately glandular meat, dried legumes, lentils, and 20 -30 grams fat/day meat extracts are limited. The purine all food rich in fat not allowed or restricted content of the diet is about 120-150 gm foods cooked by a method not requiring (regular diet contains as much as 600-1000 addition of fat; emphasis on vitamin -A rich mg/day) foods. BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE Food Selection Food Selection Foods included: Skim Milk, Egg, lean meat, Foods allowed: special attention given to cottage cheese, cereals, fruits, vegetables, the choice of foods which are naturally low sugar. in sodium content. Food avoided: Fatty meats; rich, desserts, Foods avoided: canned, processed foods fried foods. which use salt and sodium containing flavoring agents and preservatives; salts, Types of Diet/Indication for use patis, vetsin and toyo are omitted from the Modified Fatty acid ratio table or the tray. Malabsorption with steatorrhea, acute LEVELS OF RESTRICTION: attacks of pancreatitis and cholecystitis, in 1. 200-250 mg NA (9-11 mEq) Severe hypertension type I hyperlipoproteinemia, celiac intended primarily for hospitalized patients whose disease. salt tolerance is low; caution is employed to avoid Characteristics sodium depletions, azotemia and refractory heart failure. ★ Calories from fat are approximately of normal level but food sources of PUFA are Characteristics emphasizedh67 Lowest level of sodium ★ intake of SFA reduced ★ maintain P/S ratio of 1:1 Food Selection Food Selection Foods allowed: rice or oatmeal is substituted for regular bread at breakfast. ➔ Foods avoided: Fats of meat; butter, Jam is used instead of butter and hydrogenated margarine, whole milk, margarine; meal limited to 4 exchanges cream cheese, coconut oil. per day, unsalted vegetable oil for cooking; only low sodium milk, Lonalac, is Types of Diet/Indication for use used if milk is desired. Low Cholesterol 2. 500 mg NA (22 mEq) Severe CHR Atherosclerosis, hypercholesterolemia, Types II -V, ❖ Renal Disease with edema hyperlipoproteinemia gallbladder stones ❖ cirrhosis with ascites with cholesterol esters, coronary heart ❖ pulmonary edema. disease. Characteristics Characteristics Strict sodium restriction. Dietary cholesterol is reduced to less than Food Selection 300 mg per day. Foods Allowed: ordinary evaporated milk is Food Selection used but not more than 2T/day. Included Food allowed: Lean meat only of fish; skim the food plan in a 2oo mg NA diet plus 2 milk, cottage cheese, vegetables, and exchanges of regular-based and 2 fruits, tapioca, cornstarch, or rice pudding exchanges of butter or margarine/day. prepared with skim milk; honey, sugar. Avoided: all others above Foods Avoided: glandular organs, oyster, roe, caviar, animal fat, cream cheese, 3. 1000 mg NA (43 mEq): Serious CHF whole milk, cream, butter, ice cream. ❖ used as a maintenance diet for nephritis, Types of Diet/Indication for use toxemia of pregnancy ACTH therapy ❖ for patients with a tendency to develop E. Minerals: Sodium Restricted edema. Restriction depends on individual needs; Characteristics less severe restriction when diuretics are used. Moderate Sodium Restriction. Characteristics Food Selection Diets where the sodium content is limited to Foods allowed: Include the food plan in a a specific level which may range from 500 mg NA diet plus ¼ tsp NaCl/day. In a mild restriction to severe restriction; sodium-restricted high-protein diet, this provides an adequate diet with a additional salt is omitted. prescribed level of sodium according to individual needs. BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE 4. 