BACHELOR OF MEDICAL AND HEALTH SCIENCES

WITH HONOURS (BMHS)

<SEMESTER SEPTEMBER 2021>

< NBMS 1403>

<MEDICAL BIOCHEMISTRY >

NO. MATRIKULASI : 870517295649001

NO. KAD PENGNEALAN : 870517295649
NO. TELEFON : 016-6262687
E-MEL : rihaizan11@oum.edu.my
PUSAT PEMBELAJARAN : PETALING JAYA LEARNING CENTRE

Table of Contents
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1.0 Introduction.....................................................................................................................................1

2.0 Discussion of the molecular and metabolic plausibility of nutritional claims made in the medical
and lay public literature based on appraisal of scientific evidence and biochemical reasoning............2

2.2 Nutrition and clinical practice......................................................................................................3

2.3 Food standards and health claims...............................................................................................4

2.4 Evidence base..............................................................................................................................5

2.5 Dietary fat, food and lifestyle related disease.............................................................................5

3.0 Explaination of the nutritional basis for the major chronic and metabolic conditions and diseases.
...............................................................................................................................................................6

3.1 Obesity.........................................................................................................................................6

3.2 Diabetes.......................................................................................................................................7

3.3 Chronic inflammation..................................................................................................................8

5.0 Conclusion.......................................................................................................................................9

References...........................................................................................................................................10

1.0 Introduction
Bioactive components found in dietary fibre and whole grains include resistant
starches, vitamins, minerals, phytochemicals, and antioxidants. As a result, research into their
possible health advantages has gotten a lot of attention in the previous few decades. Obesity,
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type 2 diabetes, cancer, and cardiovascular disease are all linked to a lack of dietary fibre and
whole grains, according to epidemiological and clinical studies (CVD). Dietary fibre
definition is a complicated process that involves both nutritional and analytical
considerations. Nutritional physiology is the most widely used and accepted definition.
Dietary fibre, in general, refers to plant components or other carbohydrates that are resistant
to digestion and absorption in the small intestine. Dietary fibre can be divided into a variety
of fractions. Isolating these components and determining if increasing their levels in the diet
is helpful to human health has been a focus of recent research.

Nutrition science is a complicated discipline since a huge number of variables

combine to generate a desired result. Traditional linear, reductionist methods have made
significant contributions to our understanding of nutritional factors and their role in various
diseases, but their ability to examine complex reciprocal relationships between, for example,
dietary intake, activity levels, and disease manifestation is limited.

Thus, based on scientific facts and biochemical logic, this paper will evaluate the
molecular and metabolic plausibility of nutritional claims made in the medical and lay public
literature. In addition, the nutritional basis for major chronic and metabolic disorders and
diseases has been examined in recent years.
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2.0 Discussion of the molecular and metabolic plausibility of

nutritional claims made in the medical and lay public literature
based on appraisal of scientific evidence and biochemical
reasoning.

2.1 Systematic reviews

Systematic reviews of the literature (SRs) are the foundation of evidence-based

nutrition practise (Neale & Tapsell, 2019). They give a method for collecting, evaluating, and
synthesising the body of evidence on a specific research issue in a methodical manner. As a
result, they can be considered research in and of themselves. SRs differ from narrative
reviews in that they follow a predetermined methodological approach that follows a specific
design and so reduces the risk of bias (Lesser et al., 2007).

(Neale & Tapsell, 2019)

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2.2 Nutrition and clinical practice

Nutrition is regarded to be critical in the prevention, treatment, and prognosis of both
acute and chronic disorders. The field of nutritional epidemiology, which evolved from
epidemiology and other public health fields, has served as the foundation for nutrition
research for several decades and has had a significant impact on dietitian practise and dietary
counselling around the world (Johnston et al., 2019). Medicine, on the other hand, has
frequently overlooked the role of nutrition in disease prevention and management for a
variety of reasons, including a lack of adequate nutritional education, a lack of monetary
compensation for nutritional advice, and the fact that much of modern medicine is focused on
pharmaceutical and procedure-oriented care (Tapsell & Probst, 2008).

