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1 Energy content of food

 Protein = 4 kcal/g
 Fats = 9 kcal/g
 Carbohydrate = 4 kcal/g

2 Basal metabolic rate, BMR

 Energy needed for work of vitak function in a resting individual
 Factors ; age, sex, body composition, diet, hormone, body size

3 Contribution of macronutrient energy

 Protein = 15%
 Fats = 33%
 Carbohydrate = 52%

4 Trans fatty acid

 Fatty acid that comes from ruminant animal/ catalytic hydrogenation of vegetables oil
 ↑ concumption will result in↑ blood cholesterol,
 ↑ LDL ↓ HDL ↑ lip (a) acts like LDL

5 Role of fibre
 Diabetes mellitus water soluble fiber, ↓glucose absorption rate, ↓plasma glucose
 Constipation ↑ stool bulk, soften the feces

6 Define protein requirement

 Amount of protein needed for normal growth

7 Kwashiorkor with edema

 Inadequate protein diet
 Carbohydrate presence, insulin ↑, free amino acid ↓
 Albumin (plasma protein) ↓
 ↓ capillary oncotic pressure, more water move out from capillary into interstitial space
 Edema occur

8 Marasmus
 ↓ dietary protein and carbohydrate
 Protein in muscle degrade to form amino acid for gluconeogenesis
 Glucose form used to generate energy

9 Nitrogen balance after major surgery and rehabilitation

 -ve nitrogen balance; need protein intake
 Tissue protein is degrade to release free amino acid for gluconeogenesis
 ↑ *glucose+ gradient to force glucose from plasma into damaged tissue, anaerobic glycolysis
to generate energy
 Glucagon; ↑ gluconeogenesis
 Cortisol; ↑proteolysis

 Rehabilitation; +ve nitrogen balance
 Protein is used for repair and maintenance of tissue

10 Food pyramid
 Ensure healthy food intake ↓saturated fats
↓complex carbohydrate, ↑ simple carbohydrate
 Function; outline the type and quantity of food to consume each day together with physical
 Should take less saturated fats, cholesterol, salts and added sugar

11 Thiamine, vitamin B1
 Active form; thiamine pyrophosphate (TPP)
 Coenzyme for oxidative decarboxylation (TCA cycle), transketolase (PPP)
 Ion translocation in stimulated neural tissue, involve in synthesis of Ach, nt.
 Deficiency
o Deficiency cause defect in impulse transmission
o Wernicke-Korsakoff Syndrome; mental confusion and ataxia
o Beri-beri; muscle weakness, vomiting

12 Niacin, vitamin B3
 Active form; NAD⁺/NADP⁺
 Oxidation-reduction enzyme
 Deficiency
o Pellagra; dementia (nerve tissue degeneration), dermatitis, diarrhea

13 Pyridoxine, vitamin B6
 Active form; pyridoxal phosphate
 Synthesis of haem, cofactor in aminolevulinic (ALA) synthesis
 Synthesis of neurotransmitter, sphingolipid
 Deficiency
o ↓ Hb, ↓ erythrocyte, pale, sideroblastic anemia
o Neurological symptom, affect the myelin formation, affect the impulse transmission

14 Folic acid
 Active form; tetrahydrofolate
 Amino acid metabolism,
 Purine, pyrimidine synthesis
 Formation of neural tube in fetal life
 Deficiency
o Patient on methotrexate, inhibit DHFR (H2F → H4F)
o Pregnant women, causing neural tube defects
o Immature RBC, megaloblastic anemia

15 Cobalamin, vitamin B12
 Coenzyme for methionin synthase (homocysteine → methionine)
 Coenzyme for methylmalonyl CoA mutase ( methylmalonyl CoA → succinyl CoA)
 Deficiency
o Pernicious anemia (megaloblastic anemia with neuorological problem)
o ↓ B 12, methionine synthesis inhibited, 5- Methyl TH4 Folate ↑, TH4 Folate ↓, folate
deficiency, megalobalstic anemia
o ↓ B 12, methylmalonyl CoA ↑, form branch fatty acid, abnormal myelin sheath is
formed, impaired neurological function
o Cause; ↓ IF,↓ HCl, malabsorption (elderly) due to atrophic gastritis (relate with ↓
IF,↓ HCl)

