Nutrition And Diet Therapy PDF

NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester Vitamins Regulate body CHAPTER 1 processes...

NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester Vitamins Regulate body CHAPTER 1 processes INORGANIC NUTRIENTS PLANNING A HEALTHY DIET Minerals Regulate body processes Nutrition – a branch of science that studies nutrients Water Regulate body in relation to growth, maintenance, and health of the processes body Food – fuel that sustains human life and it is for CLASSIFICATION OF NUTRIENT DEFICIENCY virtually all the body processes Nutrients – components of food that are needed by Primary – caused by inadequate dietary intake the body in adequate amounts in order to grow, - Ex.: Rickets reproduce, and lead a normal life Secondary – caused by something other than diet Essential Nutrients – nutrients found in food such as disease condition that may cause Nonessential Nutrients – body is producing malabsorption, accelerated excretion or destruction Health – state of complete physical, social, and of the nutrients mental well-being and not merely the absence of disease or infirmity DEFICIENCY DISEASES Nutrition – result of processes whereby the body takes in and uses food for growth and development, RICKETS and the maintenance of health - deficiency disease; it causes poor bone Malnutrition – condition that results when the body formation in children and is due to insufficient does not receive enough nutrients, the body cells Calcium and Vitamin D don’t receive an adequate supply of the essential Ostomalacia (Adult Rickets) – in young nutrients due to poor diet intake and poor utilization adults and it causes the bones to soften and may Nutrient Deficiency – occurs when the person lacks cause the spine and legs to become bowed one or more nutrients over a period of time Osteoporosis – condition that causes bones Balanced Diet – includes all 6 classes of nutrients to become porous and excessively brittle and calories in amounts that preserve and promote good health GOITER DETERMINES WHEN TO EAT - bosyo in Tagalog Hunger – physiological need for food - enlarged tissue of the thyroid gland due to a Appetite – the psychological desire for food based on deficiency of Iodine the pleasant memories Iodine can cause 3 diseases (stunted growth, goiter, cretinism) 6 MAJOR NUTRIENTS NIGHT BLINDEDNESS ORGANIC NUTRIENTS (Matang Manok) – lack of vitamin A Carbohydrates Provide energy Fats Provide energy Protein Build and repair body tissues; DIETARY GUIDELINES provide energy Provide a science-based advice to promote health (last sort of energy) and to reduce the risk of chronic diseases through diet and physical activities NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester Nutritional Guidelines for Filipinos (NGF) – set of - Vegetables have bigger space than fruits in volume dietary guidelines based on the eating pattern, and bulk. lifestyle, and health status of Filipinos. The NGF - The Guide also teaches moderation in some food contains all the nutrition messages to healthy living for items, while emphasizing the importance of others. all age groups from infants to adults, pregnant and - The was renamed Daily Nutritional Guide Pyramid for lactating women, and the elderly Filipinos. EATING PLAN FOR HEALTHY LIVING NUTRITIONAL GUIDELINES FOR FILIPINOS - Food and Nutrition Research Institute (KUMAINMENTS) (DOST) Fats & Oils 6-8 tsps 1. Eat a variety of foods everyday to get the Sugar/Sweets 5-8 tsps nutrients needed by the body. Fish, Shellfish, Meat & Poultry, 3-4 servings 2. Breastfeed infants exclusively from birth to 6 Dried Beans & Nuts months. Then give appropriate Egg 1 piece complementary foods while continuing Milk & Milk Products 1 glass breastfeeding for 2 years and beyond for Vegetable 3 servings optimum growth and development. Fruits 2-3 servings 3. Attain normal body weight through proper diet Rice, Rie Products, Corn, Root 5-8 servings and moderate physical activity to maintain Crops, Bread, Noodles good health and prevent obesity. Water/Beverages 8 glasses 4. Consume fish, lean meat, poultry, egg, dried EXERCISE beans or nuts daily for growth and repair of PERSONAL & ENVIRONMENTAL HYGIENE - Do regular exercise in most days of the week body tissues. for at least 30 minutes 5. Eat more vegetables, fruits, and root crops. - Practice good personal and environmental 6. Eat foods cooked in edible/cooking oil daily. hygiene 7. Consume milk, milk products, and other Eat a variety of foods everyday to ensure that all calcium-rich foods such as shellfish everyday nutrients are provided in proper amount and for healthy bones and teeth. balance. 8. Use iodized salt to prevent iodine deficiency Use iodized salt and eat other fortified foods to disorders. increase the intake of micronutrients 9. Consume safe foods and water to prevent diarrhea and other food- and water-borne diseases. PINGGANG PINOY 10. Be physically active, make healthy food The first Pinggang Pinoy food guide developed by the choices, manage stress, avoid alcoholic FNRI-DOST was the Pinggang Pinoy for Filipino adults. beverages, and do not smoke to help prevent Since individual’s energy and nutrient needs vary lifestyle-related non-communicable diseases based on age and sex and level of physical activity, Pinggang Pinoy food guides for the different FOOD GUIDE PYRAMID population and physiologic groups (children, adolescents, elderly, pregnant mother, and lactating - Food guide pyramid teaches the principles of eating women) were also developed. a variety of food everyday in proper amounts of servings. Pinggang Pinoy is a new and easy-to-understand food - Rice and cereals take up the major bulk in the diet guide that uses a familiar food plate model to convey while fats and oils take up the least volume and bulk. the right food group proportions on a per-meal basis. NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester This will help Filipinos acquire healthy eating habits MALE ADOLESCENTS FEMALE needed to attain optimum nutrition. 