2000 -3000 mg NA (43 mEq) Patients with sugar, plain candies, oils and fats, coffee, tea. Moderate heart damage Foods Limited: Milk, Fruits, and Vegetables. ❖ Maintenance diet in Renal disease ❖ Steroid edema edema of Hepatic origin Alkaline Ash Diet - Kidney stones, Uric Acids ❖ Pre -menstrual tension and Cystine Calculi ❖ Mild CHF ❖ Characteristics: Alkaline-ash foods are Characteristics emphasized, acid-ash foods are limited to those necessary for good nutrition. Mild Sodium restriction, essentially a normal Neutral foods used as desired. diet; Moderate use of salt in food ❖ Foods included: large amounts of fruits, preparation. vegetables, milk. Food Selection ❖ Neutral foods: Butter, Sugar, Plain Candies, Oils, and fat, coffee and tea Allowed: may allow moderate use of salt in ❖ Food avoided or limited: Meat, poultry, food preparation. fish, cheese, noodles, cereals, bread. Avoid: Further addition of salt, toyo, patis, ❖ g. VEGETARIAN DIETS and other salty condiments at the table or on the tray; highly salted foods. Vegan Diet or Strict Vegetarian - One that includes some of the following foods: 5. No added salt (3 -5g Na) Vegetables, fruits, enriched or whole grain Characteristics breads and cereals, beans and nuts. ❖ Food excluded: All foods of animal Liberal Na restriction – no salt is added to origin, meat, poultry, fish, eggs and food during cooking and serving. dairy products such as milk, cheese, Food Selection and ice cream. Foods allowed: Cereals and breads, sugar, fats; protein foods, fruit and vegetables Lactovegetarian - One that includes dairy within the prescribed amounts. products plus some or all of the following Foods in restricted amounts: Milk, cream, foods: Vegetables, fruits, enriched or whole eggs, meat, fish, poultry, fruits, and grain breads and cereals, beans, and nuts. vegetables. ❖ Food excluded: meat, poultry, fish, and 6. Potassium Restricted eggs Renal failure, Hyperkalemia, Addison’s Disease, Oliguria, Anuria Lactoovovegetarian - One that includes eggs Characteristics and dairy products plus some or all of the following foods: vegetables, fruits, enriched or The potassium content of the diet is whole grain breads and cereals, beans, and reduced to about 1.0 to 1.5 gms/day nuts. The calcium content of the diet is reduced ❖ Food excluded: meat, poultry, and fish to approximately 150 and 350 mg per day Zen Macrobiotic Diet - Ecological and in adults and children, respectively. Religious Concerns Food Selection ❖ Characteristics: Dietary regime Foods in restricted amounts: Milk, cheese, composed of ten basic diets ranging eggs, nuts, meat, fish, and other high from the lowest level diet 3, which calcium foods. includes 10% cereals, 30% vegetables, Calcium Restricted - Calcium Stones, 10% soup, 30% animal products, 15% Hypercalcemia, recurrent pancreatitis, salads and fruits, 5% desserts, to diet 7. diagnostic test for hyperparathyroidism The highest level of the regime is 100% cereals. Vitamin B12 supplements is ❖ f. ASH CONTENT recommended. Acid Ash Diet - Kidney Stones, calcium and ❖ Foods limited: foods high in purine. magnesium phosphates, carbonates, and ❖ h. OTHER DIETS oxalates Hypoallergenic Diet - Food allergy Characteristics: ❖ Characteristics: Should be ❖ Acid-ash foods are emphasized; individualized based on an individual’s ❖ neutral foods are used as desired. specific food allergies. Food included: Acid-ash food, meat, fish, poultry, ❖ Foods limited: Specific food or food eggs, whole grain cereals, bread, noodles, groups known to produce allergic prunes, corn, and lentils. Neutral foods: Butter, manifestation. BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE Elemental Diet - Short bowel syndrome, malabsorption disorders, GI fistulas, cachexia ❖ Characteristics: Semi-synthetic fiber- free diets composed of purified amino acids, simple CHO, fats, vitamins, and ❖ II. CHILDREN minerals, have no ingestible bulk, hence require minimum digestion and are rapidly absorbed. Given orally or by tube. DIETARY CALCULATIONS A. Estimating the Desirable Body Weight (DBW) The calculations of diet prescription is usually based on desirable body weight. Other terms used are reference, ideal, expected or standard ❖ II. CHILDREN weight. In 1998, through a directive of the National - “Desirable body weight” (DBW, or Ideal Nutrition Council, the International Reference Body Weight (IBW) as used in nutrition and Standard (IRS) was adopted nationwide as basis diet therapy refers to the weight for height in the assessment of the Filipino children’s found statistically to be the most nutritional status. For adults, the “Weight for Height compatible with health and longevity. Tables for Filipinos (25 65 years)” may be utilized. If There are several tables or nomograms these references are not available, the following which give the DBW of adults of given formulas may be