Several trials on dietary supplements for the prevention of severe cardiovascular

disease provide other examples of significantly different study results. Vitamin E
supplementation was found to prevent cardiovascular death in early observational studies.
Furthermore, a major randomized clinical trial (RCT) with 2002 participants compared
vitamin E to placebo and found that supplementing with vitamin E reduced the incidence of
cardiovascular death and nonfatal myocardial infarction by 47 percent. However, a larger
RCT with 9541 participants found no difference in myocardial infarction or death from
cardiovascular causes when vitamin E was given versus placebo, and a meta-analysis and
meta-regression with 135,967 patients who participated in 19 RCTs found that vitamin E
does not only not reduce mortality but may actually increase mortality when given in high
doses. Omega 3 supplementation has lately shown discrepant outcomes across observational
studies and meta-analysis of RCTs among people at high risk for major cardiovascular
events, similar to vitamin D for cancer and cardiovascular disease prevention (Johnston et al.,
2019).

Practitioners remain a crucial link between the evidence base and the patient,
translating scientific knowledge and tailoring guidelines to the individual, even in this age of
excess information. Clinical practise guidelines can focus on how to implement the evidence
base for patients and clients, as opposed to nutrient reference values and dietary guidelines,
which focus on how much or what consumers can do (Lesser et al., 2007). They help to build
up the evidence base for treating clinical disorders.
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2.3 Food standards and health claims

In addition to developing guidelines, the evidence base might be used to establish
regulated health claims, which give the food industry a way to communicate health
advantages connected with foods and goods. Health claims, while an effective way of
communicating product benefits, are also utilised as a marketing tool, necessitating an
evidence-based approach to assure the claims' accuracy (Milner, 2002). The European Food
Safety Authority (EFSA) oversees health claims in the European Union. In 2006, the
European Union passed legislation requiring nutrition and health claims on food labels to be
backed up by scientific data. The EFSA's job so includes examining nutrition and health
claim submissions to see if they can be justified. Similarly, the US FDA and Health Canada
assess health claims for premarket approval in the United States and Canada, respectively
(Neale & Tapsell, 2019).

2.4 Evidence base

Whether it's dietary guidelines for the general public, clinical practise guidelines for
disease management, or food standards laws governing health claims on foods, establishing
evidence for practise has become an important activity in nutrition. The necessity for human
research (ideally experimental but also good quality observational studies), realistic dosage
responses, explaining processes, and consistency in the evidence base are all prevalent
themes. Convincing, likely, and potential evidence levels are commonly stated (Biesalski et
al., 2011).

The presence of abdominal obesity, overweight and obesity, physical inactivity, and
maternal diabetes were found to increase the risk of obesity, type 2 diabetes mellitus, and
cardiovascular disease, as were dietary saturated (myristic and palmitic) and trans fatty acids,
dietary sodium, high alcohol intakes, and the presence of overweight and obesity. High
intakes of non-starch polysaccharides, fruits and vegetables, as well as frequent physical
activity, were found to reduce the risk of becoming obese (Biesalski et al., 2011). Similarly,
voluntary weight loss and regular physical activity were linked to a lower risk of type 2
diabetes mellitus, while intakes of linoleic acid and fish oils (as well as fish itself) and
potassium, fruits and vegetables, as well as low to moderate alcohol consumption and regular
physical activity were linked to a lower risk of cardiovascular disease (Tapsell & Probst,
2008).
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2.5 Dietary fat, food and lifestyle related disease