13-18 Y/O ADOLESCENTS 13-18 Y/O 2 cups of rice 1 ½ cups of rice 1-2 cups of vegetables 1-1 ½ cups of vegetables 2 small pieces of fish 1 small piece of fish 1 serving of fruit 1 serving of fruit 12 or more glasses of 9 or more glasses of water water DIETARY STANDARDS Dietary standards are compilation of nutrient requirements or allowances in the specific quantities. It is tentative and may be changed due to newer findings from research unveils. It is a Quantitative tool in assessing the nutritional adequacy of diets Also observe the principle of INDIVIDUALIZATION. Dietary Requirements Intake Recommended Dietary Allowance (RDAs) Recommended Energy and Nutrient Intake Components of Pinggang Pinoy: (RENI) 17% - Bahagi ng Isda, Karne, at iba pa Dietary Reference Intake (DRIs) – USA and Canada 17% - Bahagi ng prutas 33% - Bahagi ng Kanin, Lamang-Ugat, at iba pa STEPS IN CALCULATING AND PLANNING DIETS 33% - Bahagi ng Gulay - Determine the desirable body weight Water (Tubig) - Estimate the Total Energy Requirement (TER) - Determine the amount of Macronutrients for Diet Prescription - Translate the Diet Prescription into Exchanges I. DESIRABLE BODY WEIGHT DBW using Tannhauser Method (Broca’s Index) Equation: DBW = (HEIGHT – 100) – (10% (HEIGHT – 100) NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester Example: Calculate the DBW of an adult female who stands 5’1” tall. a. Convert height to centimeter 5’1” = (5 feet x 12 inches/foot) + 1 inch = 5 x 12 = 60 + 1 = 61 inches x 2.54 cm/inch = 154.94 cm b. Deduct from the height the factor 100 DBW (Kg) = 154.94 – 100 = 54.94 c. To adjust body frame for Filipinos, Deduct additional 10%. DBW (Kg) = 54.94 – (10% of 54.94) PHYSICAL ACTIVITY LEVELS AND VALUES = 54.94 – 5.494 (kcal/kg body weight) by Occupational Work = 49.446 or 49 kg Intensity NDAP ACTIVITY LEVEL SAMPLE OCCUPATIONAL KCAL/KG CATEGORY/WORK ACTIVITIES BODY INTENSITY WEIGHT Males: 112 lbs for 5ft +/- 4 lbs for every inch above Sedentary Mostly resting with little or no 30 or below 5 ft activity Females: 106 lbs for 5 ft +/- 4 lbs for every inch Light Occupation that require minimal 35/40 above or below 5 ft movement, mostly sitting/desk work or standing for long hours Example: and/or with occasional walking 5’5” Male (professional, clerical, administrative and managerial ✓ 112 lbs staff, driving light vehicles (cars, jeepney). Housewives with light ✓ 5 x 4 = 20 lbs housework (dishwashing, ✓ 112 lbs + 20 lbs = 132 lbs preparing food) ✓ 132 lbs / 2.2 = 60 kg DBW – 60 kg or 132 lbs Moderate Occupations that require 40/45 extended periods of walking, pushing or pulling or lifting or carrying heavy objects (cleaning/domestic services, II. ESTIMATE THE TOTAL ENERGY REQUIREMENT waiting tables, home building task, farming, patient care) TER is based on the estimate of energy expenditure Very Active/ Occupations that require 45/50 according to physical activity level (PAL) and body Vigorous extensive periods of running, weight (kg) rapid movement, pushing or pulling objects or task frequently requiring strenuous effort and Equation: extensive total body movements TER (KCAL) = DBW x PAL (teaching a class or skill requiring Example: active and strenuous A 50 kg adult person with sedentary activity participation such as aerobics or physical education instructor; TER = 50kg DBW x 30 kcal/kg DBW/day firefighting; masonry and heavy TER = 1500 kcal construction work; coal mining; NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester manual shoveling; using heavy IV. TRANSLATE THE DIET PRESCRIPTION TO non-powered tools) EXCHANGES Energy and Macronutrients Composition of III. DETERMINE THE AMOUNT OF Food Exchanges MACRONUTRIENTS FOR DIET DESCRIPTION Food No. CHO Protein Fat Energy Exchange Exchange (g) (g) (g) (Kcal) Determining the carbohydrate, protein, and fat Group requirement based of Acceptable Macronutrient Vegetable 1 3 1 - 16 B Distribution Range (AMDR)as suggested in the 2015 Fruit 1 10 - - 40 PDRI. Milk 1 12 8 5 125 Rice 1 23 2 - 100 NUTRIENTS % OF TER Meat 1 - 8 6 86 Carbohydrate 55-75 Fat 1 - - 5 45 Protein 10-15 Sugar 1 5 - - 20 Fats 15-30 DOST-FNRI, 2017 Example: Sample Computation and Distribution (1500 Kcal, Carbohydrate 245 g, Protein 55g, Fat 35g) For a regular diet: Allot 65% of TER for carbohydrates, 15% Food No. CHO Protein Fat Energy Exchange Exchange (g) (g) (g) (Kcal) protein and 20% fat Group Carbohydrate: Vegetable 3 9 3 48 1500 kcal x 0.65 = 975 kcal B Protein: Fruit 5 50 200 1500 kcal x 0.15 = 225 kcal Milk 1 12 8 5 125 Fat: Rice 7 161 14 700 1500 kcal x 0.20 = 300 kcal Meat 4 32 24 344 Calculate the number of grams of Fat 1 5 45 carbohydrate, protein and fat by dividing the Sugar 3 15 60 kcal for each nutrient by the corresponding Total 247 57 34 1522 physiological fuel value (4 kcal for carbohydrates, 4 kcal for protein and 9 kcal for fat per gram). Exchange Table (Food) Carbohydrate : 975 kcal / 4 kcal/g = 243.75 ~ 245g Protein : 225 kcal / 4 kcal/g = 56.25 ~ 55g Fat : 300 kcal / 9 kcal/g = 33.33 ~ 35g Note: Round off total calories to the nearest 50, and for carbohydrate, protein and fats to the nearest 5 grams Diet Prescription: 1500 kcal Carbohydrate 245g, Protein 55g, Fat 35g NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester Exchange Table (Meal) NUTRITION FACTS Nutrition label has a formatted space called Nutrition Facts Food label information includes: ✓ Total calories ✓ Calories from fats Food Exchange Meal Plan ✓ Total fat ✓ Saturated fat Food No. Breakfa Snac Lunc Snac Dinn Exchange Exchan st k / h k / AT er ✓ Trans fat Group ge MT ✓ Cholesterol Vegetab 3 2 1 ✓ Sodium le B ✓ Total carbohydrates Fruit 5 1 1 1 1 1 ✓ Dietary fiber Milk 1 1 ✓ Sugars Rice 7 2 3 2 ✓ Protein Meat 4 1 2 1 ✓ Vitamin A Fat 1 1 ✓ Calcium Sugar 3 3 ✓ Iron A new easier-t-understand food label is nearing FDA FOOD LABELING approval Definition: Food label is any tag, brand, mark, pictorial 20 years has been updated or other descriptive matter, written, printed, stenciled, Sample Label for Frozen Lasagna marked, embossed or impressed on, or attached to, a container of food or food product. - Food labeling was pass by Congress of the Nutrition Labeling and Education Act (NLEA) in 1990, nutrition labeling regulations became mandatory in May 1994 for nearly all processed foods. - Primary objective of changes was to ensure that labels will be on most foods and will provide consistent nutrition information. - Food labels provide the consumer with more information on the nutrient contents of foods and how nutrients affects health - Health claims allowed on labels are limited and is set by the Food and Drug Administration (FDA). Serving sizes are determined by FDA and not The information in the main or top section of the the individual food processor sample nutrition label can vary with each food and Descriptive terms are standardized. Example: beverage product; it contains product-specific Low fat means that each serving contains 3g information of fat or less. serving size Calories NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester nutrient information 2. CALORIES The bottom section contains a footnote that explains the % Daily Value and gives the number of calories used for general nutrition advice. Calories provide a measure of how much energy you get from a serving of this food. In the example, there are 280 calories in one serving of lasagna. To achieve or maintain a healthy body weight, balance the number of calories you eat and drink with the number of calories your body uses. 2,000 calories a day is used as a general guide for nutrition advice. Your calorie needs may be higher or lower and vary depending on your age, sex, height, weight, and physical activity level. Remember: The number of servings you consume determines the number of calories you actually eat. Eating too many calories per day is linked to overweight and obesity. 1. SERVING INFORMATION 3. NUTRIENTS When looking at the Nutrition Facts label - First take a look at the number of servings in the package (servings per container) and the serving size. Serving sizes are standardized to make it easier to compare similar foods; they are provided in familiar units, such as cups or pieces, followed by the metric amount, e.g., the number of grams (g). The serving size reflects the amount that people typically eat or drink. It is not a recommendation of how much you should Nutrients to get less of: Saturated Fat, Sodium, and eat or drink. Added Sugars. - Pay attention to the serving size, especially how Saturated fat, sodium, and added sugars are nutrients many servings there are in the food package. For listed on the label that may be associated with example, you might ask yourself if you are consuming adverse health effects – and Americans generally ½ serving, 1 serving, or more. consume too much of them, according to the recommended limits for these nutrients. They are NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester identified as nutrients to get less of. Eating too much ▪ Diets low in fat and high in fiber-containing saturated fat and sodium, for example, is associated grains, fruits and vegetables and cancer with an increased risk of developing some health ▪ Folic Acid and Neural Tube Defects conditions, like cardiovascular disease and high ▪ Soy Proteins and Coronary Heart Disease blood pressure. Consuming too much added sugars Two additional criteria must also be met: can make it hard to meet important nutrient needs ▪ A food whose label makes a health claim while staying within calorie limits. must be naturally good source (containing at least 10% of the daily value) of at least one of the following nutrients: protein, vitamin A, WHAT ARE ADDED SUGARS AND HOW ARE THEY vitamin C, iron, calcium or fiber. DIFFERENT FROM TOTAL SUGARS? ▪ Health claims cannot be made for a food if a standard serving contains more than 20% of Total Sugars on the Nutrition Facts label include the daily value for total fat, saturated fat, sugars naturally present in many nutritious foods and cholesterol or sodium. beverages, such as sugar in milk and fruit as well as any added sugars that may be present in the product. No Daily Reference Value has been established for TERMINOLOGY total sugars because no recommendation has been The FDA has standardized Descriptors – term used by made for the total amount to eat in a day the manufacturers to describe products on food Added Sugars on the Nutrition