used. height. However, in practice, it is often necessary to compute and individual’s ❖ I. INFANTS DBW quickly. The following are some formulas that may be used. A. BODY MASS INDEX-BASED FORMULA - Body Mass Index (BMI), computed as weight in kilograms divided by height in meter squared (W/H²), has been found to be the relative weight index that shows the highest correlation which independent measure of body fat. The BMI range of 18.5 to 24.9 is generally considered as normal. - The joint FAO/WHO/UNU Expert Consultation on Energy and Protein Requirements computed the energy requirements of adults based on BMI = 22 for men and BMI = 21 for women. The NOTE TO REMEMBER weight for a given height equivalent to these BMI values may be read off directly Infants Weight: from a BMI nomogram. In the absence of - Double at 5-6 months such a nomogram, the following formulas - Triples at 12 months have been found to give weighs closely - Quadruples at 24 months equivalent to BMI = 22 for men and BMI = 21 for women. HEIGHT OR WEIGHT: - FOR MEN: 5 feet (1.52 m) tall, DBW = 112 lbs (51kg) - Increases by 24, 12, and 8 cm during the - FOR WOMEN: 5 feet (1.52 m) tall, DBW = 106 first, second, and third year, respectively, lbs (48kg) then by 4 cm every year after that up to the eighth year. B. ALTERNATIVE METHODS - Formulas that yield equivalent weights within the normal BMI range of 20 to 24.9 are considered acceptable. One such - formula is Brocca Index, more popularly called Tannhauser Formula which is: DBW = Height in centimeter – 100. BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE - For individuals of small to medium frame, a Heavy – farmer, laborer, cargador, fisherman, correction factor of 10% is suggested. The formula heavy equipment operator applies to both sexes. TANNHAUSER METHOD - Measure height in centimeters. Deduct from the factor 100 and the answer is the DBW in kg. The DBW obtained applies to Filipino stature by taking off 10%. B. Estimating Total Calorie or Total Energy Requirement (TER/day): Digestion and Absorption of Macronutrients ❖ Introduction ★ Digestion is breaking large, insoluble food molecules into smaller molecules of absorption into the bloodstream. ★ This process involves using many digestive fluids and enzymes such as saliva, mucus, bile, and hydrochloric, among others. ★ Mechanical digestion breaks large food particles into smaller ones. ★ Chemical digestion involves breaking covalent chemical bonds on organic molecules by digestive enzymes. ★ Carbohydrates break down into monosaccharides, lipids breakdown into fatty acids and monoglycerides, and proteins breakdown into amino acids. ❖ STAGES OF FOOD DIGESTION There are four primary stages of food digestion in the human body that include: 1. After intake of food through the mouth, it makes its way through the stomach into the Example of Activities: small intestine, where it is digested. Sedentary – secretary, clerk, typist, 2. The nutrients from the digested food get administrator, cashier, bank teller absorbed into the bloodstream through Light – teachers, nurse students, laboratory small pores in the small intestine. technicians, housewives with maids 3. The remaining undigested food is sent to be the large intestine, where any Moderate – housewife without a maid, vendor, unprocessed water or nutrients are mechanic, jeepney, or car driver reabsorbed into the body. BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE 4. The remaining waste food product is ➔ Amino acids are tiny elements that get passed out of the body in the form of stools. absorbed into the blood system through 5. Absorption is the process of the absorbing the wall of the small intestine. or assimilating substances into the cells or ❖ Digestion and Absorption of Lipids across the tissues and organs through the process of diffusion or osmosis. ❖ Digestion and Absorption of CHO ❖ Lipids, are organic compounds comprising fatty acids, which are insoluble in water. ❖ Fats are the common example of lipids. ❖ The insoluble property of lipids makes the digestion and absorption of fats a complicated process ❖ Digestion and Absorption of CHO The first step in lipid digestion is 1.Two types of carbohydrates can be digested by emulsification, by which large lipid droplets the digestive system: are transformed into much smaller ➔ (sugar and starch) droplets. 