16 Ascorbic acid, vitamin C

 Collagen synthesis; coenzyme for hydroxylation of proline and lysine
 Iron absorption; reduce Fe3+ → Fe 2+
 Deficiency
o Collagen synthesis ↓, collagen in skin ↓, tensile strength ↓, petechiae
o Collagen synthesis ↓, important component in Ct, teeth, gum, and capillary, loosen
teeth, bleeding gum, scurvy

17 Vitamin A
 11-cis-retinol, involve in visual cycle, one component of rhodopsin
↓ Vitamin A, ↓ 11-cis-retinal, ↓ rhodopsin, ↑ threshold of sight, night blindness
 Retinol/ retinoic acid, maintenance of epithelial cell
↓ Vitamin A, ↓ retinol/ retinoic acid, synthesis high molecular weight of keratin, follicular
 Retinyl phosphate, synthesis of glycoprotein & mucopolysaccharide
↓ Vitamin A, ↓ retinyl phosphate, ↓ mucus secretion, excessive dryness, keratinisation &
dryness of mucosal lining, fissures, prone to infection
 Xerophthalmia; ↓ vitamin A, ↓ retinol/ retinoic acid, keratinisation, inhibit secretion of
tears, ↓retinyl phosphate, dryness and infection, blindness

18 Vitamin D
 Metabolism pathway

 Vitamin D for Ca2+ absorption in GIT by stimulate calbindin synthesis
 ↓ Vitamin D, ↓ Ca2+ absorption at GIT,↓ Ca2+ in plasma, ↑PTH, ↑ bone resorption, ↓
bone mass, osteomalacia
 ↓ Vitamin D, ↓ Ca2+ absorption at GIT,↓ Ca2+ in plasma, incomplete mineralization, rickets
 Hypervitaminosis D; vitamin D is less soluble, might be precipitate if and deposited
 Hypercalcemia; ↑ vitamin D, ↑ Ca2+ absorption at GIT, ↑ Ca2+ reabsorption at kidney, ↑
resorption ,↑ Ca2+ plasma, Ca2+ deposited at the interstitial tissue of heart, kidney, lungs
and gastric mucosa
 Ca2+ supplement; ↑Ca2+ plasma, inhibit PTH & calcitriol, ↑ calcitonin, ↑ bone
mineralization,↓ bone resorption, ↑bone mass

19 Vitamin E
 As antioxidant, scavenger for molecular O2 and free radicals, prevent oxidation of LDL,
prevent myocardial infarction, ↓ coronary heart disease
 Deficiency
o Premature infant; haemolytic anemia – RBC sensitive to free radicals, haemolysis
o Congenital abetalipoproteinamea; cannot synthesis lipoprotein

20 Vitamin K
 Formation of blood clotting factor; carboxylation of 𝛾-carboxyglutamate
 ↓ vitamin K, prolonged prothrombin time, haemorrhagic disease
 Newborn infants, low plasma prothrombin and vitamin K, placenta barrier limits vitamin K
uptake, prone to haemorrhagic disease

21 Calcium
 Refer to 18

22 Iron
 Haem iron in animal sources in reduced form Fe2+ compare to plant sources Fe3+
 Metabolism pathway

 Fe3+ → Fe2+ by vitamin C
 Enter to cell and oxidized back to Fe3+, bind to apoferritin to form ferritin
 Bind to transferrin transported to liver, spleen, bone marrow
 Stored as ferritin and homosiderin at liver

23 Iodine
 Lack of iodine in drinking water, seafood
 Consumption of tapioca flour, contain thiocyanate, interfere uptake of iodine by thyroid
gland (east Malaysia)

24 Zinc
 Carbohydrate metabolism
 Deficiency
o Children; growth inhibition, impaired sexual development
o Adult; poor wound healing, dermatitis

25 Obesity
 BMI calculation = [W]/ h2
 Hyperinsulinemia → insulin resisitance → Tpe 2 DM (sometimes) → hyperglycemia
→ ↑ sympathetic → Na+, H2O retention → hypertension → CVD risk
 Hypercholestrolaemia → ↑LDL↓HDL → CVD risk