Facts label include labels to help the consumer select the most sugars that are added during the processing of foods appropriate and healthful foods. (such as sucrose or dextrose), foods packaged as Examples: sweeteners (such as table sugar), sugars from syrups Low calorie means 40 calories or less per and honey, and sugars from concentrated fruit or serving. vegetable juices. Diets high in calories from added Calorie free means less than 5 calories per sugars can make it difficult to meet daily serving. recommended levels of important nutrients while Low fat means a food has no more than 3g of staying within calorie limits. fat per serving or per 100g of the food. Note: Having the word “includes” before Added Fat free means a food contains less than 0.5g Sugars are included in the number of grams of Total of fat per serving. Sugars in the product. Low saturated fats 1g or less of saturated fat For example, a container of yogurt with added per serving. sweeteners, might list: Low cholesterol means 20mg or less of Total Sugars on Sample Label cholesterol per serving. Cholesterol free means less than 2mg of HEALTH CLAIMS cholesterol per serving. No added sugar means that no sugar or ▪ Calcium and Osteoporosis sweeteners of any kind have been added at ▪ Sodium and Hypertension any time during the preparation and ▪ Diets low in saturated fat and cholesterol and packaging. When such a term is used, the high in fruits, vegetables and grains containing package must state that it is not low calorie or dietary fiber and coronary heart disease calorie reduced (unless it actually is). ▪ Diets low in fats and high in fruits and Low sodium means less than 140mg of vegetables containing dietary fiber and the sodium per serving, antioxidants, and vitamin A and C and cancer NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester Very low sodium means less than 35mg of severing the jugular vein and carotid artery, sodium per serving. then by soaking in brine before cooking. ✓ Meat and meat products may not be prepared with milk and milk products. FOOD CUSTOMS ✓ The dishes used in the preparation and serving of meat products must be kept separate from Food customs – are food habits originating in small those used for dairy foods. section of a particular country. ✓ Dairy products and meat may not be eaten Dietary Laws – rule to be followed in meal planning is together. At least six hours must elapse after some religions. eating meat before eating dairy products, and 30 minutes to one hour must elapse after Comfort Foods – foods that where familiar to them eating dairy products before eating meat. during their childhood. ✓ The mouth must be rinsed after eating fish and FOOD PATTERNS is based on: before eating meat. ✓ There are prescribed fast days: Passover ✓ Cultures Week, Yom Kippur and Feast of Purim. ✓ Regions and countries ✓ No cooking is done on the Sabbath, from sundown Friday to sundown Saturday. Filipino Cultural Dietary Influence Jewish dietary laws forbid the eating of the ✓ Spanish following: ✓ Japanese ✓ Western ✓ The flesh of animals without cloven (split) ✓ Chinese hooves or that do not chew their cud ✓ Indian ✓ Hindquarters of any animal ✓ The Pacific Islands ✓ Shellfish or fish without scales or fins ✓ Birds of prey ✓ Creeping things and insects FOOD PATTERNS BASED ON RELIGION OR ✓ Leavened (contains ingredients that cause it PHILOSOPHY to rise) bread during Passover ✓ In general, the food served in rich. Chicken JEWISH and fresh-smoked and salted are popular; as ❖ Persons who adhere to the Orthodox view are noodles, eggs, and flour dishes. These diet consider tradition important and always can be deficient in fresh vegetables and milk. observe the dietary laws. ROMAN CATHOLIC ❖ Food prepared according to these laws are called Kosher. ❖ The dietary restrictions of the Roman Catholic ❖ Conservative Jews are inclined to observe the religion have liberalized, meat is not allowed rules only at home. on Ash Wednesday and Good Fridays, Pope ❖ Reform Jews consider their dietary laws to be request believers to abstain eating meat on essentially ceremonial and so minimize their Fridays during Lent. significance. EASTERN ORTHODOX These Law requires the following: ❖ Includes Christians from the Middle East, ✓ Slaughtering must be done by a qualified Russia, Greece person in a prescribed manner. The meat or poultry must be drained of blood, first by NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester ❖ Interpretation of the dietary laws vary meat, ❖ Contributes to reduction of obesity and poultry, fish, and dairy products are restricted reduced risk of high blood pressure, heart on Wednesdays and Fridays and during Lent disease, some cancer and diabetes. and Advent. ❖ Vegetarians need to focus in ensuring to get SEVENTH-DAY ADVENTIST enough calcium, vitamin D, vitamin B12, iron, zinc, and proteins. ❖ Seventh-Day Adventist in general are Lacto- ovo vegetarians, which means they use milk products and eggs but no meat, fish or poultry. Two types of vegetarians ❖ Use nuts, legumes and meat analogues ❖ Lacto-ovo Vegetarians - use dairy products (substitutes) and tofu. and eggs but no meat, poultry or fish. Consider coffee, tea and alcohol to be harmful. ❖ Vegans - avoids all meat foods. They use MORMON (LATTER-DAY SAINTS) soybeans, chickpeas, meat analogues, and tofu. ❖ The only dietary restriction observed is the prohibition of coffee, tea, and alcoholic beverages ZEN MACROBIOTICS DIETS ISLAMIC Macrobiotic