2. Sugar is broken down in the gastrointestinal tract Emulsification is accomplished by bile salts by the small intestine and three enzymes present secreted by the liver. in the mouth namely: lactase, sucrose, and The enzymes that digest lipids are soluble in maltase water and can digest the lipids only by 3. Starch is broken down with the help of Amylase acting at the surface of the droplets. which are present in the mouth and the stomach 4. After digestion, carbohydrates are absorbed in the small intestine with the help of minute finger- shaped projections known as Villi. ❖ The emulsification process increases the surface area of the lipid droplets exposed to the digestive enzymes by increasing the ❖ Digestion and Absorption of PRO number of lipid droplets and decreasing ➔ The digestion of proteins takes place in the the size of each droplet. stomach with the help of protease and ❖ Lipase, secreted by the pancreas, digests pepsin enzymes, which break down the lipid molecules. proteins into amino acids. ❖ The primary product of this process are ➔ The process is facilitated by the fatty acids and monoglycerides. hydrochloric acid present in the stomach. Digestion and Absorption of Lipids BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE ★ Chylomicrons are transported to the liver, Stomach: Gastric juices, including hydrochloric where the lipids are stored, converted into acid and enzymes like pepsin, break down other molecules, or used as energy. They proteins into smaller peptides. are also transported to adipose tissue, Small Intestine: Bile from the liver emulsifies fats, where they are stored until an energy and pancreatic enzymes (lipase, amylase, source is needed elsewhere in the body. proteases) further digest fats, carbohydrates, and ★ Other lipoproteins are called low-density proteins. lipoproteins (LDLs) and high-density lipoproteins (HDLs), which transport Large Intestine: Water and some electrolytes are cholesterol and fats in the blood. absorbed, and undigested food is eventually excreted. ❖ Absorption - After digestion, nutrients are absorbed into the bloodstream primarily in the small intestine: Carbohydrates: Broken down into monosaccharides (e.g., glucose) and absorbed via the intestinal lining into the blood. Proteins: Broken down into amino acids, which are absorbed into the bloodstream. Fats: Broken down into fatty acids and glycerol, absorbed into the lymphatic system as Water and Minerals chylomicrons, and eventually enter the ❖ Approximately 9 L of water enter the bloodstream. digestive tract each day. We ingest about Vitamins and Minerals: These are absorbed 2 L in food and drink, and the remaining 7 L depending on their solubility (fat-soluble vitamins are from digestive secretions. like A, D, E, K, and water-soluble vitamins like C ❖ Approximately 92% of that water is and B). absorbed in the small intestine, about ❖ 7% is absorbed in the large intestine, and ❖ Metabolism - Once absorbed, nutrients are about 1% leaves the body in the feces. transported to cells for metabolism, which ❖ Water can move in either direction by includes two processes: osmosis across the wall of the digestive Catabolism: The breakdown of complex tract. The direction of its movement is molecules to release energy. For example, determined by osmotic gradients across glucose is broken down in cellular respiration to the epithelium. When the chyme is diluted, produce ATP (energy). water moves out of the intestine into the Anabolism: The synthesis of complex molecules blood. If the chyme is concentrated and from simpler ones. For example, amino acids are contains little water, water moves into the used to build proteins, and fatty acids form lumen of the small intestine. triglycerides or cell membranes. ❖ Summary ❖ DIGESTION - This is the process by which NOTE: Energy not immediately used is stored as food is broken down into smaller glycogen in the liver or as fat in adipose tissues for components that the body can absorb. later use. involves mechanical and chemical FOOD GUIDE ❖ Qualitative tool in planning nutritious diets breakdown: for the masses. Mouth: Chewing (mechanical) breaks