I CNG V DINH DNG

ThS. BS o th Yn Phi

I TNG
-

Sinh vin Y khoa nm th 4 h tp trung di hn

Sinh vin Y khoa nm th 3 h tp trung 4 nm

MC TIU BI HC
1. Nm vng khi nim v dinh dng v tm quan trng ca dinh dng i vi i sng
con ngi, i sng x hi v trong y khoa
2. Trnh by cc cht dinh dng cn thit cho c th, phn nhm v nu c ngun cung
cp t cc nhm thc phm
3. Bit c qu trnh tiu ha cc loi thc n v s hp thu cc cht dinh dng.
I CNG V DINH DNG
Dinh dng l qu trnh cung cp nng lng t thc n v chuyn ha nng lng trong t bo
nui dng c th.
Dinh dng chim mt vai tr quan trng trong vic hnh thnh, pht trin c th v gi gn sc
khe ca con ngi. mi thi k pht trin ca mt i ngi, nhu cu v dinh dng hon ton
khc nhau, tuy nhin vic p ng nhu cu y mt cch hp l li lun lun l vn ng ch ,
v l nn tng ca sc khe. iu ny cng c bit quan trng i vi tr nh, v cc sai lm v
dinh dng trong giai an u th c khi gy nhng hu qu nghim trng v khng th phc hi
ko di n sut i.
Dinh dng lin quan n nhiu lnh vc khc nhau nh nng nghip, cng nghip ch bin, mng
li phn phi, mng li y t, mng li truyn thng... Trong y khoa, dinh dng l mt yu t
lin quan n hu ht cc chuyn khoa, gi vai tr quan trng khng th b qua, v tnh trng dinh
dng ca bnh nhn cng nh cc ch n ph hp vi cc bnh l khc nhau ng gp mt
phn ng k, i khi l phn chnh yu n kt qu iu tr. Dinh dng hp l cn c vai tr
phng nga bnh v phc hi sau bnh.

THC PHM V CHT DINH DNG

Thc n trong cc ba n hng ngy c ch bin t nhiu loi thc phm khc nhau. H tiu
ha s phn gii cc loi thc phm ny thnh cc cht dinh dng. Ch c cht dinh dng mi
c hp thu vo mu.
C trn 40 cht dinh dng cn thit cho c th hng ngy nhng nhn chung c th chia cc cht
dinh dng thit yu ny ra lm 3 nhm chnh :
1

1. Nhm cht dinh dng a lng sinh nng lng: Cht bt ng, cht bo, cht m v
cht cn. Ngoi vai tr cung cp nng lng cho c th, cc cht dinh dng a lng sinh
nng lng cn tham gia vo cu trc c th, tham gia vo cc hot ng hp thu, chuyn ha,
min dch
2.

3.

Nhm cht dinh dng vi lng: Khng cung cp nng lng nhng c vai tr quan
trng trong cc qu trnh chuyn ha ca c th, c nh hng n sc khe v bnh tt. Nhu
cu hng ngy ca c th thng t, tnh bng miligam, thm ch microgam. Bao gm cc
vitamin v khong cht vi lng.
-

Vitamin : Gm cc vitamin tan trong nc (B, C) v cc vitamin tan trong cht bo (A, D,
E, K).

Cht khong vi lng : Hin xc nh c khong 10 loi khong cht vi lng hin
din trong c th nhng ch mi bit c chc nng v chuyn ha ca Zn, Fe, Mg, Cu,
I, F, Se.

Nhm nht dinh dng a lng khng sinh nng lng: Bao gm cht khong a
lng, cht x v nc.
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Cht khong a lng : Canxi, Phosphor, Potassium, Sulfur, Sodium, Cloride, Magnesium

Nc : L thnh phn chnh yu ca khu phn d t c quan tm.

Cht x : Khng tiu ha, khng hp thu nhng c vai tr quan trng trong iu ha hot
ng ca h tiu ha.

CC CHT DINH DNG THIT YU

1.

Nhm cht dinh dng a lng cung cp nng lng :

1.1.