diets is a system of 10 diet plans ❖ Adherents of Islam are called Muslim. Developed by Zen Bhuddism ❖ Dietary Laws prohibits the use of pork and Adherents progress from lower number diet to alcohol. higher, gradually giving up food in the following ❖ Meats must be slaughtered according to order: desserts, salads, fruits, animal foods, specific laws (Halal). soups and ultimately vegetables, until only ❖ During the month of Ramadan, Muslims do cereals – usually brown rice – are consumed. not eat or drink during daylight hours. Beverages are kept in minimum. Only organically grown foods are used. HINDU Food are grouped as yang (male) or yin ❖ All life is sacred and animals contain the souls (female). A ratio of 5:1 yang to yin is of ancestors. considered important. ❖ Most Hindus are vegetarian. Most macrobiotic diets are nutritionally ❖ They do not use eggs because egg represent inadequate and can be dangerous because life. avid adherents promise medical cures from the diets that cannot be attained and medical treatment maybe delayed when needed. OTHER FOOD PATTERNS ❖ There several vegetarian diets. ❖ The most common among them do not include meat. ❖ Some include eggs, milk and cheese and some do not. ❖ It is important to carefully planned these diet could be nutritious and to include appropriate combinations of essential amino acids. NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester CHAPTER 2 Chemical energy: C, P, F, others Chemical waste: Carbon dioxide and water DIGESTION AND ABSORPTION AND METABOLISM ATP: body’s energy currency DIGESTION Digestion is breaking large, insoluble food molecules DIGESTION AND ABSORPTION OF into smaller molecules of absorption into the MACRONUTRIENTS bloodstream. DIGESTION AND ABSORPTION OF ✓ This process involves using many digestive CARBOHYDRATES fluids and enzymes such as saliva, mucus, Two types of carbohydrates can be digested by the bile, and hydrochloric acid, among others. digestive system Mechanical digestion breaks large food particles into Sugar Broken down in the gastrointestinal tract by the small smaller ones. intestine and three enzymes Chemical digestion involves breaking covalent present in the mouth namely: chemical bonds on organic molecules by digestive ✓ Lactase enzymes. ✓ Sucrose ✓ Maltase ✓ Carbohydrates breakdown into Starch Broken down with the help of monosaccharides, lipids breakdown into fatty amylase which are present in the acids, and monoglycerides and proteins mouth and the stomach breakdown into amino acids. After digestion, carbohydrates are absorbed in the small intestine with the help of minute finger-shaped projections known as Villi. STAGES OF FOOD DIGESTION There are four primary stages of food digestion in the human body that include: After intake of food through the mouth, it makes its way through the stomach into the small intestine, where it is digested. The nutrients from the digested food get absorbed into the bloodstream through small pores in the small intestine. The remaining undigested food is sent to the large intestine, where any unprocessed water nutrients are reabsorbed into the body. The remaining waste food product is passed out of the body in the form of stools. Absorption is the process of absorbing or DIGESTION AND ABSORPTION OF PROTEINS assimilating substances into the cells or across the tissues and organs through the The digestion of proteins takes place in the process of diffusion or osmosis. stomach with the help of protease and pepsin enzymes, which break down the proteins into amino acids NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester The process is facilitated by the hydrochloric The emulsification process increases the acid present in the stomach surface area of the lipid droplets exposed to Amino acids are tiny elements that get the digestive enzymes by increasing the absorbed into the blood system through the number of lipid droplets and decreasing the wall of the small intestine size of each droplet Lipase, secreted by the pancreas, digests lipid molecules The primary product of this process are fatty acids and monoglycerides In the intestine, bile salts aggregate around small droplets of digested lipids to form micelles The hydrophobic (water-fearing) ends of the bile salts are directed toward the lipid particles, and hydrophilic (water-loving) ends are directed outward, toward the water environment When a micelle comes in contact with the epithelial cells, the fatty acids and monoglycerides are recombined to form triglycerides. They are packaged inside a DIGESTION AND ABSORPTION OF LIPIDS protein coat The packaged lipid-protein complexes, or The first step in lipid digestion is lipoproteins, are called chylomicrons emulsification, by which large lipid droplets are transformed into much smaller droplets Chylomicrons leave the epithelial cells and enter the lacteals, lymphatic capillaries within Emulsification is accomplished by bile salts the intestinal villi secreted by the liver Chylomicrons are transported to the liver, The enzymes that digest lipids are soluble in where the lipids are stored, converted into the water and can digest the lipids only by acting other molecules, or used as energy. They are at the surface of the droplets also transported to adipose tissue, where they are stored until an energy source is needed elsewhere in the body Other lipoproteins are called low-density lipoproteins (LDLs) and high-density lipoproteins (HDLs), which transport cholesterol and fats