food into ❖ Teaches the principles of eating a variety of foods everyday in proper amounts of smaller pieces. Saliva (chemical) contains servings. enzymes like amylase, which starts digesting ❖ Here’s what FOOD GUIDES around the world carbohydrates. looks like: ★ CAMBODIA BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE Cambodia’s guide is in the shape of an Angkor ➔ Antigua and Barbuda uses pineapple, a Wat - a temple complex that’s one of the largest food native to the country. religious monument in the world. The guide was ★ QATAR developed with the help of school children surveyed by the Ministry of Health about the foods they most commonly eat. ★ BENIN ➔ Qatar's guide comes in the form of a seafood shell. ★ KOREA ➔ Benin’s guide is a round traditional house with a thatch roof. The water in the entrance is there for two reasons: as a symbol of Beninese hospitality and a reminder that plenty of water should be consumed throughout the day. ★ ANTIGUA and BARBUDA ➔ Korea gives importance to physical activity. BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE ★ JAPAN ★ CHINA ➔ China's pagoda uses the traditional five levels to indicate how much of each food group should be eaten. ➔ Japan's guide is in the shape of a spinning top — a traditional toy in the country. It features a person running around a glass of water or tea, to represent the need for adequate physical activity. ★ CANADA ★ PHILIPPINES ★ MALAYSIA BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE ❖ MY PLATE DASH DIET PLATE DASH DIET MEDICAL NUTRITION THERAPY (MNT) BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE DIABETES DIET PLATE METHOD It helps the patient visualize how different foods can be proportionally arranged on a plate for different meals. This method provides 1,200- 1,500 calories. The Asian-Pacific Type 2 Diabetes Policy Group has outlined the following simple reminders: ❖ Eat Most Use one or more of these foods as the basis of every meal: Vegetables, legumes, lentils, noodles, rice, bread, grains, barley, wholegrain cereals, fresh fruit (non-sweet). ❖ Note that many sauces and preservatives that are added to these foods are high in salt, sugar or fat, and should be avoided. NUTRITIONAL GUIDELINES or DIETARY GUIDELINES Nutritional Guidelines for Filipinos (NGF) Set of dietary guidelines based on the eating pattern, lifestyle, and health status of Filipinos. Provides the general public with easy and simple recommendations on proper diet and practices that bring about good health for every individual. ❖ Eat Moderately 10 KUMAINMENTS Have small servings of protein-rich food e.g., fish, seafood, eggs, lean meat, 1. Kumain ng iba’t-ibang pagkain. skinless chicken, low-fat yogurt, low-fat milk, nuts. 2. Sa unang 6 months ni baby, breastfeeding lamang; mula 6 months, bigyan din sya ng ibang ❖ Eat Least angkop na pagkain. Minimize fats, sugars, salt and 3. Kumain ng gulay at prutas araw-araw. alcohol, e.g., butter oil, cream, coconut milk and cream, processed meat, fried 4. Kumain ng isda, karne, at iba pang pagkaing goods, preserved or processed foods, may protina. pastries, sweets, biscuits, soft drink. 5. Uminom ng gatas; kumain ng pagkaing mayaman sa calcium. BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE 6. Tiyaking malinis at ligtas ang ating pagkain at 3. Reduce fat tubig. 4. Reduce sodium 5. Decrease calories 7. Gumamit ng iodized salt. 6. Eat more complex CHO 8. Hinay-hinay sa maaalat, mamantika, at ❖ Animal Foods matatamis. CARBOHYDRATES 9. Panatilihin ang tamang timbang. ❖ CLASSIFICATION 10. Maging aktibo, iwasan ang alak; huwag manigarilyo. Carbohydrates may be classified according to their degree of polymerization and may be 10 NUTRITIONAL GUIDELINES for FILIPINOS divided into 3 principal groups – sugars, 1. Eat a variety of foods everyday to get the oligosaccharides, and polysaccharides. nutrients needed by the body. ❖ 1. SUGARS 2. Breastfeed infants exclusively from birth up to 6 a. Monosaccharides months then give appropriate complementary b. Disaccharides foods while continuing breastfeeding for 2 years c. Sugar Alcohols and beyond for optimum growth and ❖ 2. OLIGOSACCHARIDES development. 