Cht bt ng (carbohydrate, glucid):

Vai tr : L cht cung cp nng lng chnh cho cc hot ng ca tt c cc t bo trong

c th, nht l cc hot ng th lc ca c bp, cc hot ng tr tu ca cc t bo no v
t bo hng cu. Ngoi ra, cht ng cn tham gia vo vi cu trc t bo v thnh phn
ca cc men hay ni tit t.

Mi gam cht bt ng cung cp 4kcalo.

Nhu cu cht bt ng: 60% nhu cu nng lng hng ngy

Cu trc v phn loi cht bt ng:

o

ng phc tp (complex carbohydrates): l loi ng c t trn 2 phn

t ng n gin, bao gm tinh bt (dng d tr glucose thc vt), glycogen
(dng d tr glucose ng vt), v cht x (non-starch polysaccharides). Cht x l
mt dng polysaccharide nhng khng tiu ha, khng hp thu vo mu, v vy
khng cung cp nng lng nn c xp vo nhm thc phm a lng khng cung
cp nng lng.
2

o
1.2.

ng n gin (simple carbohydrates) : bao gm 3 loi monosaccharide

l glucose, fructose, galactose v 3 loi disaccharides l maltose, sucrose, lactose.

Cht bo (Lipid) :
Vai tr :
o L ngun cung cp nng lng rt quan trng
o Hp thu v chuyn ho vitamin tan trong cht bo
o Nguyn liu hnh thnh t bo nht l t bo thn kinh
o Nguyn liu to hormone steroide : hormone sinh dc, thng thn...

Mi gam cht bo cung cp 9kcalo.

Nhu cu : Tr cng nh nhu cu cht bo cng cao.

o Tr nh nhi : 50% nng lng khu phn (tng ng lng cht bo trong sa
m)
o Tr la tui nh tr mu gio: 20-30% nng lng khu phn
o Ngi ln : tu th trng, trung bnh 15-25% nng lng khu phn
o Ngi cao tui : 12-15% nng lng khu phn

Cu trc v phn loi: C 3 thnh phn chnh trong cht bo

o Triglyceride : l thnh phn chnh trong m (cht bo c ngun gc ng vt) v
du (cht bo c ngun gc thc vt). Mi phn t triglyceride c cu trc bi 1
glycerol v 3 acide bo (fatty acide).
Acide bo c xem l cu trc c bn ca cht bo. C nhiu cch phn loi acide
bo
* Theo s lng cacbon trong chui : acide bo chui di (12-24 cacbon), chui
trung bnh (6-11 cacbon) v chui ngn (<6 cacbon)
* Theo s ni i trong chui : acide bo bo ha (acide bo no - khng c ni i,
ni ba) hoc khng bo ha (acide bo khng no c ni i, ni ba). Cc acid bo
khng no c t tn theo v tr ca ni i, v d omega-3 l loi acide bo c ni
i nm v tr cacbon th ba trn chui cacbon v dng ng phn omega.
o Phosphorlipid : l thnh phn chnh ca vch t bo. Hai loi phosphorlipid c
bit n nhiu nht l lecithin v cholin
o Sterol : l cc cht bo c nhn thm. Loi sterol c quan tm nhiu nht l
cholesterol.

1.3.
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Cht m (Protein) :
Vai tr :
o Cu trc t bo
o Cu thnh cc yu t min dch gip bo v c th.
o Thnh phn cc men
3

o Cung cp nng lng

-

1 gam cht m cho 4kcalo

Nhu cu cht m : 10-15% nng lng khu phn (100-150g thc n giu m mi ngy).
Nhu cu ny ch yu cho chc nng cu trc ch khng dng lm nng lng. Cht m l
ngun nng lng d v Nit trong cu trc s chuyn ha thnh NH 3 l mt cht c m
c th phi huy ng tt c cc c ch thi c gan v thn thi ra ngoi cng nhanh
cng tt.