Dietary fat has been one of the most widely researched aspects of nutrition in relation
to the development of diet-related disease. Extensive mechanistic studies have revealed the
relatively favourable effects of unsaturated fatty acids on insulin action compared to saturated
fatty acids. Observational and experimental studies in people have backed up the benefits of
modifying dietary fatty acids (Yan, 2015). However, nutritional advice must be delivered in
terms of foods rather than nutrients in order to be easily followed. The anti-oxidants given
concurrently with the walnuts and the prescribed 5 servings of vegetables and fruits per day
boosted total anti-oxidant status considerably during the intervention. First, inflammation
may possibly become a new target for nutrition strategies in the prevention of chronic
disease, and there have been favourable linked results with dietary methods. Second, while
the delivery of unsaturated fats was the primary focus of each investigation, the nutritional or
bioactive package that the whole food offered was also recognised (Rao, 2018). To put this
knowledge into reality, strategies are needed to distinguish between foods based on
characteristics like nutrient density. To adequately explain effects and cover all known bases
in disease prevention, the experimental assessment of these elements drives us back to whole
foods, and then to whole diets, just as the evidence base for risk linking diet with disease has
identified certain elements that need to be considered together (Bueney, 1958).
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3.0 Explaination of the nutritional basis for the major chronic and
metabolic conditions and diseases.

3.1 Obesity
Approximately 66 percent of adults in the United States are overweight or obese,
increasing their risk of health problems such as diabetes, cardiovascular disease, and some
types of cancer. Obesity is caused by an increase in the energy absorption:energy expenditure
ratio, which can be caused by a variety of circumstances (Bergman & Brighenti, 2020). As a
result, when it comes to managing obesity, reducing energy absorption is crucial. Scientists
have gone a step further and investigated the impact of additional dietary factors, such as
dietary fibre, on weight regulation. By diluting a diet's energy availability while retaining
other vital nutrients, increasing dietary fibre consumption may reduce energy absorption
(Tucker, 2020).

The influence of dietary fibre on body weight has been studied extensively, with the
majority of studies showing an inverse association between dietary fibre consumption and
body weight change. In a survey of 252 middle-aged women, Tucker and Thomas backed up
their claim. They discovered that by increasing dietary fibre by 8 grammes per 1000 calories,
individuals shed an average of 4.4 pounds over a 20-month period. The primary cause of this
weight loss was a reduction in body fat. Many other potential confounders, such as age,
baseline fibre and fat intakes, exercise level, and baseline energy consumption, had no effect
on the association between dietary fibre and weight change (Tucker, 2020).

3.2 Diabetes
Over the last few years, the number of people diagnosed with type 2 diabetes has risen
dramatically (Bueney, 1958). Obesity, lack of physical activity, and smoking are all risk
factors for the condition, but dietary choices appear to play a substantial impact as well.
Reduced insulin sensitivity and hyperglycemia cause type 2 diabetes. As a result,
carbohydrate intake is a main dietary element to be concerned about (Carmel & Johnson,
2017).

The carbs in totsl had no effect on diabetes risk. The type of carbohydrate
(nonstructural carbs and dietary fibre) was, nevertheless, a major factor. As a result, knowing
 8

a food's glycemic index or load is critical. In relation to a reference group such as glucose or
white bread, the glycemic index assesses total carbohydrate intake based on their immediate
postprandial glucose reaction. Low-glycemic-index carbohydrates cause a reduced
glucose/insulin response. Simple small chain carbohydrates are thought to have a higher
glycemic index because they cause greater blood glucose levels (Tapsell & Probst, 2008).

A diet high in saturated fat, low dietary fibre, and high non-structural carbohydrates
was characterised as poor. This diet would have a high glycemic load since it is high in easily
digestible and quickly absorbable carbs. A supporting, long-term (eight-year) study of over
90,000 female nurses discovered a link between glycemic index and type 2 diabetes risk
(Bennett et al., 2017).

The soluble versus insoluble portion of fibre, according to current study, may provide
some insight into the efficacy of dietary fibre on diabetes and its processes. Soluble fibre
delayed stomach emptying and lowered macronutrient absorption, resulting in lower
postprandial blood glucose and insulin levels, according to early study (Barber et al., 2020).
The viscosity of soluble fibres inside the GI tract is most likely to blame. Distinct forms of
soluble fibre had different effects on viscosity and nutrient absorption, which was surprising.
However, several recent studies have found no link between soluble fibre and a lower risk of
diabetes (Lattimer & Haub, 2010).

In addition, vitamin E is also a powerful antioxidant that helps to reduce oxidative

damage and insulin resistance. A study in New Zealand found that participants who took
vitamin E had lower plasma peroxides, blood glucose, and increased insulin sensitivity than
those who took a placebo, suggesting that vitamin E may help to prevent the onset of diabetes
(Tucker, 2020).