3. Eat more vegetables and fruits every day to get ❖ 3. POLYSACCHARIDES the essential vitamins, minerals, and fiber for a. Starch regulation of body processes. b. Resistant Starch 4. Consume fish, lean meat, poultry, egg, dried c. Non-starch polysaccharides (Dietary beans, or nuts daily for growth and report of body Fibers) tissues. FUNCTIONS 5. Consume milk, and milk products, and other ❖ 2. PROTEIN SPARER calcium-rich foods - such as small fish and shellfish - Carbohydrates are the cheapest and most - every day for healthy bones and teeth. available source of energy providing 40- 80% of the total energy intake in different 6. Consume safe foods and water to prevent countries. diarrhea and other food and water-brone - In the Philippines, carbohydrates account diseases. for an average of 74% of total energy intake. 7. Use iodized salt to prevent Iodine Deficiency - Each gram provides 4 calories. Disorders. - Glucose provides a ready source of energy 8. Limit intake of salty, fried, fatty, and sugar-rich in the brain and the red blood cells which foods to prevent cardiovascular diseases. has been estimated to be 180g/day in the adult man. 9. Attain normal body weight through proper diet ★ 2. PROTEIN SPARER and moderate physical activity to maintain good - Adequate carbohydrates provide the health and help prevent obesity. body’s energy needs to ensure that protein 10. Be physically active, make healthy food will be used for building and repairing body choices, manage stress, avoid alcoholic tissues. beverages, and do not smoke to help prevent ★ 3. REGULATION OF METABOLISM lifestyle-related non-communicable diseases. - Adequate carbohydrates prevent the rapid oxidation of fats which results in the KEY MESSAGES: accumulation of ketone bodies leading to 1. Variety ketosis. 2. Moderation - The body needs at least 50-100g of 3. Plant-based Diet carbohydrates per day to spare body MODERATION protein and prevent ketosis. ★ 4. ENSURE NORMAL GASTROINTESTINAL Be moderate in eating and drinking FUNCTION (sodium (salt), fat, cholesterol, sugar, alcohol). - Lactose promotes the growth of desirable Avoid food components in the total diet that have bacteria, some of which are useful in the been linked to diseases. synthesis of Vitamin K and B-complex PLANT-BASED DIET vitamins. - Lactose enhances the absorption and Recommendations: utilization of calcium. - Fiber maintains gut integrity and ensures ❖ Plant Foods normal elimination of waste. 1. Increase fiber ❖ 5. PROVIDES OXALOACETATE 2. Reduce cholesterol BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE - Carbohydrates provide oxaloacetate - Produced from lactose during digestion which condenses with acetylCoA to initiate - Rarely occurs naturally as a single sugar the Krebs cycle. - Constituent of glycolipids, glycoproteins, - The Krebs cycle is the final common and cerebrosides in brain and nerve metabolic pathway for the degradation of tissues. fat and protein fragments which with carbohydrates are used by the body for B. DISACCHARIDES energy. - They are double sugars produced by the A vital component of the body compounds that chemical union of 1 molecule of glucose regulate metabolism: and 1 other monosaccharides. - The most common are sucrose (glucose + - Glucuronic acid in the liver acts as a fructose), lactose (glucose + galactose), detoxifying agent. and maltose (2glucose) - Hyaluronic acid forms the matrix of connective tissues. I. SUCROSE - Heparin prevents the clotting of the blood. - Immunopolysaccharides are part of the - Also known as table sugar or simply body’s immune system. “sugar”, cane sugar, beet sugar, and - Pentoses are components of RNA and DNA saccharose that contain and transfer the genetic - Foundly main in molasses, maple syrup, characteristics of the cell. and maple sugar - Glycosides are components of steroid and - Prepared commercially from sugar cane adrenal hormones that are essential to and sugar beets cardiac therapy. - Non-reducing disaccharides - Galactose and glucose in the cerebrosides are constituents of the brain and nerve II. LACTOSE tissues. - Also known as milk sugar - Chondroitin sulfates are found in skin, - Comes from milk and milk products tendons, cartilage, bone, and heart valves. - Only carbohydrate of animal origin that is ❖ 1. SUGARS significant in the human diet - About 1/6 as sweet as sugar and is the least ❖ A. MONOSACCHARIDES sweet among the common sugars - Structurally the simplest form of - Fermentation product is lactic acid, which carbohydrates because they cannot be gives the characteristic flavor of yogurt hydrolyzed into smaller molecules. and buttermilk. - Have only 1 sugar unit and may contain 3- - Excessive fermentation may cause LBM 7 C atoms: triose (3-C chain), tetrose (4-C - According to DOH, 1 out of 2 Filipinos are chain), pentose (5-C chain), hexose (6-C lactose intolerant chain), and heptose (7-C chain). - The most common are the hexoses like III. MALTOSE glucose, fructose, and galactose, and the -Also known as malt sugar and grain sugar pentoses like ribose and deoxyribose. -Formed in plants when seeds germinate I. GLUCOSE and in humans during carbohydrate digestion - Also known as the physiologic sugar, - Used in fermentation to produce malted dextrose, corn sugar, blood sugar, and beverages like beer and whiskey grape sugar - With dextrins it forms dextrimaltose and - Most important sugar in human metabolism maltodextrin which serve as a source of - Stored in the liver and muscles as glycogen carbohydrate for some infant formulas. - ¾ as sweet as sugar - Not easily fermented in the intestine. ❖ SUGAR ALCOHOLS II. FRUCTOSE - Sugar alcohols are produced by the hydrogenation of various sugars. - Also known as levulose and fruit sugar - Sugar alcohols occur naturally in fruits, and - Sweetest of the sugars vegetables and are used by - Highly soluble and does not really manufacturers as a low-calorie bulk crystallize ingredient that provides sweetness in - Produced from the hydrolysis of sucrose “sugar-free” or reduced-calorie products - Converted to glucose in the liver like hard candies, cookies, jams, jellies, and gums. They are suitable substitutes for III. GALACTOSE sucrose in weight-reducing diets. - Sugar alcohols evoke a low glycemic - Converted to glucose in the liver response and are slowly absorbed in the BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE body. They do not contribute to dental I. ACESULFAME-K caries because they are not utilized by mouth bacteria. - Approved for use by the FDA in 1988 and is - Sugar alcohols yield energy and are also used in more than 60 countries called “sugar replacers” or nutritive - ADI is 15 mg/kg/d sweeteners. - Derivative of acetoacetic acid that is 200 - Side effects such as abdominal discomfort, times sweeter than sugar flatulence, and diarrhea make them less - Zero calories attractive than artificial sweeteners. - Retains its sweetness in liquids (as in softdrinks) I. SORBITOL - Suitable for baking - Brands: Sunette, Sweet One, Sweet & Safe - Hydrogenation product of glucose - ½ as sweet as sugar II. ASPARTAME - Sweetener for chewing gums and candies - May cause diarrhea - Approved for use by the FDA in more than - Absorbed slowly therefore little or no effect 100 countries on blood glucose level - ADI 50 mg/kg/d - Composed of phenylalanine, aspartic II. DULCITOL acid, and a methyl group - Because of phenylalanine, the label must - Hydrogenation product of galactose have a warning for people with - In people with galatokinase deficiency, a phenylketonuria form of galactosemia, excess dulcitol forms - 4 cal/g in the lens of the eye leading to cataracts - 180-200 times sweeter than sugar - Brands: Nutrasweet, Equal, Quali Sweet, III. MANNITOL and Pal - Hydrogenation product of mannose III. NEOTAME - Least acceptable among the sugar alcohols - Approved for use by the FDA in 2002 - Considerably less sweet than sugar so large - ADI is 18mg/kg/d amount is required - Zero calories - Composed of phenylalanine, aspartic IV. XYLITOL acid, a methyl group, and an additional side group that blocks the digestive - Hydrogenation product of xylose enzymes that normally separate - Used in chewing gums phenylalanine and aspartic acid. Thus, - Prevents growth of caries-producing both amino acids are not absorbed and bacteria neotame need not carry a warning for - As sweet as fructose people with phenylketonuria. - 4cal/g - Reports that it may cause tumors in animals IV. SACCHARIN have led to voluntary curtailing of its use by US food producers - Approved for use by the FDA in more