Cc nguy c khi n cht m vt qu nhu cu :

o Cc c quan lc thi tng hot ng (gan, thn)
o Tng urea mu
o Bing n do tng acide amin trong mu
o Tng thi Canxi qua ng thn

Cu trc v phn loi cht m :

n v cu trc cn bn ca cht m l cc acide amin (aminoacide). Trong t nhin ch
c khong 22 loi acide amine nhng cc acide amine ny kt ni vi nhau theo th t v
cu trc khc nhau to nn v s cc loi protid khc nhau c trng cho tng loi. i vi
loi ngi, c 8 acid amin thit yu , l cc acide amin bt buc phi a vo c th qua
thc phm v c th khng t tng hp c l Hidstidin, Isoleucine, Leucine, Lysine,
Methionine, Phenylalanine, Threonin, Tryptophan ( tr em c thm Valine v Taurine)

2.

Nhm cht dinh dng vi lng: Khng cung cp nng lng nhng c vai tr quan trng
trong cc qu trnh chuyn ha ca c th, c nh hng n sc khe v bnh tt. l cc
vitamin v khong cht vi lng.

Vitamine , cn gi l sinh t, c chia ra lm 2 nhm chnh

-

Vitamin tan trong nc : vitamine nhm B, vitamine C

Vitamine tan trong cht bo : vitamine A, D, E, K.

Nhu cu hng ngy v vitamin rt nh, tnh bng miligam, thm ch microgam, tuy nhin
thiu hoc tha cc vitamin trong khu phn gy ra nhiu xo trn cho hot ng hng ngy
ca c th thm ch c th gy bnh.
Cht khong vi lng cng nh cc vitamine, l nhng cht c th cn vi s lng rt t
nhng ng vai tr quan trng trong qu trnh sng m cho n nay khoa hc cng cha
khm ph ht hoc cha bit ht cng dng ca chng vi s sng.
4. Nhm nht dinh dng a lng nhng khng cung cp nng lng :
3.1. Cht khong a lng
L cc cht khong nhng nhu cu hng ngy tnh bng n v gam tr ln. Cc cht ny c
vai tr khc nhau vi c th. C 7 cht khong a lng c xc nh vai tr bao gm
Canxi, Phosphor, Potassium, Sulfur, Sodium, Cloride, Magnesium
3.2. Cht x :
-

Vai tr : Gip iu ha nhu ng rut, iu ha hot ng ca h tiu ha, gim to bn,

gim s hp thu cholesterol v cc cht bo.
4

Cc dng cht x :
o Cht x tan trong nc: gum, oligosaccharide...
o Cht x khng tan trong nc: cellulose

3.3. Nc : L mt thnh phn ht sc quan trng ca ch dinh dng mc d rt hay b b

qun. Nhu cu nc hng ngy ca mt ngi trung bnh khong 1500-2000ml, c cung cp
qua nc ung, sa, cc ba n... Nhu cu ny tng ln khi hot ng nhiu, m hi nhiu,
hay khi b bnh, st, tiu chy... hoc nhng ngy thi tit nng bc nhu cu nc cng s cao
hn.
HP THU V CHUYN HO CC CHT DINH DNG TRONG C TH

1. Tiu ho v hp thu cht ng

-

Cc cht ng c trong thc n: Tinh bt, sucrose (ma), lactose (sa), fructose (tri cy) ,
maltose (mt ong)...
- Cc men tiu ho cc cht ng: Amylase trong nc bt, dch tu, lactase, maltase,
sucrase, galactase... c tit t bo nim mc rut.
- Cc men tiu ho ny phn gii cc polysaccharide thnh monosaccaride (glucose).
Fructose v galactose c hp thu ngay khng tiu ha
- Cc monosaccharide c hp thu vo mu qua thnh rut non.
- Bn trong c th, cc monosaccharide c dng :
o Sinh nng lng cho hot ng ca tt c cc t bo ca c th, c bit l t bo no, hng
cu v t bo c.
o Chuyn thnh glycogen, mt dng ng d tr tch lu trong t bo gan v c. Khi c th
thiu ng glycogen s c chuyn thnh glucose s dng.
o Chuyn thnh dng Lipid d tr trong m m
- Sn phm chuyn ho ca cht ng l CO2 v nc, c th c thi hon ton qua
ng h hp v thn.
- ng c xem l cht cung cp nng lng sch cho c th