3.3 Chronic inflammation

Low dietary fibre intake has been proposed as a risk factor for both local and systemic
chronic inflammation. Limited dietary fibre consumption, according to current thinking,
stymies the creation and maintenance of a healthy, viable, and diversified colonic microbiota
(Carmel & Johnson, 2017). Inflammatory processes are influenced both locally (including
gut-wall leakiness and colonic inflammation in patients with inflammatory bowel disease)
and systemically by signalling pathways involving nuclear factor kappa-B (NF-kB) and
deacetylase inhibition, and both are likely influenced by levels of butyrate within the colon.
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Butyrate may also help to reduce oxidative stress in the colon by affecting gene expression
linked to glutathione and uric acid metabolism (Rao, 2018).

Given the above-mentioned effects of dietary fibre on colonic microbiota diversity

and short-chain fatty acids production, as well as the known role of butyrate in the mediation
of inflammatory pathways, it is entirely plausible, if not probable, that dietary fibre has some
impact on inflammatory status both within the colon and systemically (Barber et al., 2020).
Future research should concentrate on the mechanisms implicated.

3.4 Cardiovascular Disease

Given the link between dietary fibre and improved insulin sensitivity, body
composition, appetite regulation, and the richness and viability of the gut bacteria, it's vital to
see if these effects are also shown in total cardiovascular disease rates (CVD) (Tapsell &
Probst, 2008). Threapleton and colleagues performed a systematic review and meta-analysis
of the available literature on this topic, which included 22 prospective cohort studies with a
minimum follow-up length of 3 years, reporting on relationships between dietary fibre
consumption and coronary heart disease or CVD (Rao, 2018).

Data from a more recent study demonstrate a relationship between consumption of

ultra-processed meals (with usual dietary fibre depletion) and higher CVD risk, which is
consistent with dietary fiber's positive influence on total CVD risk. Finally, Kim et al.
published a meta-analysis of 15 prospective cohort studies that looked at the link between
dietary fibre consumption and CVD and cancer mortality. Increased dietary fibre
consumption was also linked to a decreased risk of death from coronary heart disease and all
malignancies. A dose–response meta-analysis also found that increasing dietary fibre
consumption by 10 grammes per day reduced CVD mortality by 9% (Jameson & Morris,
2011).

Vitamin E is a powerful antioxidant that may lower the risk of heart disease by
protecting against the oxidation of LDL cholesterol, which contributes to heart disease by
releasing inflammatory cytokines and increasing endothelial adhesion, resulting in
atherosclerosis (Rao, 2018).
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5.0 Conclusion

The nutrition evidence base is a constantly growing and evolving field, functioning in
a world where knowledge is more freely available than ever before. Although this makes it
easier for customers to obtain information, the quality of that information is frequently
compromised. Although the key confounders (e.g., age, sex, smoking, and physical activity)
have been adjusted for many of these dietary relative hazards, residual confounding cannot be
ruled out.

Dietary components are described as hazards in terms of their share of the diet, not as
absolute amounts of exposure, as a result of this energy adjustment. To keep total energy
intake constant, an increase in the consumption of foods and macronutrients should be offset
by a decrease in the intake of other dietary components. As a result, the relative risk of a diet
alteration is dependent on the other components for which it is substituted.

In conclusion, we discovered that poor eating habits are linked to a variety of chronic
diseases and may be a major contribution to NCD mortality in all nations. This conclusion
emphasises the critical importance of coordinating global efforts to improve human diet
quality. Given the complexities of dietary behaviours and the wide range of influences on
diet, improving diet necessitates active collaboration across a variety of actors across the food
system, as well as policies that target several food system sectors.

All recognised metabolic illnesses have reached epidemic proportions worldwide,

including hypertension, obesity, endothelial dysfunction, subclinical atherosclerosis,
metabolic syndrome, and type-2 diabetes. We will cover some of the known metabolic
abnormalities that increase the chance of developing metabolic disorders and give our
perspectives on the subject in this overview.
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