in the blood WATER AND MINERALS Approximately 9 L of water enter the digestive tract each day. We ingest about 2 L in food and drink, and the remaining 7 L are form digestive secretions. Approximately 92% of that water is absorbed in the small intestine, about 7% is absorbed in the large intestine, and about 1% leaves the body in the feces. NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester Water can move in either direction by osmosis across Vitamins and These are absorbed depending the wall of the digestive tract. The direction of its Minerals on their solubility (fat-soluble movement is determined by osmotic gradients across vitamins like A, D, E, K, and water- the epithelium. When the chyme is diluted, water soluble vitamins like C and B) moves out of the intestine into the blood. If the chyme is concentrated and contains little water, water moves Metabolism – once absorbed, nutrients are into the lumen of the small intestine. transported to cells for metabolism, which includes SUMMARY two processes: Digestion is the process by which food is broken down Catabolism The breakdown of complex into smaller components that the body can absorb. It molecules to release energy. For involves mechanical and chemical breakdown: example, glucose is broken down in cellular respiration to produce Mouth Chewing (mechanical) breaks ATP (energy). food into smaller pieces. Saliva Anabolism The synthesis of complex (chemical) contains enzymes like molecules from simpler ones. amylase, which starts digesting For example, amino acids are carbohydrates. used to build proteins, and fatty Stomach Gastric juices, including acids form triglycerides or cell hydrochloric acid and enzymes membranes. like pepsin, break down proteins Note: Energy not immediately used is stored as into smaller peptides. glycogen in the liver or as fat in adipose tissues for Small Bile from the liver emulsifies fats, later use. Intestine and pancreatic enzymes (lipase, amylase, proteases) further digest fats, carbohydrates, and proteins. Large Intestine Water and some electrolytes are 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 (eg. Glucose) CHAPTER 3 and absorbed via the intestinal CARBOHYDRATES lining into the blood. CARBOHYDRATE STRUCTURE AND FORMULA IN Proteins Broken down into amino acids, BIOLOGY which are absorbed into the bloodstream. Carbohydrate structure refers to the specific Fats Broken down into fatty acids and arrangement of carbon (C), hydrogen (H), and oxygen glycerol, absorbed into the (O) atoms in these organic molecules showing in lymphatic system as general as C(n)H(2n)O(n). chylomicrons, and eventually enter the bloodstream. TOP 10 BENEFITS OF CARBOHYDRATES ✓ Energy source NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester ✓ Improves brain function Galactose - Is the product of the ✓ Supports muscle recovery digestion of milk ✓ Improves digestive health - It is not found naturally ✓ Reduces blood sugar control ✓ Nutrient delivery DISACCHARIDES ✓ Enhances heart health ✓ Supports weight management Are pairs of the two sugars. They are sweet and must ✓ Mood regulation be changed to simple sugars by hydrolysis before they ✓ Provides immunity can be absorbed. CARBOHYDRATES AND ITS CLASSIFICATION Sucrose - Is composed of glucose and fructose - It is the form of carbohydrates present in granulated, powdered, and in brown sugar and in molasses - It is one of the sweetest and cheapest sugars - Its sources are sugar cane, sugar beets, and the sap from maple tree Maltose - It is an intermediary MONOSACCHARIDES product in the hydrolysis of starch Are the simplest form of carbohydrates. They are - It is produced by enzyme sweet and require no digestion and absorbed directly action during digestion of from the bloodstream from the small intestine starch in the body - It is also created during Glucose - Also called dextrose fermentation process - Is the form of that produces alcohol carbohydrates to which - It can be found in some all other forms are infant formulas, mall converted and beverage products and metabolized beer - It is found naturally in - It is less sweet than corn syrup and some glucose and sucrose fruits and vegetables Lactose - Is the sugar found in milk - The Central Nervous - It is distinct from most System, the red blood sugar because it is not cells and the brain uses found in plant only glucose as fuel - It helps the body absorb Fructose - Also called levulose or calcium fruit sugar - Is less sweet than - Is found in glucose in monosaccharides and many fruits and honey other disaccharides - It is the sweetest Lactose Intolerance – is unable monosaccharides to digest lactose and suffer from NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester bloating, abdominal cramps, and Some hemicellulose is found mainly in diarrhea after drinking milk or whole-grain cereal. consuming a milk-based food Lignins are woody part of vegetables such as processed cheese. It is such as carrots and asparagus or the caused by insufficient lactase, small seeds of strawberries the enzyme required for digestion - They are not carbohydrate of lactose. Soluble It partially dissolve in water. - Special Low-Lactose Milk ✓ Gums Products ✓ Pectins ✓ Some hemicellulose ✓ Mucilages – are soluble in POLYSACCHARIDES water and form a gel that helps Are commonly known as complex carbohydrates provide bulk for intestines - they bind cholesterol thus because it is composed of many monosaccharides reducing the amount of blood (simple sugar). can absorb Starch - Is a polysaccharide found in grains and vegetables FUNCTIONS OF FIBERS - It is the storage form of glucose in plants - Is helpful to clients with diabetes mellitus Glycogen - Is the storage form of because it help lower blood glucose levels glucose in the body - It prevents colon cancer by moving waste - Is stored in the liver and materials through the colon faster than muscles normal thereby reducing the colon’s exposure - Glucagon – is the to potential carcinogen hormone that helps the liver convert glycogen to - Helps prevent constipation, hemorrhoids and glucose as needed for diverticular disease by softening and energy increasing the size of stool BENEFITS THE FIBERS Insoluble Fiber Soluble Fiber - Eases and - Lowers blood Dietary Fibers – also called roughage prevents cholesterol constipation - Stay fuller longer ✓ Is indigestible because it cannot be broken - Good for colon - Improve blood down by digestive enzymes health sugars TYPES OF FIBERS Insoluble It does not readily dissolve in water. STARCH Cellulose – primary source of dietary - Starch is made up of many sugar units bonded fiber together - It is found in the skin of fruits, - It is found in plant-derived foods such as the leaves, and stem of couscous, quinoa, corn, barley, sweet vegetables and legumes potatoes, oats, bread, rice, potatoes, and - Has no energy value pasta - It provides bulk for the stool NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester - Starchy foods such as bread, rice, potatoes, SUGAR and pasta, provide a slow and steady release - sugar is found naturally in some foods, of energy throughout the day including fruit, honey, fruit juices, milk FIBER (lactose), and vegetables - sugar is also added to many processed foods - Fiber is only found in foods that come from and drinks such as cookies, candy, sports plants drinks, and dressing - Fiber helps keep our bowels healthy - added sugars should be limited to a maximum - Some types of fibers may help lower of 10 percent of daily energy intake cholesterol - Research shows diets high in fiber are NAMES FOR ADDED SUGARS INCLUDE associated with a lower risk of cardiovascular Anhydrous Brown Confectioner’s Corn disease, type 2 diabetes, and bowel cancer dextrose sugar powdered syrup - Good sources of fiber include vegetables with sugar skins on whole grain bread, whole-wheat Corn Dextrose Fructose High pasta, and pulses such as beans and lentils syrup Fructose solids Corn WATER-SOLUBLE WATER-INSOLUBLE Syrup FIBER FIBER (HFCS) - Fruit (Protein) - All vegetables Honey Invert Lactose Malt syrup - Apples - Fruit sugar - Peaches - Whole grains Maltose Maple Molasses Nectars - Plums and - Brown rice syrup (eg. Peach prunes - Wild rice nectar, - Banana - Wheat bran pear - Grains - Nuts seeds nectar) - Oats Raw sugar Sucrose Sugar White - Barley granulated - Legumes sugar - Dried peas - Beans - Lentils DIFFERENCES BETWEEN THE TWO MAIN TYPES OF CARBOHYDRATES SOURCES OF CARBOHYDRATES CARBOHYDRATE TYPES HIGH GLYCEMIC INDEX LOW GLYCEMIC INDEX Cereals Wheat, corn, bread, cereal, (HIGH GI) (HIGH GI) pasta, rye, oats CARBOHYDRATES CARBOHYDRATES Vegetables Potatoes, beets, peas, starchy What happens in our body when we eat them? beans – lima beans, green leafy - Digested faster - Digested slower vegetables - Germ is also - Blood sugar Fruits Apple, orange, rambutan, papaya removed level rises slowly Sugars Table sugar, syrup, honey, - Blood sugar level - Slow release of desserts, candies rises quickly insulin into Quick release of insulin bloodstream into bloodstream What would you feel then? NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester - Energy slump - Energized all day SUMMARY after eating a - Reduced - carbohydrates is the major source of energy meal that is rich tendency to - it is composed of carbon, hydrogen, and in this type of snack oxygen carbs - one gram of carbohydrate provides 4 - Makes you reach calories for that - are least expensive and most abundant candy/chocolate nutrient bar to give you - the principal sources of carbohydrates are that burst of plant products such as grains and their energy products, vegetables, fruits, legumes, and Examples sugars - White bread, - Brown rice, red - carbohydrates provides energy, spares white rice, with rice, black rice protein, and provides fiber flour, etc. - Whole meal - digestion of carbohydrate start in the mouth - Table sugar noodles or pasta continues to the stomach and is completed (sugar), jams, - Healthy grains in the small intestine marmalade, like quinoa, - although they are essential to health and honey, maple barley well-being of the body, eating an excess of syrups - Beans and the wrong type of carbohydrates can cause - Anything made legumes dental caries, digestive disturbances and with white flour - Whole fruit obesity (eg. Biscuits, - Starchy pastries, and vegetables with cakes) skin on (eg. RDA FOR CARBOHYDRATES - Fruit juice Potatoes, yam) Age Recommended Carbohydrate (contains - Wholegrain or minimum as percent of minimal fiber) multigrain bread carbohydrate daily calorie - Regular soft intake intake drinks, cordial grams/day CONCLUSION 0-6 months 60 g Choose less often Choose more often 7-12 months 95 g 1-8 years 130 g 45-65 - the optimal recommendation for fiber intake is 9-18 years 130 g 45-65 20/35 grams per day 19+ years 130 g 45-65 - the recommended intake amount of fruit is 2 Pregnancy 175 g 45-65 cups and 2 ½ cups vegetables for a day who Lactation 210 