2. Tiu ho v hp thu cht m

-

Cc men tiu ho cht m (protease) ch yu c trong dch tu v dch rut. Khi thc n
vo n d dy, pepsin c trong dch v thy phn mt phn cht m thnh cc peptide
trc khi cc protease thy phn cc peptide ny thnh acide amin.
T bo rut hp thu acide amin v mt t dipeptid. Cc acide amin ging nhau trong t
nhin nn khng to phn ng min dch, nhng cc peptid c th l khng nguyn to
phn ng min dch.
Sn phm chuyn ho cht m to nng lng ngoi CO2 v nc cn c thm NH3 do
trong thnh phn cu to cht m c Nit. NH 3 cn c thanh thi qua gan, thn di
dng ur, v vy cht m c xem l ngun nng lng d. Cc trng hp s dng
cht m qu cao trong khu phn s lm tng hot ng ca gan thn, c th thc y n
tnh trng suy thn, suy gan trn cc c a c sn vn gan, thn

3. Tiu ho v hp thu cht bo

-

Men tiu ho cht bo ch yu nm rut non, on D2 t trng, gm c mt v lipase ca

dch tu. Cc t bo thnh rut non cng tit mt t men lipase. Men lipase l men tiu ha
cht bo, cn mt ch l cht h tr.
5

Mt c t bo gan tng hp t cholesterol trong c th, d tr ti mt v vo rut

khi thc n vo n t trng. Mt cha acid mt, phosphorlipid, cholesterol. Cc acid mt
lm nhim v nh tng ho cht bo tc l to cc ht cht bo c mt u ha tan
men lipase bm ln v thy phn cht bo.
- Lipase t dch tu v t bo nim mc rut non thy phn cht bo thnh glycerol, cc
acide bo v monoggyceride. n v cht bo c hp thu ti rut bao gm glycerol,
acide bo, monoglyceride, cholesterol v phosphorlipide. Mi loi c cch hp thu khc
nhau :
Glycerol v cc acid bo chui ngn (C 2 - C5), chui trung bnh (C6 - C12) trc tip
hp thu qua t bo ri vo thng h tnh mch ca.
Monoglyceride v acide bo chui di kt hp vi mt thnh cc ht Michelle mi
hp thu vo trong t bo rut v c ti t hp thnh triglyceride. Phospholipid v
Cholesterol c hiu sut hp thu thp (20-40%) c th trc tip hp thu vo trong t
bo rut. Trong lng t bo rut non, triglycerid mi, phosphorlipid v cholesterol
c ng gi thnh cc chylomicrons vo h bch huyt.
4. Hp thu cc vitamin
- Cc loi vitamin A,D,E,K tan trong du m c hp thu theo cht bo.
-

Cc loi vitamin tan trong nc hp thu th ng theo nc

5. Bi tit v hp thu cc cht in gii

Cc cht in gii c hp thu theo nhu cu ca c th. C ch phc tp v b nh hng bi
nhiu yu t.
6. Bi tit v hp thu nc

Nc gip gi lng cho cc cht trong lng rut, to mi trng cho hot ng ca cc
men, lm thun li cho s hp thu
Lng nc hng ngy i qua rut non rt ln, trong phn ln nht l do s bi tit cc dch
tiu ho
- n ung vo
2000ml
- Nc bt
1500ml
- Dch v
2500ml
- Dch ty
1500ml
- Mt
500ml
- Dch rut
1000ml
9000ml
Rut c kh nng hp thu nc rt ln nn hu ht lng dch ny c ti hp thu dc theo rut
non, n u rut gi ch cn 1500-2000ml v thi qua phn ch khong 100ml. Bnh thng rut
non ch bi tit khong 1000ml/ngy nhng nu c kch thch ca toxin, cht kch thch... s bi
tit tng ln nhiu ln, khi b t rut c th bi tit n 30l nc/ngy. Nc c bi tit v hp
thu th ng theo s bi tit v hp thu cc cht in gii.