than 100 countries V. MALTITOL - ADI is 5mg/kg/d - 300-500 times sweeter than sugar - Hydrogenation product of maltose - Often used in low-calorie carbonated soft - Has pleasant sweet taste similar to sugar drinks - 90% as sweet as sugar - Zero calories - Non-carcinogenic - Brands: Sweet n Low, Sweet Magic, Sugar - Used in the production of sugarless and Twin, and Hermesetas candies, chewing gums, chocolates, baked goods, and ice cream V. SUCRALOSE - Gives creamy texture to food ❖ ARTIFICIAL SWEETENERS - Approved for use by the FDA in 1998ADI is - Provide virtually no energy and are also 5mg/kg/d called non-nutritive sweeteners. They are - Zero calories zero or low-calorie alternatives to nutritive - 600 times sweeter than sugar sweeteners intended to provide the sweet - Body does not recognize it as a taste of sugars without the calories. carbohydrate so it passes the GIT - The FDA has approved the use of several undigested and unabsorbed. artificial sweeteners awaiting FDA approval. C. OLIGOSACCHARIDES BSN 2104_A.Y. 2024-2025 NCM 105 FIRST SEM NUTRITION AND DIET THERAPY LECTURE - They are made up of 3 to 9 - Refers to starch that escapes digestion in monosaccharide units. the small intestine and enters the colon. This - Examples are raffinose, portion has been linked with the control of fructooligosaccharides, diabetes and hyperlipidemia. galactoolisaccharides, inulin, - With non-starch polysaccharides, it makes maltodextrin, and stachyose. up approximately 15% of ingested - Oligosaccharides like raffinose and carbohydrates that escape digestion and maltodextrins are readily soluble while are fermented in the colon producing the fructooligosaccharides are not digested short chain fatty acids which are acetate, but are partly hydrolyzed by gastric acid. propionate, and butyrate. I. RAFFINOSE III. NON-STARCH POLYSACCHARIDES (DIETARY FIBERS) - Trisaccharide composed of galactose, glucose and fructose - A joint FAO/WHO Expert group defined - Found in beans, cabbages, brussels dietary fiber as “the sum of lignin and sprouts, broccoli, asparagus, other polysaccharides that are not hydrolyzed vegetables, and whole grains. by endogenous enzymes of the gastrointestinal tract”. However, they may II. FRUCTOOLIGOSACCHARIDES be hydrolyzed or fermented in the colon to produce the short chain fatty acids. - Made up of plant sugars linked in chains - The non-starch polysaccharide fibers - Obtained from asparagus, Jerusalem include: cellulose, hemicelluloses, pectins, artichokes, and soybeans, or produced in gums, and mucilages. The fermentation the laboratory. products of indigestible carbohydrates in - Used for constipation, traveler’s diarrhea, the colon decrease the risk of certain and high cholesterol levels. diseases. - Used as prebiotics which act as food for - Fibers also include some “good” bacteria in the intestines nonpolysaccharides such as lignins, cutin, - Pass undigested into the colon where they and tannins. are fermented by colonic microflora. They - Dietary fiber may be soluble or insoluble. increase bowel mass and promote the Soluble dietary fibers are natural gel- growth of certain bacteria that are thought forming fibers like beta-glucan, psyllium, to be beneficial. pectin, and guar gum. Insoluble dietary fibers include cellulose, lignin, and some D. POLYSACCHARIDES hemicelluloses. ❖ GLYCOGEN - They are complex carbohydrates made up - Also called “animal starch” and is of 10 or more monosaccharide units. They structurally similar to amylopectin but are less soluble but more stable than simple contains many more branched chains of sugars and are digested with varying glucose. degrees of completeness. - Major form of stored carbohydrate in - Polysaccharides of importance in nutrition human and animal tissues which is readily are starch, resistant starch, and non-starch converted to glucose as needed. polysaccharides (dietary fibers) - Rapidly synthesized from glucose in the I. STARCH liver and muscles where it is stored. - Found to a limited extent in meats and not - Most significant source of carbohydrate in all in plants, therefore is not significant the diet source of carbohydrate and is not counted - Storage form of carbohydrates in plants as one of the complex carbohydrate