g 45-65 needs to consume 2000 calories - fiber intake should be increased gradually and 5 TIPS FOR SMART CARB CONSUMPTION should be accompanied by an increase intake of water 1. choose whole grain, low GI carbohydrates - eating too much fiber in a short time can including whole grain breads with lots of produce discomfort flatulence (abdominal seeds, basmati whole grain rice, whole-wheat gas) and diarrhea pasta, and rolled oats. - insoluble fiber has binders (phytic acid or 2. Try some different sources of cars from time to phytate) which is found in outer covering of time such as lentils, butter beans, and rolled grains and vegetables oats. NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester 3. Limit high-fat processed carb foods such as split beans, chickpeas, and peanuts. Grains chips, cookies, and pastries. like wheat, barley, corn, and rice. 4. Remember that all sugar, whether it comes - Plant proteins is used to produce textured soy from honey, agave nectar, or table sugar, and proteins and tofu. Known as “analogues”. the less sugar you can have the better - Meat alternatives (analogues) are made from - Check labels on cereals and other packaged soy protein and other ingredient mixed goods. together to create various kinds of meat. - More than 22.5 grams sugar per 100 grams is CLASSIFICATION OF PROTEINS considered a high amount. 5. Increase in fiber intake by choosing oat-based Complete - contains all the essential cereals and whole grains, and eating at least amino acids five portions of fruit and vegetables. - all animal proteins, except gelatin Partially - contains all the EAA in CHAPTER 4 complete limited amounts to PROTEINS support growth - gliadine, hordein - The word protein is a Greek word derived and Incomplete - lacks one or more EAA means “of first importance” - cannot sustain life nor - Is composed of carbon, hydrogen, oxygen, and support growth nitrogen - zein, gelatin - Are composed of chemical known as “amino acids” CLASSIFICATION OF AMINO ACIDS Amino acids is the building blocks of protein. Essential Amino - that the body cannot FUNCTIONS OF PROTEINS Acids make at all or cannot - Builds and repairs tissue make in sufficient - Regulates body function quantity to meet its - Provides energy needs - isoleucine, leucine, lysine, methionine, FOOD SOURCES tryptophan, valine - Proteins are found both in animal and plant Semi-Essential - are those whose rate of foods Amino Acids synthesis in the body is - The animal food sources provides the highest inadequate to support growth and are quality of complete proteins. It includes meat, therefore needed by fish, poultry, eggs, milk, and cheese. young animals - The plant food sources provides the - arginine, histidine incomplete proteins and are of a lower Non-Essential - can be synthesized in biological quality than those found n animal Amino Acids the body in sufficient foods, Even though, plant foods are important amounts food sources of protein when a variety of and - alanine, asparagine, are consumed within the day. Ex.: nuts, aspartic acid, cystine, sunflower seeds, sesame seeds, legumes cysteine, glutamic acid, such as soybeans, navy beans, pinto beans, glutamine, glycine, NUTRITION AND DIET THERAPY Nutrition and Diet Therapy 12th Ed. (Roth & Wehrle) 2nd Year | 1st Semester hydroxyproline, proline, DIGESTION AND ABSORPTION serine, tyrosine - The mechanical digestion of protein begins in the mouth, where the teeth grind the food into NITROGEN BALANCE small pieces - Chemical digestion begins in the stomach. - one gram nitrogen = 6.25 g dietary protein Hydrochloric acid prepares the stomach so - at nitrogen equilibrium: N intake = N output that the enzyme pepsin can begin its → - at positive IV balance: metabolism and elimination N intake > N output - All essential amino acids must be present to Growth, pregnancy, rehabilitation from illness build and repair the cells is needed - At negative N balance: - When the amino acids are broken down, the N intake < N output nitrogen containing amine group is stripped Illness, malnutrition off. The process is called deamination PROTEIN EXCESS - Deamination produces ammonia, which is released into the bloodstream by the cells - Burden on liver for ammonia detoxification - The liver picks up the ammonia then converts and kidneys for nitrogen excretion it to urea and return it to the bloodstream for - Obesity the kidney to filter out and excrete - Depressed calcium absorption - The remaining parts are used as energy or are - Hypercholesterolemia converted to carbs or fat and stored as - Heart diseases – meat sources are high in glycogen or adipose tissue saturated fats correlated but no independent effect DIETARY REQUIREMENTS - Cancer – correlation of cancer and protein - 10-15% of TER intake from meats - Safe protein intake level for adults (balance - Weight control – protein-rich sources are high losses of nitrogen) fat sources, weight gain - Safe protein intake level for children (based on WHAT IS PROTEIN-ENERGY MALNUTRITION? reference protein – egg or milk, adjusted for protein quality of Filipino rice-based diets of Protein energy malnutrition (PEM) is a type of 70% protein digestibility corrected AA score malnutrition that is defined as pathological conditions ➔ Task of reducing proteins into polypeptides arising from coincident lack of dietary protein and - The polypeptides reach the small intestines, energy (calories) in varying proportions. the pancreatic proteases continue the Growth: