1

MEENAKSHI SUNDARARAJAN ENGINEERING COLLEGE,

KODAMBAKKAM,CHENNAI-24.

FUNDAMENTALS OF NUTRITION
OBT553
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COURSE NAME : FUNDAMENTALS OF NUTRITION

COURSE CODE : OBT553

SEMESTER : V

Course Objective:

 The course aims to develop the knowledge of students in the basic area of
Food Chemistry.

 This is necessary for effective understanding of food processing and

technology subjects.

 This course will enable students to appreciate the similarities and

complexities of the chemical components in foods.
UNIT I

OVERVIEW OF NUTRITION

Definition, six classes of nutrients, calculating energy values from food, using
the RDA, nutritional status, nutritional requirement, malnutrition, nutritional
assessment of individuals and populations, dietary recommendations, Balanced
diet planning: Diet planning principles, dietary guidelines; food groups,
exchange lists, personal diet analysis;

UNIT II

DIGESTION

Digestion, Absorption and Transport: Anatomy and physiology of the digestive

tract, mechanical and chemical digestion, absorption of nutrients.

UNIT III

CARBOHYDRATES
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Glycemic and Non-glycemic carbohydrates, blood glucose regulation,

recommendations of sugar intake for health, health effects of fiber and starch
intake, Artificial sweeteners; Importance of blood sugar regulation, Dietary
recommendations for NIDDM and IDDM

UNIT IV

PROTEINS & LIPIDS

Proteins; Food enzymes; Texturized proteins; Food sources, functional role and
uses in foods. Review of structure, composition & nomenclature of fats. Non-
glyceride components in fats & oils; Fat replacements; Food sources, functional
role and uses in foods. Health effects and recommended intakes of lipids.
Recommended intakes of proteins, Deficiency- short term and long-term effects.

UNIT V

METABOLISM, ENERGY BALANCE AND BODY COMPOSITION

Energy Balance; body weight and body composition; health implications;

obesity, BMR and BMI calculations; Weight Control: Fat cell development;
hunger, satiety and satiation; dangers of unsafe weight loss schemes; treatment
of obesity; attitudes and behaviours toward weight control. Food and
Pharmaceutical grades; toxicities, deficiencies, factors affecting bioavailability,
Stability under food processing conditions.

TEXT BOOKS:

1. Chopra, H.K. and P.S. Panesar. “Food Chemistry”. Narosa, 2010.

2. Vaclavik, V. A. and Christian E. W. “Essentials of Food Science”. II Edition,

KluwerAcademic, Springer, 2003.

3. Mann, Jim and Stewart Truswell “Essentials of Human Nutrition”. 3rd

Edition. Oxford University Press, 2007.

4. Gibney, Michael J., et al., “Introduction to Human Nutrition”. 2nd Edition.

Blackwell,2009.
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5. Gropper, Sareen S. and Jack L.Smith “Advanced Nutrition and Human

Metabolism”. 5th Edition. Wadsworth Publishing, 2008

REFERENCES:

1. Gopalan C., B.V. Rama Sastri, and S.C. Balasubramanian S. C. “Nutritive

Value of Indian Foods”. NIN, ICMR, 2004.

2. Damodaran, S., K.L. Parkin and O.R. Fennema. “Fennema‟s Food

Chemistry”. 4th Edition, CRC Press, 2008

3. Belitz,H.-D, Grosch W and Schieberle P. “Food Chemistry”, 3rd Rev.

Edition, SpringerVerlag, 2004.

4. Walstra, P. “Physical Chemistry of Foods”. Marcel Dekker Inc. 2003.

5. Owusu-Apenten, Richard. “Introduction to Food Chemistry”. CRC Press,

2005

S.NO UNIT TOPIC PAGE.NO

1. I OVERVIEW OF NUTRITION 5-31

2. II DIGESTION 32-57

3. III CARBOHYDRATES 58-70

4. IV PROTEINS & LIPIDS 71-111

5. V METABOLISM, ENERGY 112-142

BALANCE AND BODY
COMPOSITION
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UNIT I

OVERVIEW OF NUTRITION

Definition, six classes of nutrients, calculating energy values from food, using
the RDA, nutritional status, nutritional requirement, malnutrition, nutritional
assessment of individuals and populations, dietary recommendations, Balanced
diet planning: Diet planning principles, dietary guidelines; food groups,
exchange lists, personal diet analysis;

NUTRITION

Nutrition is the biochemical and physiological process by which

an organism uses food to support its life. Nutrition is the study of nutrients in
food, how the body uses them, and the relationship between diet, health, and
disease.

Nutrition also focuses on how people can use dietary choices to reduce the risk
of disease, what happens if a person has too much or too little of a nutrient, and
how allergies work.

Nutrition involves various chemical reaction and physiological process which

transform food into body tissues and activities. It involves the ingestion,
digestion and absorption of the various nutrients their transport to all body cells
and the removal of unusable elements and waste products of metabolism.

Nutrition is a series of processes by which an organism takes in and assimilates

food for promoting growth and repairing worn injured tissues.Nutrition can be
defined as the branch of science which deals with nutrients.
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Nutrition in points:

 Series of physiochemical Process

 Convert food into body tissue and activities
 Used for maintenance and production

NUTRITIONIST

A nutritionist is a person who advises others on matters of food

and nutrition and their impacts on health. Some people specialize in particular
areas, such as sports nutrition, public health, or animal nutrition, among other
disciplines.

A nutritionist a person self-titled as a nutritionist is not legally defined, whereas

a dietitian is professionally certified and registered.

Nutritionists use ideas from molecular biology, biochemistry, and genetics to

understand how nutrients affect the human body.

NUTRIENTS
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Nutrients are compounds in foods essential to life and health, providing us with
energy, the building blocks for repair and growth and substances necessary to
regulate chemical processes.

Nutrients are those substances which nourishes the body. The term nutrients
mean any single class of food or group of food that aid in the support of life.
Nutrient is a substance that promotes the maintenance, growth and reproduction
of a cell or an organisms.

If people do not have the right balance of nutrients in their diet, their risk of
developing certain health conditions increases.

SIX CLASSES OF NUTRIENTS

There are 6 essential nutrients that the body needs to function properly.
There are six major nutrients:

 Carbohydrates (CHO)
 Lipids (fats)
 Proteins
 Vitamins
 Minerals
 Water

Carbohydrates: pasta, rice, cereals, breads, potatoes, milk, fruit, sugar

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Lipids (most commonly called fats): oils, butter, margarine, nuts, seeds,
avocados and olives, meat and seafood

Proteins: meat, dairy, legumes, nuts, seafood and eggs

Vitamins: common vitamins include the water soluble B group vitamins and
vitamin C and the fat soluble vitamins A, D, E and K

 Fruits and vegetables are generally good sources of Vitamin C and A and
folic acid (a B group vitamin)
 Grains and cereals are generally good sources of the B group vitamins
and fibre
 Full-fat dairy and egg yolks are generally sources of the fat soluble
vitamins A, D and E
 Milk and vegetable or soya bean oil are generally good sources of vitamin
K, which can also be synthesised by gut bacteria

Minerals: (sodium, calcium, iron, iodine, magnesium, etc.): all foods contain
some form of minerals.

 Milk and dairy products are a good source of calcium and magnesium
 Red meat is a good source of iron and zinc
 Seafood and vegetables (depending on the soil in which they are
produced) are generally good sources of iodine

Water: As a beverage and a component of many foods, especially vegetables

and fruits.
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CLASSIFICATION OF NUTRIENTS

1. According to physical, chemical and biological properties

2. According to Dry matter (DM)
3. According to physical properties
4. According to amount required
5. According to Energy giving properties
6. According to Digestibility of Nutrients

1.According to physical, chemical and biological properties

 Water.
 Carbohydrate,
 Protein,
 Fat,
 Minerals or Inorganic elements and
 Vitamin

2.According to Dry matter (DM)

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 Dry matter
 Carbohydrate,
 Protein,
 Fat
 Vitamin
 Minerals.
 Moisture-
 Water

3.According to physical properties

 Organic nutrients or Matter (OM) – Organic matter or organic material,

natural organic matter, NOM is matter composed of organic compounds
that has come from the remains of organisms such as plants and animals
and their waste products in the environment.
 Carbohydrate,
 Protein,
 Fat
 Vitamin
 Inorganic elements or minerals

4.According to amount required

 Macro nutrient
i.e. Carbohydrate, Protein , fat and water
 Micronutrients
i.e. vitamin and minerals

5.According to Energy giving properties

Energy giving nutrients –

 carbohydrate,
 Protein and
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 Fat.
Non energy giving nutrients –

 water,
 vitamin and
 minerals

6.According to Digestibility of Nutrients

Digestible nutrients

 Carbohydrate,
 protein and
 fat
Non digestible nutrients or directly absorbable nutrients:

 water,
 vitamin and
 minerals

ENERGY :

Food that we eat gives us energy to go through our day. It gives us energy by
providing energy to the cells inside our body. Carbohydrates in food are used
first. When they are all used up, the body then uses fats, and then proteins as
energy sources. So carbohydrates, fats and proteins provide energy to our
bodies through the foods that we eat.

The energy in the food that we it is measured in units of kilocalories or

Calories. The Calorie (Cal, with an uppercase C) used to measure the nutrition
in food is actually 1000 calories (cal) (with a lowercase c) or 1 kilocalorie
(kcal). While the Calorie unit is used widely in the U.S., the kilojoule (kJ) is in
widespread use internationally.

The conversion factors for calories, kilocalories, joules, kilojoules, and Calories
are as follows:

Energy Values used in Nutrition

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1000cal = 1 kcal = 1 Cal

4184 J = 4.184 kJ = 1 Cal

HOW TO CALCULATE ENERGY FROM FOOD

The energy content of a food is a measure of how many calories the food
contains. Your body needs a certain number of calories each day -- the required
amount varies with your age, gender, weight status and activity level -- to
maintain itself. Eating fewer than the required calories each day will result in
weight loss, while eating more calories than your body requires on a regular
basis will result in weight gain. Most foods have information about energy
content printed on the label. However, for foods that don't, as long as you have
access to information about the masses of different nutrients in the food, you
can calculate energy content.

The energy content of a food is a measure of how many calories the food
contains. Your body needs a certain number of calories each day -- the required
amount varies with your age, gender, weight status and activity level -- to
maintain itself. Eating fewer than the required calories each day will result in
weight loss, while eating more calories than your body requires on a regular
basis will result in weight gain. Most foods have information about energy
content printed on the label. However, for foods that don't, as long as you have
access to information about the masses of different nutrients in the food, you
can calculate energy content.

CALCULATING ENERGY

Step 1

Multiply grams of carbohydrate in the food by 4 calories per gram. A calorie is

a unit of how much energy is in a given amount of food, also called a kcal.
Regardless of whether the carbohydrate in food is sugar or starch, all
carbohydrates provide the body with 4 calories/gram, explains Dr. Lauralee
Sherwood in her book "Human Physiology." Be sure not to include grams of
fiber in your calculation -- despite the fact fiber is technically a carbohydrate,
humans can't digest it, so it contains no energy.
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Step 2

Multiply grams of protein in the food by 4 calories per gram. It does not matter
what kind of protein a food contains; all proteins provide the same energy per
unit mass, because they're all composed of the same basic building blocks,
explain Drs. Reginald Garrett and Charles Grisham in their book
"Biochemistry."

Step 3

Multiply grams of fat in the food by 9 calories per gram. Different kinds of fat
vary slightly in their energy content -- some contain more than 9 calories/gram
while others contain less. Regardless, the human diet tends to consist of a
mixture of fats that average out to around 9 calories/gram, meaning that this
relatively accurately assesses the energy content of a food due to fat.

Step 4

Add the energy from carbohydrate, protein and fat. The total, in calories, is the
energy content of the food. This is the same information available on a
nutritional label, for those foods that provide nutritional information.

Tip

Be sure you don't include water weight in your calculations. For instance, a 100-
gram slice of lean ham may contain nearly all its calories from protein, but not
all 100 grams of the ham are protein -- most are water.

Warning

In order to do these calculations, you have to know the masses of carbohydrate,

protein and fat in a food.
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Median Heights and Weights and Recommended Energy Intake

Average Energy Allowance (kcal) b

Weight Height

Categor Age (kg (lb (cm (in REE a (kcal/day Multiple Pe Per
y (years) or ) ) ) ) ) s of REE r day c
Conditio kg
n

Infants 0.0–0.5 6 13 60 24 320 10 650

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0.5–1.0 9 20 71 28 500 98 850

Children 1–3 13 29 90 35 740 10 1,30

2 0

4–6 20 44 112 44 950 90 1,80

0

7–10 28 62 132 52 1,130 70 2,00

0

Males 11–14 45 99 157 62 1,440 1.70 55 2,50

0

15–18 66 14 176 69 1,760 1.67 45 3,00

5 0
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Average Energy Allowance (kcal) b

Weight Height

Categor Age (kg (lb (cm (in REE a (kcal/day Multiple Pe Per
y (years) or ) ) ) ) ) s of REE r day c
Conditio kg
n

19–24 72 16 177 70 1,780 1.67 40 2,90

0 0

25–50 79 17 176 70 1,800 1.60 37 2,90

4 0

51+ 77 17 173 68 1,530 1.50 30 2,30

0 0

Females 11–14 46 10 157 62 1,310 1.67 47 2,20

1 0

15–18 55 12 163 64 1,370 1.60 40 2,20

0 0

19–24 58 12 164 65 1,350 1.60 38 2,20

8 0

25–50 63 13 163 64 1,380 1.55 36 2,20

8 0
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Average Energy Allowance (kcal) b

Weight Height

Categor Age (kg (lb (cm (in REE a (kcal/day Multiple Pe Per
y (years) or ) ) ) ) ) s of REE r day c
Conditio kg
n

51+ 65 14 160 63 1,280 1.50 30 1,90

3 0

Pregnant 1st trimester +0

2nd trimester +300

3rd trimester +300

Lactating 1st 6 months +500

2nd 6 months +500

COMPARISON OF RDA AND REPORTED INTAKES

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Energy intakes of children as reported in both the 1977–1978 Nationwide Food

Consumption Survey (USDA, 1984) and the 1976– 1980 second National
Health and Nutrition Examination Survey (NCHS, 1979) coincide with the
allowances proposed for these age groups. From early adolescence onward in
women and in men a few years later, reported average intakes are substantially
below the RDA. Data from the 1986 Continuing Survey of Food Intakes by
Individuals (USDA, 1988) indicate that mothers consume an average of 1,473
kcal/day, the same amount of energy as their children ages 1 to 5 years. It is
commonly believed that adults underestimate food intake and that alcohol
consumption in particular is underreported (NRC, 1986). If the underreported
items are seasonings or adjuvants with low levels of essential nutrients (e.g., fats
and oils, sweeteners) or alcoholic beverages, only energy intake will be affected
seriously.

METABOLIC RESPONSE TO FOOD

Metabolic rate increases after eating, reflecting the size and composition of the
meal. It reaches a maximum approximately 1 hour after the meal is consumed
and virtually disappears 4 hours afterward (Garrow, 1978). In relation to total
energy expenditure, the thermic effect of meals is relatively small—on the order
of 5 to 10% of energy ingested. Small differences in this component of energy
expenditure could have significant cumulative long-term effects, but are
generally undetectable, being lost in the day-to-day variation in energy
metabolism.

NUTRITIONAL STATUS
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The definition of nutritional status is: the condition of the body as a result of the
intake, absorption and use of nutrition, as well as the influence of disease-
related factors.

NUTRITION REQUIREMENT

The amount of each nutrient needed is called the nutritional requirement. These
are different for each nutrient and also vary between individuals and life stages,
e.g. women of childbearing age need more iron than men.

MALNUTRITION
Malnutrition can be caused by over nutrition (excess energy or nutrient in-take)
or undernutrition (deficient energy or nutrient intake). We usually think of
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malnutrition as a condition that results when the cells do not receive an adequate
supply of the essential nutrients because of poor diet or poor utilization of food
(Figure 1-2).

Sometimes it occurs because people do not or cannot eat enough of the foods
that provide the essential nutrients to satisfy body needs. At other times people
may eat well-balanced diets but suffer from dis-eases that prevent normal usage
of the nutrients.
Over nutrition has become a larger problem in the United States than
undernutrition. Overeating and the ingestion of mega doses of various vitamins
and minerals (without prescription) are two major causes of over nutrition in the
United States.

NUTRITIONAL DIFICIENCY
A nutrient deficiency occurs when a person lacks one or more nutrients over a
period of time. Nutrient deficiencies are classified as primary or secondary.
Primary deficiencies are caused by inadequate dietary intake. Secondary
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deficiencies are caused by something other than diet, such as a disease condition
that may cause malabsorption, accelerated excretion, or destruction of the
nutrients. Nutrient deficiencies can result in malnutrition.

NUTRITION ASSESSMENT
A Nutritional Assessment can be defined as a structured way to establish
the nutritional status and energy requirements by objective measurements
and whereby, accompanied by objective parameters and in relation to
specific disease indications, an adequate (nutritional) treatment can be
developed for the patient. All this happens preferably in a multidisciplinary
setting.
That old saying, “You are what you eat,” is true, indeed; but one could change it
a bit to read, “You are and will be what you eat.” Good nutrition is essential for
the attainment and maintenance of good health. Determining whether a person is
at risk requires completion of a nutrition assessment, which should, in fact,
become part of a routine exam done by a registered dietitian or other health care
professional specifically trained in the diagnosis of at-risk individuals. A proper
nutrition assessment includes anthropometric measurements, clinical
examination, biochemical tests, and dietary-social history.
Anthropometric measurements include height and weight and measurements of
the head (for children), upper arm, and skinfold (Figure 1-3). The skinfold
measurements are done with a calliper. They are used to determine the
percentage of adipose and muscle tissue in the body. Measurements out of line
with expectations may reveal failure to thrive in children, wasting (catabolism),
enema, or obesity, all of which reflect nutrient deficiencies or excesses.
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During the clinical examination, signs of nutrient deficiencies are noted. Some
nutrient deficiency diseases, such as scurvy, rickets, iron deficiency,
and kwashiorkor, are obvious; other forms of nutrient deficiency can be far
more subtle. Table 1-4 lists some clinical signs and probable causes of nutrient
deficiencies.
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Biochemical tests include various blood, urine, and stool tests. A deficiency or
toxicity can be determined by laboratory analysis of the samples. The tests allow
detection of malnutrition before signs appear. The following are some of the
most commonly used tests for nutritional evaluation.
 Serum albumin level measures the main protein in the blood and is used
to determine protein status.
 Serum transferrin level indicates iron-carrying protein in the blood. The
level will be above normal if iron stores are low and below normal if the
body lacks protein.
 Blood urea nitrogen (BUN) may indicate renal failure, insufficient renal
blood supply, or blockage of the urinary tract.
 Creatinine excretion indicates the amount of creatinine excreted in the
urine over a 24-hour period and can be used in estimating body muscle
mass. If the muscle mass has been depleted, as in malnutrition, the level
will be low.
 Serum creatinine indicates the amount of creatinine in the blood and is
used for evaluating renal function.
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Examples of other blood tests are haemoglobin (Hgb), haematocrit (Hct), red
blood cells (RBCs), and white blood cells (WBCs). A low Hgb and Hct can
indicate anaemia. Not a routine test, but ordered on many clients with heart
conditions, is the lipid profile, which includes total serum cholesterol, high-
density lipoprotein (HDL), low-density lipoprotein (LDL), and serum
triglycerides. Urinalysis also can detect protein and sugar in the urine, which
can indicate kidney disease and diabetes.
The dietary-social history involves evaluation of food habits and is very
important in the nutritional assessment of any client. It can be difficult to obtain
an accurate dietary assessment. The most common method is the 24-hour
recall. In this method, the client is usually interviewed by the dietitian and is
asked to give the types of, amounts of, and preparation used for all food eaten in
the 24 hours prior to admission (PTA). Another method is the food diary. The
client is asked to list all food eaten in a 3–4-day period. Neither method is
totally accurate because clients forget or are not always totally truthful. They are
sometimes inclined to say they have eaten certain foods because they know they
should have done so. Computer analysis of the diet is the best way to determine
if nutrient intake is appropriate. It will reveal any nutrient deficiencies or
toxicities.
The dietary-social history is important to determine whether the client has the
financial resources to obtain the needed food and the ability to properly store
and cook food once home. After completing the dietary-social history, the
dietitian can assess for risk of food–drug interactions that can lead to
malnutrition. Clients need to be instructed by a dietitian on possible interactions,
if any.
When the preceding steps are evaluated together, and in the context of the
client’s medical condition, the dietitian has the best opportunity of making an
accurate nutrition assessment of the client. This assessment can then be used by
the entire health care team. The doctor will find it helpful in evaluating the
client’s condition and treatment. The dietitian can use the information to plan
the client’s dietary treatment and counselling, and other health care professional
will be able to use it in assisting and counselling the client.

DIETARY GOALS
 Maintenance of a state of positive health and optimal performance in
populations at large by maintaining ideal body weight.
 Ensuring adequate nutritional status for pregnant women and lactating
mothers.
 Improvement of birth weights and promotion of growth of infants,
children and adolescents to achieve their full genetic potential.
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 Achievement of adequacy in all nutrients and prevention of deficiency

diseases.
 Prevention of chronic diet-related disorders.
 Maintenance of the health of the elderly and increasing the life
expectancy.

BALANCE DIET

A balanced diet is one which provides all the nutrients in required amounts and
proper proportions. It can easily be achieved through a blend of the four basic
food groups. The quantities of foods needed to meet the nutrient requirements
vary with age, gender, physiological status and physical activity. A balanced
diet should provide around 50-60% of total calories from carbohydrates,
preferably from complex carbohydrates, about 10-15% from proteins and 20-
30% from both visible and invisible fat. In addition, a balanced diet should
provide other non-nutrients such as dietary fibre, antioxidants and
phytochemicals which bestow positive health benefits. Antioxidants such as
vitamins C and E, beta-carotene, riboflavin and selenium protect the human
body from free radical damage. Other phytochemicals such as polyphenols,
flavones, etc., also afford protection against oxidant damage. Spices like
turmeric, ginger, garlic, cumin and cloves are rich in antioxidants.
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BALANCE YOUR DIET THROUGHOUT THE DAY:

When you’re choosing foods and drinks, take a look at the DIG thumbnail for
energy. It can be easier to look at the % Daily Intake for energy and compare
to the % of energy recommended for that meal instead of thinking about what
you need for a whole day.

The Daily Intake Guide has been developed to show you how you can distribute
your energy intake over a day. It's based on 3 meals plus 2 smaller in-between
meal snacks.

You can modify the guide to adapt it to your eating pattern on a given day. For
example if you have a large breakfast (greater than 20% of your daily energy
needs), you will need to modify (reduce) your intake amount for mid-morning
and afternoon snacks, lunch or dinner. Its common sense - and now easier to
understand with DIG!

ENERGY VARIANCE

The percent Daily Intake values used in DIG are based on an average adult diet
of 8,700 kilojoules (kJ). Many people will require different amounts of food
energy at various stages of their lives and as their activity level varies.
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A very active teenager, for example, will require more food energy than a
sedentary older person.

PRINCIPLES OF DIET PLANNING:

1. Eat a variety of different foods. No one food contains all the proteins,
carbohydrates, fats, vitamins and minerals you need for good health, so
you have to eat a range of different foods.

2. Eat staple foods with every meal. Staple foods should make up the
largest part of a meal. These foods are relatively cheap and supply a good
amount of carbohydrates and some proteins. Staples include cereals (such
as rice, maize, millet, wheat and oats), pulses (such as lentils, beans, chick
peas and barley) and starchy roots (such as potatoes and cassava).
Unrefined staples like whole grains, brown unpolished rice, millet, barley
and potatoes provide more sustained energy over a longer period of time
and are also a good source of protein and a wide range of vitamins and
minerals. Refined foods like white rice and white flour have much less
nutrients and fibre.

3. Eat legumes every day. These foods provide a person with

the proteins needed to develop and repair the body and also to build up
strong muscles. They are good sources of vitamins, minerals and fibre and
help to keep the immune system active. Legumes include beans, peas,
lentils, groundnuts (including peanut butter) and soybeans. When eaten
with staple foods the quality of protein is increased. Legumes are a
cheaper protein source than animal foods, such as beef and chicken, and
should be eaten every day, if possible.

4. Eat vegetables and/or fruits every day. Vegetables and fruits are an
important part of a healthy and balanced meal. They supply the vitamins
and minerals that keep the body functioning and the immune system
strong. Eat a wide variety as each one provides
different vitamins, minerals and dietary fibre.

5. Use little fats and sugar. Fats, oils and sugars are good sources of energy
and play an important part in a healthy and balanced diet. Even small
amounts can provide lots of energy. Fats include butter, lard, margarine,
cooking oil (vegetable, coconut and palm oil) and coconut cream. They
are also found in avocados, oilseeds (sunflower, groundnut and sesame),
fatty meat and fish, curds and cheese. It is important to learn how to
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distinguish between good fats and bad fats. Sugars and sugary foods
include honey, jam, table sugar, cakes and biscuits. Indian jaggery and
raw sugar cane are the healthiest and easiest substitutes for white sugar.
Although fats and sugars are good sources of energy, they are not rich in
other nutrients. They should therefore be eaten moderately in addition to
other foods, not instead of them.

6. Eat animal and milk products regularly. Foods from animals and fish
should also be eaten as often as you can afford them but not in excess as
they interfere with the cholesterol level. They supply good-quality
proteins, vitamins and minerals and extra energy. They will help to
strengthen muscles and the immune system. These foods include all forms
of meat, poultry (birds), fish, eggs and dairy products such as milk, sour
milk, buttermilk, yoghurt and cheese. If insects, such as caterpillars or
grasshoppers, are part of your diet, they also provide good nutrients.

7. Eat the right amount of food to keep a healthy weight and exercise
regularly. The correct amount of food for an individual will depend on
sex, height, age and lifestyle as well as other factors. Choose foods that
provide lots of nourishment but are low in fat.

DIETARY GUIDELINES

Right nutritional behavior and dietary choices are needed to achieve dietary
goals. The following 15 dietary guidelines provide a broad framework for
appropriate action:

 Eat variety of foods to ensure a balanced diet.

 Ensure provision of extra food and healthcare to pregnant and lactating
women.
 Promote exclusive breastfeeding for six months and encourage
breastfeeding till two years or as long as one can.
 Feed home based semi solid foods to the infant after six months.
 Ensure adequate and appropriate diets for children and adolescents, both
in health and sickness.
 Eat plenty of vegetables and fruits.
 Ensure moderate use of edible oils and animal foods and very less use of
ghee/ butter/ vanaspati.
 Avoid overeating to prevent overweight and obesity.
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 Exercise regularly and be physically active to maintain ideal body weight.

 Restrict salt intake to minimum.
 Ensure the use of safe and clean foods.
 Adopt right pre-cooking processes and appropriate cooking methods.
 Drink plenty of water and take beverages in moderation.
 Minimize the use of processed foods rich in salt, sugar and fats.
 Include micronutrient-rich foods in the diets of elderly people to enable
them to be fit and active.

FOOD GROUPS

Foods are conventionally grouped as :

1.Cereals, millets and pulses

2.Vegetables and fruits

3.Milk and milk products, egg, meat and fish

4.Oils & fats and nuts & oilseeds

As the My Plate icon shows, the five food groups are Fruits, Vegetables, Grains,
Protein Foods, and Dairy. The 2015-2020 Dietary Guidelines for
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Americans emphasizes the importance of an overall healthy eating pattern with

all five groups as key building blocks, plus oils. (While oils are not a food
group, they are emphasized as part of a healthy eating pattern because they are a
major source of essential fatty acids and vitamin E). Each food group includes a
variety of foods that are similar in nutritional makeup, and each group plays an
important role in an overall healthy eating pattern. Some of the food groups are
broken down further into subgroups to emphasize foods that are particularly
good sources of certain vitamins and minerals. For example, the subgroups
within the Grains Group encourage whole grains, which provide more fiber,
magnesium, and zinc than refined grains.

PURPOSE OF FOOD GROUP

As nutrition science has progressed over time, scientists have discovered

vitamins, minerals, and other components that make up our foods, and surely,
there are more yet to be discovered. Food groups simplify dietary
recommendations by focusing on foods instead of nutrients. For example, it’s
much easier to try to eat two cups of fruit a day than 75 milligrams of vitamin C
and 25 grams of fiber. The USDA Food Patterns provide the recommended
amounts of each food group and subgroup at 12 different calorie levels, ranging
from 1,000 to 3,200. These patterns are developed using food pattern modeling.
By eating recommended amounts, individuals can meet their nutritional needs
without having to track dozens of individual nutrients.
 30

FOOD GROUP AMOUNT

The USDA Food Patterns specify targets for each food group in cup equivalents
(for Fruits, Vegetables, and Dairy) and ounce equivalents (for Grains and
Protein Foods). Each pattern also includes a limited number of calories (8-19%)
that can be used in other ways, such as small amounts of added sugars and
saturated fats. Americans are encouraged to choose foods in their most nutrient
dense forms as often as possible, to keep added sugars and saturated fat intakes
each below 10 percent of total calorie intake.
 31

FOOD EXCHANGE LIST

The following pages separate foods into these seven groups: -

1. Starches
2. Fruits and Fruit Juices
3. Milk, Yogurt, and Dairy-like foods
4. Non-Starchy Vegetables
5. Sweets, Desserts, and Other Carbohydrates
6. Meats and Meat Substitutes
7. Fats

At the top of each section you will find the amount of carbohydrate, protein, fat
and calories found in each selection.

These food lists can be used for:

• counting carbohydrates

• counting calories

• counting grams of fat

• counting grams of protein

To help you make healthy food choices:

• milk products are separated by fat and calorie content

• meats and protein foods are separated by fat and calorie content

• dietary fats are divided into unsaturated and saturated sources

https://dtc.ucsf.edu/pdfs/FoodLists.pdf

DIETARY GUIDELINES FOR INDIANS

https://www.nin.res.in/downloads/DietaryGuidelinesforNINwebsite.pdf
 32

UNIT II

DIGESTION

Digestion, Absorption and Transport: Anatomy and physiology of the digestive

tract, mechanical and chemical digestion, absorption of nutrients.

Digestion

Digestion is the process whereby food is broken down into smaller

parts,chemically changed, and moved through the gastrointestinal system.

DIGESTION

Digestion is the process whereby food is broken down into smaller

parts,chemically changed, and moved through the gastrointestinal system.
The gas-trointestinal (GI) tract consists of the body structures that participate
indigestion. Digestion begins in the mouth and ends at the anus. Along the entire
GI tract secretions of mucus lubricate and protect the mucosal tissues. As the
process of digestion is discussed, refer to Figure 3-1 and note the locations of
the structures that perform the functions of digestion.
 33

Digestion occurs through two types of action—mechanical and chemi-cal.

During mechanical digestion, food is broken into smaller pieces by the teeth. It
is then moved along the gastrointestinal tract through the esophagus, stomach,
and intestines. This movement is caused by a rhythmic contraction of the
muscular walls of the tract called peristalsis. Mechanical digestion helps to
prepare food for chemical digestion by breaking it into smaller pieces. Several
small pieces collectively have more surface area than fewer large ones and thus
are more readily broken down by digestive juices.

During chemical digestion, the composition of carbohydrates, pro-teins, and

fats is changed. Chemical changes occur through the addition of water and the
resulting splitting, or breaking down, of the food molecules. This process is
called hydrolysis. Food is broken down into nutrients that the tissues can absorb
and use. Hydrolysis also involves digestive enzymes that act on food
substances, causing them to break down into simple compounds. An enzyme
can also act as a catalyst, which speeds up the chemical reactions without itself
being changed in the process. Digestive enzymes are secreted by the mouth,
stomach, pancreas, and small intestine (Table 3-1). An enzyme is often named
for the substance on which it acts. For example, the enzyme sucrase acts on
sucrose, the enzyme maltase acts on maltose, and lactase acts on lactose.
 34

Digestion in the Mouth

Digestion begins in the mouth, where the food is broken into smaller pieces by
the teeth and mixed with saliva (Figure 3-2). At this point, each mouthful of
food that is ready to be swallowed is called a bolus. Saliva is a secretion of the
salivary glands that contains water, salts, and a digestive enzyme called salivary
amylase (also called ptyalin), which acts on complex carbo-hydrates (starch).
Food is normally held in the mouth for such a short time that only small
amounts of carbohydrates are chemically changed there. The salivary glands
also secrete a mucous material that lubricates and binds food particles to help in
swallowing the bolus. The final chemical digestion of carbohydrates occurs in
the small intestine.
 35

The Esophagus

The esophagus is a 10-inch muscular tube through which food travels from the
mouth to the stomach. When swallowed, the bolus of food is moved down the
esophagus by peristalsis and gravity. At the lower end of the esophagus,
the cardiac sphincter opens to allow passage of the bolus into the stomach. The
cardiac sphincter prevents the acidic content of the stomach from flowing back
into the esophagus. When this sphincter mal-functions, it causes acid reflux
disease.

Digestion in the Stomach

The stomach consists of an upper portion known as the fundus, a middle area
known as the body of the stomach, and the end nearest the small intestine called
the pylorus. Food enters the fundus and moves to the body of the stom-ach,
where the muscles in the stomach wall gradually knead the food, tear it, and mix
it with gastric juices, and with the intrinsic factor necessary for the absorption of
vitamin B12, before it can be propelled forward in slow, controlled movements.
The food becomes a semiliquid mass called chyme (pronounced “kime”). When
 36

the chyme enters the pylorus, it causes distention and the re-lease of the
hormone gastrin, which increases the release of gastric juices.Gastric juices are
digestive secretions of the stomach. They containhydrochloric acid, pepsin, and
mucus. Hydrochloric acid activates the enzyme pepsin, prepares protein
molecules for partial digestion by pepsin, destroys most bacteria in the food
ingested, and makes iron and calcium more soluble. As the hydrochloric acid is
released, a thick mucus is also secreted to protect the stomach from this harsh
acid. In children, there are two additional enzymes: rennin, which acts on milk
protein and casein, and gastric lipase, which breaks the butterfat molecules of
milk into smaller molecules.

In summary, the functions of the stomach include the following:

• Temporary storage of food

• Mixing of food with gastric juices

• Regulation of a slow, controlled emptying of food into the intestine

• Secretion of the intrinsic factor for vitamin B12

• Destruction of most bacteria inadvertently consumed

Digestion in the Small Intestine

Chyme moves through the pyloric sphincter into the duodenum, the first sec-
tion of the small intestine. Chyme subsequently passes through the jejunum, the
midsection of the small intestine, and the ileum, the last section of the small
intestine.

When food reaches the small intestine, the hormone secretin causes the
pancreas to release sodium bicarbonate to neutralize the acidity of the chyme.
The gallbladder is triggered by the hormone cholecystokinin (CCK), which is
pro-duced by intestinal mucosal glands when fat enters, to release bile. Bile is
produced in the liver but stored in the gallbladder. Bile emulsifies fat after it is
 37

secreted into the small intestine. This action enables the enzymes to digest the
fats more easily.

Chyme also triggers the pancreas to secrete its juice into the small intes-tine.
Pancreatic juice contains the following enzymes:

• Trypsin, chymotrypsin, and carboxypeptidases split proteins intosmaller

substances. These are called pancreatic proteases because they are protein-
splitting enzymes produced by the pancreas.

• Pancreatic amylaseconverts starches (polysaccharides) to simplesugars.

• Pancreatic lipasereduces fats to fatty acids and glycerol.

The small intestine itself produces an intestinal juice that contains the
enzymes lactase, maltase, and sucrase. These enzymes split lactose, maltose,
and sucrose, respectively, into simple sugars. The small intestine also produces
enzymes called peptidases that break down proteins into amino acids.

The Large Intestine

The large intestine, or colon, consists of the cecum, colon, and rectum. The
cecum is a blind pouchlike beginning of the colon in the right lower quadrant of
the abdomen. The appendix is a diverticulum that extends off the cecum.
Thececum is separated from the ileum by the ileocecal valve and is considered
to be the beginning of the large intestine (colon). Its primary function is to
absorb water and salts from undigested food. It has a muscular wall that can
knead the contents to enhance absorption. One of the end products of
fermentation in the cecum is volatile fatty acids. The major volatile fatty acids
are acetate, propionate, and butyrate. These are absorbed from the large intestine
and used as sources of energy. The digested food then enters the ascending
colon and moves through the transverse colon and on to the descending colon,
the sigmoid colon, the rectum, and, finally, the anal canal.
ABSORPTION

After digestion, the next major step in the body’s use of its food is absorp-tion
(Figure 3-3). Absorption is the passage of nutrients into the blood or lymphatic
 38

system (the lymphatic vessels carry fat-soluble particles and molecules that are
too large to pass through the capillaries into the bloodstream).
 39

To be absorbed, nutrients must be in their simplest forms. Carbohydrates must

be broken down to the simple sugars (glucose, fructose, and galactose), proteins
to amino acids, and fats to fatty acids and glycerol. Most absorption of nutrients
occurs in the small intestine, although some occurs in the large intes-tine. Water
is absorbed in the stomach, small intestine, and large intestine.

Absorption in the Small Intestine

The small intestine is approximately 22 feet long. Its inner surface has mucosal
folds, villi, and microvilli to increase the surface area for maximum absorption.
The fingerlike projections called villi have hundreds of microscopic, hairlike
pro-jections called microvilli. The microvilli are very sensitive to the nutrient
needs of our bodies (Figure 3-4). Each villus contains numerous
blood capillaries (tiny blood vessels) and lacteals (lymphatic vessels). The villi
absorb nutrients from the chyme by way of these blood capillaries and lacteals,
which eventually transfer them to the bloodstream. Glucose, fructose, galactose,
amino acids, minerals, and water-soluble vitamins are absorbed by the
capillaries. Fructose and galactose are subsequently carried to the liver, where
they are converted to glucose. Lacteals absorb glycerol and fatty acids (end
products of fat digestion) in addition to the fat-soluble vitamins.

Anatomy of the Digestive System

The human gastrointestinal tract refers to the stomach and intestine, and
sometimes to all the structures from the mouth to the anus.

LEARNING OBJECTIVES

Outline the anatomical organization of the digestive system

KEY TAKEAWAYS

Key Points

 The major organs of the digestive system are the stomach and intestine.
 The upper gastrointestinal tract consists of the esophagus, stomach, and
duodenum.
 The lower gastrointestinal tract includes the small intestine and the large
intestine.
 Digestive juices are produced by the pancreas and the gallbladder.
 40

 The small intestine includes the duodenum, jejunum, and ileum.

 The large intestine includes the cecum, colon, rectum, and anus.

Key Terms
 upper gastrointestinal tract: This tract consists of the esophagus,
stomach, and duodenum.
 lower gastrointestinal tract: This tract includes most of the small
intestine and all of the large intestine.

Upper and lower gastrointestinal tract: The major organs of the human
gastrointestinal system.

The human gastrointestinal tract refers to the stomach and intestine, and
sometimes to all the structures from the mouth to the anus.
 41

Upper Gastrointestinal Tract

The upper gastrointestinal tract consists of the esophagus, stomach, and

duodenum. The exact demarcation between upper and lower can vary. Upon
gross dissection, the duodenum may appear to be a unified organ, but it is often
divided into two parts based upon function, arterial supply, or embryology.

The upper gastrointestinal tract includes the:

 Esophagus, the fibromuscular tube that food passes through—aided by

peristaltic contractions—the pharynx to the stomach.
 Stomach, which secretes protein -digesting enzymes called proteases and
strong acids to aid in food digestion, before sending the partially digested
food to the small intestines.
 Duodenum, the first section of the small intestine that may be the principal
site for iron absorption.

Lower Gastrointestinal Tract

The lower gastrointestinal tract includes most of the small intestine and all of
the large intestine. According to some sources, it also includes the anus.

The small intestine has three parts

Small intestine: This image shows the position of the small intestine in the
gastrointestinal tract.
 Duodenum: Here the digestive juices from the pancreas ( digestive
enzymes ) and the gallbladder ( bile ) mix together. The digestive enzymes
break down proteins and bile and emulsify fats into micelles. The
duodenum contains Brunner’s glands that produce bicarbonate, and
pancreatic juice that contains bicarbonate to neutralize hydrochloric acid in
the stomach.
 Jejunum: This is the midsection of the intestine, connecting the duodenum
to the ileum. It contains the plicae circulares and villi to increase the
surface area of that part of the GI tract.
 Ileum: This has villi, where all soluble molecules are absorbed into the
blood ( through the capillaries and lacteals).

The large intestine has four parts:

1. Cecum, the vermiform appendix that is attached to the cecum.

 42

2. Colon, which includes the ascending colon, transverse colon, descending

colon, and sigmoid flexure. The main function of the colon is to absorb
water, but it also contains bacteria that produce beneficial vitamins like
vitamin K.
3. Rectum.
4. Anus.

The ligament of Treitz is sometimes used to divide the upper and lower GI
tracts.

Processes and Functions of the Digestive System

Digestion is necessary for absorbing nutrients from food and occurs through two
processes: mechanical and chemical digestion.

LEARNING OBJECTIVES

Describe the processes and functions of the digestive system

KEY TAKEAWAYS

Key Points
 Two important functions of the digestive system are digestion and
absorption.
 The nutrients that come from food are derived from proteins, fats,
carbohydrates, vitamins, and minerals. These complex macromolecules
must be broken down and absorbed in the gastrointestinal (GI) tract.
 Mechanical digestion starts in the mouth, with the physical processing of
food by the teeth, and continues in the stomach.
 Chemical digestion starts with the release of enzymes in saliva, and
continues in the stomach and intestines.
 During absorption, the nutrients that come from food pass through the wall
of the small intestine and into the bloodstream.

Key Terms

 mastication: The process of mechanical breakdown by the teeth; also

known as chewing.
 bolus: Moistened and mechanically manipulated food.
 43

 mechanical digestion: The breaking down of food into digestible chunks,

normally using the teeth.
 chemical digestion: A process that involves the action of enzymes to
break down food into components that can be absorbed by the small
intestine.
 gastrointestinal tract: This tract consists of the stomach and intestine, and
sometimes includes all the structures from the mouth to the anus. The
digestive system is a broader term that includes other structures, including
the accessory organs of digestion, such as the liver, gallbladder, and
pancreas.

The Digestive System

The proper functioning of the gastrointestinal (GI) tract is imperative for our
well being and life -long health. A non-functioning or poorly-functioning GI
tract can be the source of many chronic health problems that can interfere with
your quality of life.

Here is a look at the importance of two main functions of the digestive system:
digestion and absorption.

Digestion

The gastrointestinal tract is responsible for the breakdown and absorption of the
various foods and liquids needed to sustain life. Many different organs have
essential roles in the digestion of food, from the mechanical breakdown of food
by the teeth to the creation of bile (an emulsifier) by the liver.

Bile production plays a important role in digestion: it is stored and concentrated

in the gallbladder during fasting stages, and discharged to the small intestine.
Pancreatic juices are excreted into the digestive system to break down complex
molecules such as proteins and fats.

Absorption

Absorption occurs in the small intestines, where nutrients directly enter the
bloodstream.

Each component of the digestive system plays a special role in these

complimentary processes. The structure of each component highlights the
function of that particular organ, providing a seamless anatomy to keep our
body fueled and healthy.
 44

Components of the Digestive System

The digestive system is comprised of the alimentary canal, or the digestive tract,
and other accessory organs that play a part in digestion—such as the liver, the
gallbladder, and the pancreas. The alimentary canal and the GI tract are terms
that are sometimes used interchangeably.

The alimentary canal is the long tube that runs from the mouth (where the food
enters) to the anus (where indigestible waste leaves). The organs in the
alimentary canal include the mouth (the site of mastication), the esophagus, the
stomach, the small and large intestines, the rectum, and the anus. From mouth to
anus, the average adult digestive tract is about thirty feet (30′) long.

Processes of Digestion

Food is the body’s source of fuel. The nutrients in food give the body’s cells the
energy they need to operate. Before food can be used it has to be mechanically
broken down into tiny pieces, then chemically broken down so nutrients can be
absorbed.

In humans, proteins need to be broken down into amino acids, starches into
sugars, and fats into fatty acids and glycerol. This mechanical and chemical
breakdown encompasses the process of digestion.

To recap these twin processes:

1. Mechanical digestion: Larger pieces of food get broken down into smaller
pieces while being prepared for chemical digestion; this process starts in
the mouth and continues into the stomach.
2. Chemical digestion: Several different enzymes break down
macromolecules into smaller molecules that can be absorbed. The process
starts in the mouth and continues into the intestines.

Moistening and Breakdown of Food

Digestion begins in the mouth. A brain reflex triggers the flow of saliva when
we see or even think about food. Enzymes in saliva then begin the chemical
breakdown of food; teeth aid in the mechanical breakdown of larger food
particles.

Saliva moistens the food, while the teeth masticate the food and make it easier
to swallow. To accomplish this moistening goal, the salivary glands produce an
estimated three liters of saliva per day.
 45

Amylase, the digestive enzyme found in saliva, starts to break down starch into
simple sugars before the food even leaves the mouth. The nervous pathway
involved in salivary excretion requires stimulation of receptors in the mouth,
sensory impulses to the brain stem, and parasympathetic impulses to salivary
glands. Once food is moistened and rolled and ready to swallow, it is known as
a bolus.

Swallowing and the Movement of Food

For swallowing to happen correctly a combination of 25 muscles must all work

together at the same time. Swallowing occurs when the muscles in your tongue
and mouth move the bolus into your pharynx.

The pharynx, which is the passageway for food and air, is about five inches (5″)
long—a remarkably small space. A small flap of skin called the epiglottis closes
over the pharynx to prevent food from entering the trachea, which would cause
choking. Instead, food is pushed into the muscular tube called the esophagus.
Waves of muscle movement, called peristalsis, move the bolus down to the
stomach.

While in the digestive tract, the food is really passing through the body rather
than being in the body. The smooth muscles of the tubular digestive organs
move the food efficiently along as it is broken down into easily absorbed ions
and molecules.

Large-scale Breakdown in the Stomach

Once the bolus reaches the stomach, gastric juices mix with the partially
digested food and continue the breakdown process. The bolus is converted into a
slimy material called chyme.
 46

Major digestive hormones: There are at least five major digestive hormones in
the gut of mammals that help process food through chemical digestion in the
gall bladder, duodenum, stomach, and pancrease. These hormones are
cholecystokinin, gastric inhibitory polypeptide, motilin, secretin, and gastrin.

The stomach is a muscular bag that maneuvers food particles, mixing highly
acidic gastric juice and powerful digestive enzymes with the chyme to prepare
for nutrient absorption in the small intestine. Stimulatory hormones such as
gastrin and motilin help the stomach pump gastric juice and move chyme. The
complex network of hormones eventually prepares chyme for entry into the
duodenum, the first segment of the small intestine.

Absorption in the Small Intestine

During absorption, the nutrients that come from food (such as proteins, fats,
carbohydrates, vitamins, and minerals) pass through the wall of the small
intestine and into the bloodstream. In this way nutrients can be distributed
throughout the rest of the body. The small intestine increases surface area for
absorption through tiny interior projections, like small fingers, called villi.
 47

Waste Compaction in the Large Intestine

In the large intestine there is resorption of water and absorption of certain

minerals as feces are formed. Feces are the waste parts of the food that the body
passes out through the anus.

Organs of the Digestive System

The organs of the digestive system can be divided into upper and lower
digestive tracts. The upper digestive tract consists of the esophagus, stomach,
and the small intestine; the lower tract includes all of the large intestine, the
rectum, and anus.

LEARNING OBJECTIVES

Outline the relationship, structure, and function of the digestive organs

KEY TAKEAWAYS

Key Points
 The gastrointestinal tract is made up of upper and lower tracts.
 Food moves from the mouth to the stomach via the esophagus.
 The small intestine has three parts: the duodenum, jejunum, and ileum.
 The large intestine has four parts: the cecum, colon, rectum, and anus.

Key Terms

 small intestine: A winding, digestive tube and the site of large scale
nutrient absorption comprised of the duodenum, jejunum, and ileum.
 esophagus: An organ in vertebrates that is a muscular tube through which
food passes from the pharynx to the stomach.
 stomach: An organ in animals that stores and breaks down food in the
process of digestion.
 large intestine: The second to last part of the digestive system comprised
of the cecum and colon.

The human body uses a variety of mental and physiological cues to initiate the
process of digestion. Throughout our gastrointestinal (GI) tract, each organ
serves a specific purpose to bring our food from the plate to a digestible
substance from which nutrients can be extracted.
 48

The Digestive Tube

The organs of the gastrointestinal tract: This diagram shows the relationship
between the various organs of the digestive system. It shows how the oral cavity
connects to the esophagus and descends into the stomach and then the small
intestine. It then connects to the large intestine, then the rectum, and, finally, the
anus.

Our digestive system is like a long tube, with different segments doing different
jobs. The major organs within our digestive system can be split into two major
segments of this tube: the upper gastrointestinal tract, and the lower
gastrointestinal tract.

The Upper Gastrointestinal Tract

The upper gastrointestinal, or GI, tract is made up of three main parts:

 49

1. The esophagus.
2. The stomach.
3. The small intestine.

The Lower Gastrointestinal Tract

The lower GI tract contains the remainder of the system:

1. The large intestine.

2. The rectum.
3. The anus.

The exact dividing line between upper and lower tracts can vary, depending on
which medical specialist is examining the GI tract.

Food Breakdown and Absorption: The Upper GI Tract

When we take a bite of food, the food material gets chewed up and processed in
the mouth, where saliva begins the process of chemical and mechanical
breakdown. The chewing process is also known as mastication.

When we mix up food with saliva, the resulting mushy wad is called a bolus.
The bolus gets swallowed, and begins its journey through the upper
gastrointestinal tract.

The Esophagus

The upper GI tract begins with the esophagus, the long muscular tube that
carries food to the stomach. The throat cavity in which our esophagus originates
is known as the pharynx. As we swallow, the bolus moves down our esophagus,
from the pharynx to the stomach, through waves of muscle movement known as
peristalsis. Next the bolus reaches the stomach itself.

The Stomach

The stomach is a muscular, hollow bag that is an important part of the upper GI
tract. Many organisms have a variety of stomach types, with many segments or
even multiple stomachs. As humans, we have only one stomach.
 50

Here our bolus gets mixed with digestive acids, furthering breakdown of the
bolus, and turning the bolus material into a slimy mess called chyme. The
chyme moves on into the small intestine, where nutrients are absorbed.

The Small Intestine

The small intestine is an impressive digestive tube, spanning an average of 20

feet in length. The twists and turns of the small intestine, along with tiny interior
projections known as villi, help to increase the surface area for nutrient
absorption.

This snaking tube is made up of three parts, in order from the stomach:

1. The duodenum.
2. The jejunum.
3. The ileum.

As the chyme makes its way through each segment of the small intestine,
pancreatic juices from the pancreas start to break down proteins. Soapy bile
from the liver, stored in the gallbladder, gets squirted into the small intestine to
help emulsify—or break apart—fats.

Now thoroughly digested, with its nutrients absorbed along the path of the small
intestine, what remains of our food gets passed into the lower GI tract.

Waste Compaction and Removal: The Lower Gastrointestinal Tract

The Large Intestine (Colon)

Following nutrient absorption, the food waste reaches the large intestine, or
colon. The large intestine is responsible for compacting waste material,
removing water, and producing feces —our solid-waste product.

Accessory organs like the cecum and appendix, which are remnants of our
evolutionary past, serve as special pockets at the beginning of the large
intestine. The compacted and dried-out waste passes to the rectum, and out of
the body through the anus. Healthy gut bacteria in the large intestine also help to
metabolize our waste as it finishes its journey.

LICENSES AND ATTRIBUTIONS

 51

Absorption in the Large Intestine

When the chyme reaches the large intestine, most digestion and absorption have
already occurred. The colon walls secrete mucus as a protection from the acidic
digestive juices in the chyme, which is coming from the small intestine through
the ileocecal valve.

The major tasks of the large intestine are to absorb water, to synthesize some B
vitamins and vitamin K (essential for blood clotting), and to collect food
residue. Food residue is the part of food that the body’s enzyme action cannot
digest and consequently the body cannot absorb. Such residue is commonly
called dietary fiber. Examples include the outer hulls of corn kernels and grains
of wheat, celery strings, and apple skins. It is important that the diet contain
adequate fiber because it promotes the health of the large intestine by helping to
produce softer stools and more frequent bowel movements.
 52

Undigested food is excreted as feces by way of the rectum. In healthy people,

99% of carbohydrates, 95% of fat, and 92% of proteins are absorbed.
METABOLISM

After digestion and absorption, nutrients are carried by the blood to the cells of
the body. Within the cells, nutrients are changed into energy through a complex
process called metabolism. During aerobic metabolism, nutrients are combined
with oxygen within each cell. This process is known as oxida-tion. Oxidation
ultimately reduces carbohydrates to carbon dioxide and water; Proteins are
reduced to carbon dioxide, water, and nitrogen. Anaerobic me-
tabolism reduces fats without the use of oxygen. The complete oxidation
ofcarbohydrates, proteins, and fats is commonly called the Krebs cycle.

As nutrients are oxidized, energy is released. When this released energy is used
to build new substances from simpler ones, the process is called anabolism. An
example of anabolism is the formation of new body tissues. When released
energy is used to reduce substances to simpler ones, the process is
called catabolism. This building up (anabolism) and breaking down
(catabolism) of substances is a continuous process (metabolism) within the body
and requires a continuous supply of nutrients.

What is chemical digestion?

When it comes to digestion, chewing is only half the battle. As food travels
from your mouth into your digestive system, it’s broken down by digestive
enzymes that turn it into smaller nutrients that your body can easily absorb.

This breakdown is known as chemical digestion. Without it, your body wouldn’t
be able to absorb nutrients from the foods you eat.

Read on to learn more about chemical digestion, including how it’s different
from mechanical digestion.
 53

How is chemical digestion different from mechanical digestion?

Chemical and mechanical digestion are the two methods your body uses to
break down foods. Mechanical digestion involves physical movement to make
foods smaller. Chemical digestion uses enzymes to break down food.

Mechanical digestion

Mechanical digestion begins in your mouth with chewing, then moves to

churning in the stomach and segmentation in the small intestine. Peristalsis is
also part of mechanical digestion. This refers to involuntary contractions and
relaxations of the muscles of your esophagus, stomach, and intestines to break
down food and move it through your digestive system.

Chemical digestion

Chemical digestion involves the secretions of enzymes throughout your

digestive tract. These enzymes break the chemical bonds that hold food particles
together. This allows food to be broken down into small, digestible parts.

How they work together

Once food particles reach your small intestine, the intestines continue to move.
This helps keep food particles moving and exposes more of them to digestive
enzymes. These movements also help to move the digested food toward the
large intestine for eventual excretion.

What’s the purpose of chemical digestion?

Digestion involves taking large portions of food and breaking them down into
micronutrients small enough to be absorbed by cells. Chewing
and peristalsis help with this, but they don’t make particles small enough. That’s
where chemical digestion comes in.

Chemical digestion breaks down different nutrients, such as proteins,

carbohydrates, and fats, into even smaller parts:
 54

 Fats break down into fatty acids and monoglycerides.

 Nucleic acids break down into nucleotides.
 Polysaccharides, or carbohydrate sugars, break down into
monosaccharides.
 Proteins break down into amino acids.

Without chemical digestion, your body wouldn’t be able to absorb nutrients,

leading to vitamin deficiencies and malnutrition.

Some people may lack certain enzymes used in chemical digestion. For
example, people with lactose intolerance usually don’t make enough lactase, the
enzyme responsible for breaking down lactose, a protein found in milk.

Where does chemical digestion begin?

Chemical digestion begins in your mouth. As you chew, your salivary glands
release saliva into your mouth. The saliva contains digestive enzymes that start
off the process of chemical digestion.
 55

Digestive enzymes found in the mouth include:

 Lingual lipase. This enzyme breaks down triglycerides, a kind of fat.

 Salivary amylase. This enzyme breaks down polysaccharides, a complex
sugar that’s a carbohydrate.

What path does chemical digestion follow?

Chemical digestion doesn’t just stop with enzymes in your mouth.

Here’s a look at some of the main stops on the digestive system involving
chemical digestion:

Stomach

In your stomach, unique chief cells secrete digestive enzymes. One is pepsin,
which breaks down proteins. Another is gastric lipase, which breaks down
triglycerides. In your stomach, your body absorbs fat-soluble substances, such
as aspirin and alcohol.

Small intestine

The small intestine is a major site for chemical digestion and absorption of key
food components, such as amino acids, peptides, and glucose for energy. There
are lots of enzymes released in the small intestine and from the nearby pancreas
for digestion. These include lactase to digest lactose and sucrase to digest
sucrose, or sugar.

Large intestine

The large intestine doesn’t release digestive enzymes, but it does contain
bacteria that further break down nutrients. It also absorbs vitamins, minerals,
and water.
 56

The bottom line

Chemical digestion is a vital part of the digestive process. Without it, your body
wouldn’t be able to absorb nutrients from the foods you eat. While mechanical
digestion involves physical movements, such as chewing and muscle
contractions, chemical digestion uses enzymes to break down food.
 57

UNIT III

CARBOHYDRATES

Glycemic and Non-glycemic carbohydrates, blood glucose regulation,

recommendations of sugar intake for health, health effects of fiber and starch
intake, Artificial sweeteners; Importance of blood sugar regulation, Dietary
recommendations for NIDDM and IDDM

Introduction:
Energy foods are those that can be rapidly oxidized by the body to release
energy and its by-product, heat. Carbohydrates, fats, and proteins provide
energy for the human body, but carbohydrates are the primary source. They are
the least expensive and most abundant of the energy nutrients. Foods rich in
carbohydrates grow easily in most climates. They keep well and are generally
easy to digest.

Carbohydrates provide the major source of energy for people all over the world
(Figure 4-1). They provide approximately half the calories for people liv-ing in
the United States. In some areas of the world, where fats and proteins are scarce
and expensive, carbohydrates provide as much as 80 to 100% of calo-ries.
Carbohydrates are named for the chemical elements they are composed of—
carbon (C), hydrogen (H), and oxygen (O).
Definition:
Carbohydrates are polyhydroxy aldehydes or ketones, or compounds that can be
hydrolyzed to them. Carbohydrate is an organic compound comprising
only carbon, hydrogen, and oxygen, usually with a hydrogen: oxygen atom ratio
of 2:1 (as in water). Carbohydrates are technically hydrates of carbon.
 58

The empirical formula is Cn(H2O)n.

FOOD SOURCES:
The principal sources of carbohydrates are plant foods: cereal grains, vegetables,
fruits, and sugars . The only substantial animal source of carbohydrates is milk.

Cereal grains and their products are dietary staples in nearly every part of the
world. Rice is the basic food in Latin America, Africa, Asia, and many sections
of the United States. Wheat and the various breads, pastas, and breakfast cereals
made from it are basic to American and European diets. Rye and oats are
commonly used in breads and cereals in the United States and Europe. Cereals
also contain vitamins, minerals, and some proteins. During processing, some of
these nutrients are lost. To compensate for this loss, food producers in the
United States commonly add the B vitamins— thiamine, riboflavin, and
niacin—plus the mineral iron to the final product. The product is then
called enriched. When a nutrient that has never been part of a grain is added, the
grain is said to be fortified. An example of fortification is the addition of folic
acid to cereal grains to prevent neural tube defects.

Vegetables such as potatoes, beets, peas, lima beans, and corn provide
substantial amounts of carbohydrates (in the form of starch). Green leafy
vegetables provide dietary fiber. All of them also provide vitamins and minerals.
Fruits provide fruit sugar, fiber, vitamins, and minerals.
Sugars such as table sugar, syrup, and honey and sugar-rich foods such as
desserts and candy provide carbohydrates in the form of sugar with few other
nutrients except for fats. Therefore, the foods in which they predominate are
commonly called low-nutrient-dense foods.
 59

CLASSIFICATION
Carbohydrates are divided into three groups: monosaccharides, disaccharides,
and polysaccharides.

The Glycemic Index (GI):

The glycemic index (GI) is a way of ranking carbohydrate-containing foods

based on how slowly or quickly they are digested and increase blood glucose
levels over a period of time – usually two hours.
 60

The GI uses glucose or white bread as a reference food – it has a GI score of

100. Carbohydrate-containing foods are then compared with this reference to
assign their GI. This ensures all foods compared have the same amount of
carbohydrate, gram for gram.

Carbohydrates that break down quickly during digestion have a higher glycemic
index. These high GI carbohydrates, such as a baked potato, release their
glucose into the blood quickly.

Carbohydrates that break down slowly, such as oats, release glucose gradually
into the bloodstream. They have low glycemic indexes. The blood glucose
response is slower and flatter. Low GI foods prolong digestion due to their slow
breakdown and may help with feeling full.

Blood Glucose Regulation:

The body converts the carbohydrates from food into glucose, a simple sugar that
serves as a vital source of energy.

Blood sugar levels are a measure of how effectively the body uses glucose.
 61

These vary throughout the day. However, in most instances, insulin and
glucagon keep these levels within a healthy range.

When the body does not convert enough glucose, blood sugar levels remain
high. Insulin helps the cells absorb glucose, reducing blood sugar and providing
the cells with glucose for energy.

When blood sugar levels are too low, the pancreas releases glucagon. Glucagon
instructs the liver to release stored glucose, which causes blood sugar to rise.

Islet cells in the pancreas are responsible for releasing both insulin and
glucagon. The pancreas contains many clusters of these cells. There are several
different types of islet cell, including beta cells, which release insulin, and alpha
cells, which release glucagon.

How Insulin works:

The cells need glucose for energy. However, most of them are unable to use
glucose without the help of insulin.

Insulin gives glucose access to the cells. It attaches to the insulin receptors on
cells throughout the body, instructing the cells to open up and grant entry to
glucose.

Low levels of insulin constantly circulate throughout the body. A spike in

insulin signals to the liver that blood glucose is also high. The liver absorbs
glucose then changes it into a storage molecule called glycogen.

When blood sugar levels drop, glucagon instructs the liver to convert the
glycogen back to glucose, causing blood sugar levels to return to normal.

Insulin also supports healing after an injury by delivering amino acids to the
muscles. Amino acids help build the protein that is present in muscle tissue, so
when insulin levels are low, muscles may not heal properly.

How Glucagon works:

The liver stores glucose to power the cells during periods of low blood sugar.
Skipping meals and poor nutrition can lower blood sugar. By storing glucose,
 62

the liver makes sure that blood glucose levels remain steady between meals and
during sleep.

When blood glucose falls, cells in the pancreas secrete glucagon. Glucagon
instructs the liver to convert glycogen to glucose, making glucose more
available in the bloodstream.

From there, insulin attaches to its receptors on the body’s cells and ensures that
they can absorb glucose.

Insulin and glucagon work in a cycle. Glucagon interacts with the liver to
increase blood sugar, while insulin reduces blood sugar by helping the cells use
glucose.

Ideal blood sugar levels:

A range of factors, including insulin resistance, diabetes, and an unbalanced

diet, can cause blood sugar levels to spike or plummet.

The standard measurement units for blood sugar levels are milligrams per
deciliter (mg/dl). Ideal blood sugar ranges are as follows:

Timing Blood glucose level (mg/dL)

Person without diabetes: 100 mg/dL
Before breakfast
Person with diabetes: 70–13
Person without diabetes: Less than 140 mg/dL
2 hours after a meal
Person with diabetes: Less than 180 mg/dL
Person without diabetes: 120 mg/dL
Bedtime
Person with diabetes: 90–150 mg/dL

Recommendations of sugar intake for health:

It’s very important to make the distinction between added sugars and sugars that
occur naturally in foods like fruits and vegetables.
 63

These foods contain water, fiber, and various micronutrients. Naturally

occurring sugars are absolutely fine, but the same does not apply to added sugar.

Added sugar is the main ingredient in candy and abundant in many processed
foods, such as soft drinks and baked products.

The most common added sugars are regular table sugar (sucrose) and high
fructose corn syrup.

What is a safe amount of sugar to eat per day?

Some people can eat a lot of sugar without harm, while others should avoid it as
much as possible.

According to the American Heart Association (AHA), the maximum amount of

added sugars you should eat in a day are:

 Men: 150 calories per day (37.5 grams or 9 teaspoons)

 Women: 100 calories per day (25 grams or 6 teaspoons)

To put that into perspective, one 12-ounce (355-mL) can of Coke contains 140
calories from sugar, while a regular-sized Snickers bar contains 120 calories
from sugar.

In contrast, the US dietary guidelines advise people to limit their intake to less
than 10% of their daily calorie intake. For a person eating 2,000 calories per
day, this would equal 50 grams of sugar, or about 12.5 teaspoon.
 64

How to minimize sugars in your diet:

Limit these foods, in order of importance:

1. Soft drinks. A single 12-ounce (355-mL) can of soda contains as much as

8 teaspoons of sugar.
2. Fruit juices. Fruit juices contain the same amount of sugar as soft drinks.
Choose whole fruit or canned fruit with no additional sweetening instead.
3. Candies and sweets. Try to limit your consumption of sweets.
4. Baked goods. These include cookies, cakes, and pies, among other
pastries. They tend to be very high in sugar and refined carbohydrates.
5. Low fat or diet foods. Foods that have had the fat removed from them
are often very high in sugar.

Heath Effects of Fiber & Starch:

Fiber:

Fiber is one of the main reasons whole plant foods are good for
you.Growing evidence shows that adequate fiber intake may benefit your
digestion and reduce your risk of chronic disease.
 65

Benefits of a high-fiber diet

A high-fiber diet:

 Normalizes bowel movements. Dietary fiber increases the weight and size
of your stool and softens it. A bulky stool is easier to pass, decreasing your
chance of constipation. If you have loose, watery stools, fiber may help to
solidify the stool because it absorbs water and adds bulk to stool.
 Helps maintain bowel health. A high-fiber diet may lower your risk of
developing hemorrhoids and small pouches in your colon (diverticular
disease). Studies have also found that a high-fiber diet likely lowers the risk
of colorectal cancer. Some fiber is fermented in the colon. Researchers are
looking at how this may play a role in preventing diseases of the colon.
 Lowers cholesterol levels. Soluble fiber found in beans, oats, flaxseed and
oat bran may help lower total blood cholesterol levels by lowering low-
density lipoprotein, or "bad," cholesterol levels. Studies also have shown that
high-fiber foods may have other heart-health benefits, such as reducing blood
pressure and inflammation.
 Helps control blood sugar levels. In people with diabetes, fiber —
particularly soluble fiber — can slow the absorption of sugar and help
improve blood sugar levels. A healthy diet that includes insoluble fiber may
also reduce the risk of developing type 2 diabetes.
 Aids in achieving healthy weight. High-fiber foods tend to be more filling
than low-fiber foods, so you're likely to eat less and stay satisfied longer.
And high-fiber foods tend to take longer to eat and to be less "energy dense,"
which means they have fewer calories for the same volume of food.
 Helps you live longer. Studies suggest that increasing your dietary fiber
intake — especially cereal fiber — is associated with a reduced risk of dying
from cardiovascular disease and all cancers.
Your best fiber choices
If you aren't getting enough fiber each day, you may need to boost your
intake. Good choices include:
 66

 Whole-grain products
 Fruits
 Vegetables
 Beans, peas and other legumes
 Nuts and seeds

Starch:
Starchy foods are our main source of carbohydrate and have an important role in
a healthy diet. Starchy foods – such as potatoes, bread, rice, pasta, and cereals

Benefits of starch:
Starchy foods are a good source of energy and the main source of a range of
nutrients in our diet. As well as starch, they contain fibre, calcium, iron and B
vitamins.Some people think starchy foods are fattening, but gram for gram they
contain fewer than half the calories of fat.
Foods rich with starch:
 Potato
 Bread
 Cereal products
 Rice and grains
 Pasta.
Artificial sweeteners:
Artificial sweeteners are synthetic sugar substitutes. But they may be derived
from naturally occurring substances, such as herbs or sugar itself. Artificial
sweeteners are also known as intense sweeteners because they are many times
sweeter than sugar.
Artificial sweeteners can be attractive alternatives to sugar because they add
virtually no calories to your diet. Also, you need only a fraction of artificial
 67

sweetener compared with the amount of sugar you would normally use for
sweetness.
Uses for artificial sweeteners
Artificial sweeteners are widely used in processed foods, including:
Soft drinks, powdered drink mixes and other beverages
 Baked goods
 Candy
 Puddings
 Canned foods
 Jams and jellies
 Dairy products
Artificial sweeteners are also popular for home use. Some can even be used in
baking or cooking.
Certain recipes may need modification because unlike sugar, artificial
sweeteners provide no bulk or volume. Check the labels on artificial sweeteners
for appropriate home use.
Some artificial sweeteners may leave an aftertaste. A different artificial
sweetener or a combination may be more appealing.

Possible health benefits of artificial sweeteners:

Artificial sweeteners don't contribute to tooth decay and cavities. Artificial
sweeteners may also help with:
Weight control. Artificial sweeteners have virtually no calories. In contrast, a
teaspoon of sugar has about 16 calories — so a can of sweetened cola with 10
teaspoons of added sugar has about 160 calories. If you're trying to lose weight
or prevent weight gain, products sweetened with artificial sweeteners may be an
 68

attractive option, although their effectiveness for long-term weight loss isn't
clear.
Diabetes. Artificial sweeteners aren't carbohydrates. So unlike sugar, artificial
sweeteners generally don't raise blood sugar levels. Ask your doctor or dietitian
before using any sugar substitutes if you have diabetes.

Dietary recommendations for NIDDM and IDDM:

NIDDM: Noninsulin-Dependent Diabetes Mellitus

Noninsulin-dependent diabetes mellitus is a major health problem, highly

correlated with obesity and, therefore, overeating. Diet continues as the
cornerstone of therapy, with oral hypoglycemic agents or insulin added, if
needed, to maintain normal blood glucose values. The diet prescription should
be implemented in stages, with caloric restriction the first priority, as weight
loss itself diminishes hyperglycemia to or toward normal. Combinations of
foods and even different processing or cooking of the same food may produce
different glucose responses. These factors minimize the role of the glycemic
index in overall diabetes management. Foods with high soluble fiber content
may diminish glucose elevations after meals; however, high-fiber foods appear
to be less important for the obese diabetic person than adhering to a calorie-
restricted diet and achieving weight loss. Attempts should be made to alter life-
style within an acceptable degree for any given patient to encourage weight
reduction. For example, although exercise may have a small but transient direct
effect in lowering blood glucose and insulin resistance, it can be considered an
adjunct to decreased calorie diets for weight reduction. Finally, it appears
prudent to prevent or reverse obesity, especially in individuals with a family
history of diabetes, in the hope that the onset of diabetes may be prevented or
postponed.
IDDM: Insulin-Dependent Diabetes Mellitus
 69

In Type 1 diabetes the pancreas can do longer release insulin. This is important
because insulin is needed to move sugar (glucose) out of the blood and into
muscle, brain, and other target cells where it is used for energy. The high blood
sugar that results can lead to a number of complications such as kidney, nerve,
and eye damage, as well as cardiovascular disease.

Food recommendations for IDDM:

Carbohydrates are the primary food category that raises blood sugar.
Carbohydrates can be classified as simple sugars or complex carbohydrates.
Most people think about breads, pastas, sweets, and baked goods when they
think about carbs. Fruits and vegetables also contain carbohydrates, but the high
amounts of fiber and nutrition make them good options despite the carbs.

Complex carbohydrates are in their whole food form and include additional
nutrients such as fiber, vitamins, and smaller amounts of proteins and fats.
These additional nutrients slow down the absorption of the glucose and keep
blood sugar more stable. Examples of complex carbohydrates are

 brown rice,
 whole wheat,
 quinoa,
 steel-cut oatmeal,
 vegetables,
 fruits,
 beans, and
 lentils.

Simple carbohydrates are easily recognized as "white foods," for example,

 sugar,
 pasta,
 70

 white bread,
 flour,
 cookies,
 pastries, and
 white potatoes.
 71

UNIT IV

PROTEINS & LIPIDS

Proteins; Food enzymes; Texturized proteins; Food sources, functional role and
uses in foods. Review of structure, composition & nomenclature of fats. Non-
glyceride components in fats & oils; Fat replacements; Food sources, functional
role and uses in foods. Health effects and recommended intakes of lipids.
Recommended intakes of proteins, Deficiency- short term and long-term effects.

PROTEINS

Proteins are the basic material of every body cell. By the age of 4 years, body
protein content reaches the adult level of about 18% of body weight. An
adequate supply of proteins in the daily diet is essential for normal growth and
development and for the maintenance of health. Proteins are appro-priately
named. The word protein is of Greek derivation and means “of first
importance.”
 72

FUNCTIONS
Proteins build and repair body tissue, play major roles in regulating various
body functions, and provide energy if there is insufficient carbohydrate and fat
in the diet.

Building and Repairing Body Tissue

The primary function of proteins is to build and repair body tissues. This is
made possible by the provision of the correct type and number of amino acids in
the diet. Also, as cells are broken down during metabolism (catabolism), some
amino acids released into the blood are recycled to build new and repair other
tissue (anabolism). The body uses the recycled amino acids as efficiently as
those obtained from the diet.
 73

Regulating Body Functions

Proteins are important components of hormones and enzymes that are essen-tial
for the regulation of metabolism and digestion. Proteins help maintain fluid and
electrolyte balances in the body and thus prevent edema (abnormal reten-tion of
body fluids). Proteins also are essential for the development of antibodies and,
consequently, for a healthy immune system.

Providing Energy

Proteins can provide energy if and when the supply of carbohydrates and fats in
the diet is insufficient. Each gram of protein provides 4 calories. This is not a
good use of proteins, however. In general, they are more expensive than
carbohydrates, and most of the complete proteins also contain saturated fats and
cholesterol.

FOOD SOURCES

Proteins are found in both animal and plant foods (Table 6-1). The animal food
sources provide the highest quality of complete proteins. They include meats,
fish, poultry, eggs, milk, and cheese.

Despite the high biologic value of proteins from animal food sources, they also
provide saturated fats and cholesterol. Consequently, complete proteins should
be carefully selected from low-fat animal foods such as fish, lean meats, and
low-fat dairy products. Whole eggs should be limited to two or three a week if
hyperlipidemia is a problem.
 74

Proteins found in plant foods are incomplete proteins and are of a lower biologic
quality than those found in animal foods. Even so, plant foods are important
sources of protein. Examples of plant foods containing protein are corn, grains,
nuts, sunflower seeds, sesame seeds, and legumes such as soy-beans, navy
beans, pinto beans, split peas, chickpeas, and peanuts.

Plant proteins can be used to produce textured soy protein and tofu, also called
analogues. Meat alternatives (analogues) made from soybeans contain soy
protein and other ingredients mixed together to simulate various kinds of meat.
Meat alternatives may be canned, dried, or frozen. Analogues are excel-lent
sources of protein, iron, and B vitamins.

Tofu is a soft cheeselike food made from soy milk. Tofu is a bland product that
easily absorbs the flavors of other ingredients with which it is cooked. Tofu is
rich in high-quality proteins and B vitamins, and it is low in sodium. Textured
soy protein and tofu are both economical and nutritious meat replacements.

Because of their inclusion of either dairy products and eggs or dairy prod-ucts
alone, most individuals who follow lacto-ovo vegetarian or lacto-vegetarian
diets will be able to meet their protein requirements through a balanced diet that
includes milk and milk products, enriched grains, nuts, and legumes. Strict veg-
etarians who consume no animal products will need to be more careful to
include other protein-rich food sources such as soybeans, soy milk, and tofu.

CLASSIFICATION

The classification and quality of a protein depends on the number and types of
amino acids it contains. There are 20 amino acids, but only 10 are considered
essential to humans (Table 6-2). Two additional amino acids are sometimes
incorporated into proteins during translation: selenocyteine and pyrrolysine.
Essential amino acids are necessary for normal growth and development and
must be provided in the diet. Proteins containing all the essential amino acids
are of high biologic value; these proteins are called complete proteins and are
extremely bioavailable. The nonessential amino acids can be produced in the
body from the essential amino acids, vitamins, and minerals.
 75

Incomplete proteins are those that lack one or more of the essentialamino
acids. Consequently, incomplete proteins cannot build tissue without the help of
other proteins. The value of each is increased when it is eaten in combination
with another incomplete protein, not necessarily at the same meal but during the
same day. In this way, one incomplete protein food can provide the essential
amino acids the other lacks. The combination may thereby pro-vide all the
essential amino acids (Figure 6-1). When this occurs, the proteins are
called complementary proteins (Table 6-3). Gelatin is the only protein from an
animal source that is an incomplete protein.
 76

COMPOSITION

Like carbohydrates and fats, proteins contain carbon, hydrogen, and oxygen, but
in different proportions. In addition, and most important, they are the only
nutrient group that contains nitrogen, and some contain sulfur. Figure 6-1 is an
example of an amino acid with a nitrogen (N) molecule.

Proteins are composed of chemical compounds called amino acids (Figure 6-2).
Amino acids are sometimes called the building blocks of protein because they
are combined to form the thousands of proteins in the human body. Heredity
determines the specific types of proteins within each person.
 77

DIGESTION AND ABSORPTION

The mechanical digestion of protein begins in the mouth, where the teeth grind
the food into small pieces. Chemical digestion begins in the stomach.
Hydrochloric acid prepares the stomach so that the enzyme pepsin can begin its
task of reducing proteins to polypeptides.

After the polypeptides reach the small intestine, three pancreatic en-zymes
(trypsin, chymotrypsin, and carboxypeptidase) continue chemical digestion.
Intestinal peptidases finally reduce the proteins to amino acids.

After digestion, the amino acids in the small intestine are absorbed by the villi
and are carried by the blood to all body tissues. There, they are used to form
needed proteins.
 78

METABOLISM AND ELIMINATION

All essential amino acids must be present to build and repair the cells as needed.
When amino acids are broken down, the nitrogen-containing amine group is
stripped off. This process is called deamination. Deamination pro-duces
ammonia, which is released into the bloodstream by the cells. The liver picks up
the ammonia, converts it to urea, and returns it to the bloodstream for the
kidneys to filter out and excrete. The remaining parts are used for energy or are
converted to carbohydrate or fat and stored as glycogen or adipose tissue.

DIETARY REQUIREMENTS

One’s protein requirement is determined by size, age, sex, and physical and
emotional conditions. A large person has more body cells to maintain than a
small person. A growing child, a pregnant woman, or a woman who is
breastfeeding needs more protein for each pound of body weight than the
average adult. When digestion is inefficient, fewer amino acids are absorbed by
the body; consequently the protein requirement is higher. This is sometimes
thought to be the case with the elderly. Extra proteins are usually required after
surgery, severe burns, or during infections in order to replace lost tissue and to
manufacture antibodies. In addition, emotional trauma can cause the body to
excrete more nitrogen than it normally does, thus increasing the need for protein
foods.
 79

The National Research Council of the National Academy of Sciences con-siders

the average adult’s daily requirement to be 0.8 gram of protein for each
kilogram of body weight. To determine your requirement, do the following:

Divide body weight by 2.2 (the number of pounds per kilogram).

Multiply the answer obtained in step 1 by 0.8 (gram of protein per

kilogram of body weight).

In 2002 the Dietary Reference Intakes (DRIs) for protein were published by the
National Academy of Sciences (see Table 6-4). An Adequate Intake (AI) was
established for infants 0 to 6 months, with all other recommendations based on
0.8 g/kg of body weight. Table 6-5 provides an idea of the amount of protein in
an average day’s diet. (For specific amounts of protein in other foods, refer to
Appendix D.)
80
 81

Protein Excess

It is easy for people living in the developed parts of the world to ingest more
protein than the body requires. There are a number of reasons why this should
be avoided. The saturated fats and cholesterol common to complete protein
foods may contribute to heart disease and provide more calories than are
desirable. Some studies seem to indicate a connection between long-term high-
protein diets and colon cancer and high calcium excretion, which de-pletes the
 82

bones of calcium and may contribute to osteoporosis. People who eat excessive
amounts of protein-rich foods may ignore the also essential fruits and
vegetables, and excess protein intake may put more demands on the liver (which
converts nitrogen to urea) and the kidneys to excrete excess urea than they are
prepared to handle. Therefore, the National Research Council recommends that
protein intake represent no more than 15% to 20% of one’s daily calorie intake
and not exceed double the amount given in the table of DRIs (Table 6-4).

Protein and Amino Acid Supplements

Protein and amino acid supplements are taken for a number of reasons, such as
“bulking up” by athletes, growing fingernails, and sparing body protein in
weight loss. It is weight lifting, not protein bars or protein supplements, that
builds muscles. Fingernails have never been affected by extra protein, and
dieters need a balanced diet using the guidelines of MyPyramid.

High-quality protein foods are more bioavailable than expensive sup-plements.

Single amino acids can be harmful to the body and never occur naturally in
food. The body was designed to handle food, not supplements. If a single amino
acid has been recommended, it is very important that a physician be consulted
before the amino acid is used.

Nitrogen Balance

Protein requirements may be discussed in terms of nitrogen balance. This

occurs when nitrogen intake equals the amount of nitrogen excreted. Posi-tive
nitrogen balance exists when nitrogen intake exceeds the amountexcreted. This
indicates that new tissue is being formed, and it occurs dur-ing pregnancy,
during children’s growing years, when athletes develop additional muscle tissue,
and when tissues are rebuilt after physical trauma such as illness or
injury. Negative nitrogen balance indicates that protein is being lost. It may be
caused by fevers, injury, surgery, burns, starvation, or immobilization.

Protein Deficiency

When people are unable to obtain an adequate supply of protein for an extended
period, muscle wasting will occur, and arms and legs become very thin. At the
 83

same time, albumin (protein in blood plasma) deficiency will cause edema,
resulting in an extremely swollen appearance. The water is excreted when
sufficient protein is eaten. People may lose appetite, strength, and weight, and
wounds may heal very slowly. Patients suffering from edema become lethar-gic
and depressed. These signs are seen in grossly neglected children or in the
elderly, poor, or incapacitated. It is essential that people following vegetarian
diets, especially vegans, carefully calculate the types and amount of protein in
their diets so as to avoid protein deficiency.

Protein Energy Malnutrition (PEM)

People suffering from protein energy malnutrition (PEM) lack both protein
and energy-rich foods. Such a condition is not uncommon in developing coun-
tries where there are long-term shortages of both protein and energy foods.
Children who lack sufficient protein do not grow to their potential size. Infants
born to mothers eating insufficient protein during pregnancy can have perma-
nently impaired mental capacities.

Two deficiency diseases that affect children are caused by a grossly inad-equate
supply of protein or energy or both. Marasmus, a condition resulting from
severe malnutrition, afflicts very young children who lack both energy and
protein foods as well as vitamins and minerals. The infant with marasmus
appears emaciated but does not have edema. Hair is dull and dry, and the skin is
thin and wrinkled (Figure 6-3). The other protein deficiency disease that affects
children as well as adults is kwashiorkor (Figure 6-4). Kwashiorkor appears
when there is a sudden or recent lack of protein-containing food (such as during
a famine). This disease causes fat to accumulate in the liver, and the lack of
protein and hormones results in edema, painful skin lesions, and changes in the
pigmentation of skin and hair. The mortality rate for kwashiorkor patients is
high.
 84

Those who survive these deficiency diseases may suffer from permanent mental
retardation. The ultimate cost of food deprivation among youngchildren is
high, indeed.
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Table 6-6 lists some signs that help distinguish marasmus from kwashiorkor.
 86

Food Enzymes: What Are They & Why Are They Important?

You probably are hearing a lot of talk about enzymes. Usually the information
is shared by medical professionals with very thorough knowledge and advanced
vocabularies. So, I’d like to help clarify some of the confusion in this article by
pointing out—in simple terms—some things you need to know. Let’s start with
this… Enzymes are a very important part of life. In fact, enzymes are the spark
of life! Today, I want to share with you some information about food enzymes.
You Can’t Live Without Enzymes!
Enzymes are the mechanics that make your body function. Although the action
of enzymes cannot be seen, they are the driving force behind virtually every
biochemical process that occurs in the body. There are hundreds of thousands of
enzymes active in every organ, tissue, and fluid; and each has its own function.
Enzymes activate our muscles, stimulate our nerves, and make our hearts beat,
keep us breathing, and even help us think.
There Are Three Distinct Types Of Enzymes
Food enzymes which are contained in all raw food.
Metabolic enzymes which run other biochemical processes.
Digestive enzymes which are secreted by the body to digest food.
What Food Enzymes Do
Plant enzymes bring the plant to maturity or ripeness. Enzymes are released by
either chewing or cutting the plant. All enzymes require the following in order
to work:
 Presence of water
 Proper temperature
 The correct pH range (Acid vs. Alkaline)
 Something to digest
There Are Four Types Of Food Enzymes
Food enzymes can digest protein, fat, carbohydrates, and fiber.
Proteases break down protein (meats, beans, etc.)
Amylases break down carbohydrates (potatoes, pasta, cookies, etc.)
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Lipases break down fats (olives, avocadoes, etc)

Cellulases break down fiber (celery, carrots, etc)
Food enzymes work in a very wide pH range and can be used to “pre-digest”
food in the stomach. Pre-digestion enables food enzymes to assist the body’s
digestive response and relieve digestive symptoms.
Three Amalyses Are Essential For The Digestion Of Carbohydrates
Lactase breaks down lactose (milk)
Sucrase breaks down sucrose (refined sugar)
Maltase breaks down maltose (malt sugar)
Nutritionally Balanced Diet And Enzymes
If you eat food—no matter how it’s prepared from raw to microwave—you need
enzymes! When food enzymes are missing, the body is forced to produce all the
enzymes necessary for digestion. This stresses our organs to supply the enzymes
needed to complete the digestive process. This can lead to indigestion and a
wide variety of avoidable conditions.
Are You Enzyme Deficient?
In the United States alone, more than $80 billion is spent each year to relieve
heartburn, excess acid, bloating, and other symptoms of indigestion. You might
be enzyme deficient if you regularly experience one or more of the following
symptoms:
 Fatigue
 Bowel irregularity
 Abdominal gas
 Headaches
These are just a few of the symptoms known to occur from consuming enzyme
deficient foods. ALL of these symptoms can be attributed to POOR
DIGESTION. If permitted to progress, chronic degenerative diseases may
become evident in later years. The good news is that you don’t have to live with
these conditions.
How to Avoid Enzyme Deficiency
We live in an age of fast foods and processed food. This may be convenient, but
most likely not nutritious. To explain why we’re often tired after eating this
food, understand they contain little to no plant enzymes. This means our body
must produce all of the enzymes needed to digest that “fast meal.” To balance
that, taking plant enzymes with every meal will lessens the stress on your
digestive system and digestive organs. Of course, it’s wiser to skip the fast food
and processed food and choose more healthy options.
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TEXTURIZED PROTEINS
Texturized protein (also referred to textured soy protein or soy meat) is
primarily made from a defatted soy flour. It is used to make a variety
of vegetarian and vegan dishes or as a meat extender.

Fibrated protein is less expensive than meat, poultry or fish and is an

environmentally friendly source of protein.

HOW IS TEXTURIZED PROTEIN MADE?

Dry protein-based ingredients, liquids and steam are mixed and heated in a pre-
conditioner. The paste is then conveyed to a twin-screw extruder where it is
processed thermo-mechanically. This allows proteins to be denatured, to
deactivate certain enzymes that cause rancidity, to destroy growth inhibitors and
to reduce bitterness.
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The mix then goes through the die where protein macromolecules are cross-
linked to form a cell-based structure and to size the final extrudate. Product
texture is then determined by laminar shearing of the protein and evaporation. A
rotating blade then cuts the product as it comes out of the die. Cooling and
drying to reach 10% or less moisture content complete the process.

The product can then be packaged and sold as an ingredient or directly

rehydrated and incorporated into complete meals.

TECHNOLOGY & PROCESS ADVANTAGES :

Clextral twin-screw extrusion systems enable processors to produce texturized
protein economically and eco-friendly :

 Intensified processing to reduce water and energy consumption, while

lowering costs, thus contributing to Sustainable Development
 New die and cutter technology to make complex shapes and sophisticated
recipes
 Control of water holding capacity of extruded textured proteins guaranteed
by accurate process control
 Variable output capacities, from 20 kg/h to 4000 kg/h (depending on raw
material)
 Improved process control to ensure consistent results, traceability and
optimal hygienic conditions
 Expert advice and testing facilities to design new products and recipes

Texturization (plant proteins) => development => physical structure =>

sensation of meat =>"texture" (visible fibres), chewiness, elasticity, tenderness
and juiciness. ❖meat => texture => muscle fibres & connective tissue.

❖plant proteins => globular structure.

❖Texturization => globular proteins => fiber-like structure .

❖ Suitable processes => protein chewiness & good water holding property,
cooking strength & meat-like structure => retain these properties even during
subsequent hydration and heat treatment.

❖ texturized proteins => used as meat analogues, meat substitutes & extenders

❖ Commercial products => exclusively from soy protein.

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Process of Texturization Two categories:

❖1. assemble => heterogeneous structure with protein fibres (by "spinning"
process) within a matrix of binding material.

❖2. soy material => convert => into a hydratable, laminar, chewy mass <=
without true fibres.

Two different processes :

❖1. Steam texturization.

❖2. Thermoplastic extrusion

❖During texturization => globular proteins are unfolded (<= breaking of

intramolecular binding forces) => stabilized through interactions within the
neighbouring chains. Spin Process/Fiber Spinning

❖starting material => protein isolate => contain 90 % or more protein ❖

molecular weight of proteins => 10-50 kdal.

❖ Proteins < 10 kdal => weak fiber builders

❖ Proteins > 50 kdal => disadvantageous (their viscosity & tendency to gel in
alkaline pH range).

Major steps :

❖Dope [High (10-40%) protein concentration] => solublized by addition of

alkali ( pH to 10) => aged (continuous stirring) => complete dissociation of the
protein( sub units) & extensive unfolding of polypeptide chain => high viscosity
=> pressed through a die-plate ( a thousand or more holes) with diameter 50-150
μm => streaming orientation of unfolded protein molecules => extend and align
them in a parallel manner => liquid filaments from the die => coagulation bath
(acetic, citric, phosphoric, lactic, or hydrochloric) and usually 10 % NaCl at pH
2-3 => proteins coagulated (iso-electric pH and by salting-out effect) =>
elongated, parallel protein molecules of each filament interacts with each other (
hydrogen, ionic and disulfide bond ) => form hydrated protein fiber => removed
on rollers=> stretched = better alignment=> associate closely => form more
intermolecular bonds => increases mechanical strength and chewiness =>
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compressed between rollers => promote adhesion and toughness => bundles=>
neutralizing bath (NaHCO3 and NaCl) at pH 5.5 to 6.0 => bath (a binder and
other additives such as aroma compounds and lipids) to improve the thermal
stability and aroma => heated, cut, assembled & compressed=> fibers and
texture resembles meat.

Extrusion Method/Thermoplastic Extrusion

❖Major technique => for texturization of vegetable proteins => leads =>
formation of dry, fibrous, porous granules / chunks => possess chewy texture <=
rehydration.

❖starting material => need not be protein isolates.

❖Cheap protein concentrates / flours (45-70% protein) => use

❖small amounts of starch / amylose / 3% NaCl / CaCl2 (addition) => improves

final texture

❖lipid content >5-10% is detrimental.

The major steps involved are :

Starting material => moisture content (30-40%) => incorporate additives

=>Protein mixture => fed to extruder => exposed to a high pressure(10,000 to
20,000 kPa) 20-150 s => mixture => elevated to a temperature of 150-200oC =>
transformed => a plastic viscous state=> in which solids are dispersed => partial
unfolding of the globular proteins => Hydration => stretching and
rearrangement of the protein strands => thermal coagulation of proteins may
occur => extruded through a small diameter orifice => normal pressure
environment => results in formation of expanding steam bubbles by flash
evaporation of internal water => leaving vacuoles in the protein chunks=>
cooling => highly expanded dry structure of protein polysaccharide matrix =>
may absorb 2 to 4 times of water => giving a fibrous, spongy structure &
chewiness like meat=> stable even under sterilization conditions
 92

LIPIDS OR FATS

Fats belong to a group of organic compounds called lipids. The word lipid is
derived from lipos, a Greek word for fat. Forms of this word are found in
several fat-related health terms such as blood lipids (fats in the blood),
hyperlipidemia (high levels of fat in the blood), and lipoproteins (carriers of fat
in human blood).

Fats are greasy substances that are not soluble in water. They are soluble in
some solvents such as ether, benzene, and chloroform. They provide a more
concentrated source of energy than carbohydrates; each gram of fat contains 9
calories. This is slightly more than twice the calorie content of carbohydrates.
Fat-rich foods are generally more expensive than carbohydrate-rich foods. Like
carbohydrates, fats are composed of carbon, hydrogen, and oxygen but with a
substantially lower proportion of oxygen.

FUNCTIONS
In addition to providing energy, fats are essential for the functioning and
structure of body tissues (Table 5-1). Fats are a necessary part of cell
membranes (cell walls). They contain essential fatty acids and act as carriers for
fat-soluble vitamins A, D, E, and K. The fat stored in body tissues provides
energy when one cannot eat, as may occur during some illness and after
abdominal surgery. Adipose (fatty) tissue protects organs and bones from injury
by serving as protective padding and support. Body fat also serves as insulation
from cold. In addition, fats provide a feeling of satiety (satisfaction) after meals.
This is due partly to the flavor fats give other foods and partly to their slow rate
of digestion, which delays hunger.
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FOOD SOURCES
Fats are present in both animal and plant foods. The animal foods that provide
the richest sources of fats are meats, especially fatty meats such as bacon,
sausage, and luncheon meats; whole, low-fat, and reduced-fat milk; cream;
butter; cheeses made with cream; egg yolks (egg white contains no fat; it is
almost entirely protein and water); and fatty fish such as tuna and salmon.
The plant foods containing the richest sources of fats are cooking oils made
from olives sunflower, safflower, or sesame seeds or from corn, peanuts, or
soybeans, margarine (which is made from vegetable oils), nuts, avocados,
coconut, and cocoa butter.

Visible and Invisible Fats in Food

Sometimes fats are referred to as visible or invisible, depending on their food
sources. Fats that are purchased and used as fats such as butter, margarine, lard,
and cooking oils are called visible fats. Hidden or invisible fats are those found
in other foods such as meats, cream, whole milk, cheese, egg yolk, fried foods,
pastries, avocados, and nuts.
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It is often the invisible fats that can make it difficult for clients on limited-fat
diets to regulate their fat intake. For example, one 3-inch doughnut may contain
12 grams of fat, whereas one 3-inch bagel contains only 2 grams of fat. One
fried chicken drumstick may contain 11 grams of fat, whereas one roasted
drumstick may contain only 2 grams of fat.

It is essential that the health care professional confirm that clients on limited-fat
diets are carefully educated about sources of hidden fats.

CLASSIFICATION

Triglycerides, phospholipids, and sterols are all lipids found in food and the hu-
man body. Most lipids in the body (95%) are triglycerides. They are in body
cells, and they circulate in the blood.

Triglycerides are composed of three (tri) fatty acids attached to aframework

of glycerol, thus their name (Figure 5-1). Glycerol is derived from a water-
soluble carbohydrate. Fatty acids are organic compounds of carbon atoms to
which hydrogen atoms are attached. They are classified in two ways: essential
or nonessential. Essential fatty acids (EFAs) are necessary fats that humans
cannot synthesize; EFAs must be obtained through diet. EFAs are long-chain
polyunsaturated fatty acids derived from linoleic, linolenic, and oleic acids.
There are two families of EFAs: omega-3 and omega-6. Nec-essary, but
nonessential, are the omega-9 fatty acids because the body can manufacture a
modest amount, provided EFAs are present.
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The other method of classification of fatty acids is by their degree of satu-ration

with hydrogen atoms. In this method, they are described
as saturated,monounsaturated, or polyunsaturated, depending on their hydrogen
content(Figure 5-2).
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Saturated Fats
When a fatty acid is saturated, each of its carbon atoms carries all the hydrogen
atoms possible. In general, animal foods contain more saturated fatty acids than
unsaturated. Examples include meat, poultry, egg yolks, whole milk, whole milk
cheeses, cream, ice cream, and butter. Although plant foods generally contain
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more polyunsaturated fatty acids than satu-rated fatty acids, chocolate, coconut,
palm oil, and palm kernel oils are exceptions. They contain substantial amounts
of saturated fatty acids. Foods containing a high proportion of saturated fats are
usually solid at room tem-perature. It is recommended that one consume no
more than 7% of total daily calories as saturated fats.

Monounsaturated Fats

If a fat is monounsaturated, there is one place among the carbon atoms of its
fatty acids where there are fewer hydrogen atoms attached than in saturated fats.
Examples of foods containing monounsaturated fats are olive oil, peanut oil,
canola oil, avocados, and cashew nuts. Research indicates that monounsaturated
fats lower the amount of low-density lipoprotein (LDL) (“bad cholesterol”) in
the blood, but only when they replace saturated fats in one’s diet. They have no
effect on high-density lipoproteins (HDLs) (“good cholesterol”). It is
recommended that one consume 15% of total daily calories as monounsaturated
fats (Table 5-2).

Polyunsaturated Fats

If a fat is polyunsaturated, there are two or more places among the carbon
atoms of its fatty acids where there are fewer hydrogen atoms attached than in
saturated fats. The point at which carbon-carbon double bonds occur in a poly-
unsaturated fatty acid is the determining factor in how the body metabolizes it.
The two major fatty acids denoted by the placement of their double bonds are
the omega-3 and omega-6 fatty acids. Omega-3 fatty acids have been reported
 98

to help lower the risk of heart disease. Because omega-3 fatty acids are found in
fish oils, an increased intake of fatty fish is recommended.
Omega-6 (linoleic acid) has a cholesterol-lowering effect. The use of
supplements of either of these fatty acids is not recommended. Examples of
foods containing polyunsaturated fats include cooking oils made from
sunflower, safflower, or sesame seeds or from corn or soybeans; soft margarines
whose major ingredient is liquid vegetable oil; and fish. Foods containing high
proportions of polyunsaturated fats are usually soft or oily. Polyunsaturated fats
should not exceed 8% of total daily calories.

Trans-Fatty Acid

Trans-fatty acids (TFAs) are produced when hydrogen atoms are added
tomonounsaturated or polyunsaturated fats to produce a semisolid product like
margarine and shortening. A product is likely to contain a significant amount of
TFAs if partially hydrogenated vegetable oil is listed in the first three
ingredients on the label. The major source of TFAs in the diet is from baked
goods and foods eaten in restaurants. TFAs raise LDLs and total cholesterol.

Hydrogenated Fats.Hydrogenated fats are polyunsaturated veg-etable oils to

which hydrogen has been added commercially to make them solid at room
temperature. This process, called hydrogenation, turns polyunsaturated
vegetable oils into saturated fats. Margarine is made in this way. (Soft
margarine contains less saturated fat than firm margarine.)

CHOLESTEROL

Cholesterol is a sterol (Figure 5-2). It is not a true fat but a fatlike substancethat
exists in animal foods and body cells. It does not exist in plant foods.
Cholesterol is essential for the synthesis of bile, sex hormones, cortisone, and
vitamin D and is needed by every cell in the body. The body manufactures 800
to 1,000 mg of cholesterol a day in the liver.
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Cholesterol is a common constituent (part) of one’s daily diet because it is found

so abundantly in egg yolk, fatty meats, shellfish, butter, cream, cheese, whole
milk, and organ meats (liver, kidneys, brains, sweetbreads) (Table 5-3).

Cholesterol is thought to be a contributing factor in heart disease be-cause high

serum cholesterol, also called hypercholesterolemia, is common in clients with
atherosclerosis.
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Atherosclerosis is a cardiovascular disease in which plaque (fatty deposits

containing cholesterol and other substances) forms on the inside of artery walls,
reducing the space for blood flow. When the blood cannot flow through an
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artery near the heart, a heart attack occurs. When this is the case near the brain,
a stroke occurs.

It is considered advisable that blood cholesterol levels not exceed 200 mg/dl
(200 milligrams of cholesterol per 1 deciliter of blood). A reduction in the
amount of total fat, saturated fats, and cholesterol and an increase in the
amounts of monounsaturated fats in the diet, weight loss, and exercise all help to
lower serum cholesterol levels. Soluble dietary fiber also is considered help-ful
in lowering blood cholesterol because the cholesterol binds to the fiber and is
eliminated via the feces, thus preventing it from being absorbed in the small
intestine. In some cases, medication may be prescribed if diet, weight loss, and
exercise do not sufficiently lower serum cholesterol.

Because the development of plaque is cumulative, the preferred means of

avoiding or at least limiting its development is to limit cholesterol and fat intake
throughout life. If children are not fed high-cholesterol foods on a regular basis,
their chances of overconsuming them as adults are reduced. Thus, their risk of
heart attack and stroke is also reduced.

DIGESTION AND ABSORPTION

Although 95% of ingested fats are digested, it is a complex process. The chemi-
cal digestion of fats occurs mainly in the small intestine. Fats are not digested in
the mouth. They are digested only slightly in the stomach, where gastric lipase
acts on emulsified fats such as those found in cream and egg yolk. Fats must be
mixed well with the gastric juices before entering the small intestine.

In the small intestine, bile emulsifies the fats, and the enzyme pancreatic lipase
reduces them to fatty acids and glycerol, which the body subsequently absorbs
through villi (Figure 5-3).
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Lipoproteins

Fats are insoluble in water, which is the main component of blood. There-fore,
special carriers must be provided for the fats to be absorbed and transported by
the blood to body cells. In the initial stages of absorption, bile joins with the
products of fat digestion to carry fat. Later, protein com-bines with the final
products of fat digestion to form special carriers called lipoproteins. The
lipoproteins subsequently carry the fats to the body cellsby way of the blood.

Lipoproteins are classified as chylomicrons, very-low-density lipo-proteins

(VLDLs), low-density lipoproteins (LDLs), and high-density lipoproteins
(HDLs), according to their mobility and density. Chylomicronsare the first
lipoprotein identified after eating. They are the largest lipoproteins and the
lightest in weight. They are composed of 80% to 90% triglycerides. Lipoprotein
lipase acts to break down the triglycerides into free fatty acids and glycerol.
Without this enzyme, fat could not get into the cells.

Very-low-density lipoproteins are made primarily by the liver cells and are
composed of 55% to 65% triglycerides. They carry triglycerides and other lipids
to all cells. As the VLDLs lose triglycerides, they pick up cholesterol from other
lipoproteins in the blood, and they then become LDLs. Low-density lipoproteins
are approximately 45% cholesterol with few triglycerides. They carry most of
the blood cholesterol from the liver to the cells. Elevated blood levels greater
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than 130 mg/dl of LDL are thought to be contributing factors in atherosclerosis.

Low-density lipoprotein is sometimes termed bad cholesterol.
High-density lipoproteins carry cholesterol from the cells to the liver for
eventual excretion. The level at which low HDL becomes a major risk factor for
heart disease has been set at 40 mg/dl. Research indicates that an HDL level of
60 mg/dl or more is considered protective against heart disease. High-density
lipoproteins are sometimes called good cholesterol. Exercising, maintaining a
desirable weight, and giving up smoking are all ways to in-crease one’s HDL.

METABOLISM AND ELIMINATION

The liver controls fat metabolism. It hydrolyzes triglycerides and forms new
ones from this hydrolysis as needed. Ultimately, the metabolism of fats occurs
in the cells, where fatty acids are broken down to carbon dioxide and water,
releasing energy. The portion of fat that is not needed for immediate use is
stored as adipose tissue. Carbon dioxide and water are by-products that are used
or removed from the body by the circulatory, respiratory, and excretory systems.

FATS AND THE CONSUMER

Fats continue to be of particular interest to the consumer. Most people know that
fats are high-calorie foods and that they are related to heart disease. But people
who are not in the health field may not know how fats affect health.
Consequently, they may be easily duped by clever ads for or salespersons of
nutritional supplements or new “health food” products.

It is important that the health care professional carefully evaluate any new
dietary “supplement” for which a nutrition claim is made. If the item is not
included in the RDA, DRI, or AI, it is safe to assume that medical research has
not determined that it is essential. Ingestion of dietary supplements of un-known
value could, ironically, be damaging to one’s health.
Lecithin

Lecithin is a fatty substance classified as a phospholipid. It is found in

bothplant and animal foods and is synthesized in the liver. It is a natural
emulsifier that helps transport fat in the bloodstream. It is used commercially to
make food products smooth.
 104

Lecithin supplements have been promoted by some health food salesper-sons as

being able to prevent cardiovascular disease. To date, this has not been
scientifically proven.
Fat Alternatives

Research into fat alternatives has been in progress for decades. Olestra, the
newest product on the market, is made from carbohydrates and fat. The FDA
has approved olestra for use only in snack foods such as potato chips, tortilla
chips, and crackers. The government requires that food la-bels indicate that
olestra “inhibits the absorption of some vitamins and other nutrients.”
Therefore, the fat-soluble vitamins A, D, E, and K havebeen added to foods
containing olestra. Olestra contains no calories, but it can cause cramps and
diarrhea. The products manufactured with olestrashould be used in moderation.
Simplesse is made from either egg white or milk protein and contains1.3 kcal/g.
Simplesse can be used only in cold foods such as ice cream because it becomes
thick or gels when heated. Simplesse is not available forhome use.
Oatrim is carbohydrate-based and is derived from oat fiber. Oatrim isheat-stable
and can be used in baking but not in frying. Manufacturers haveused
carbohydrate-based compounds for years as thickeners. Oatrim does provide
calories, but significantly less than fat.
The long-term effects these products may have on human health andnutrition are
unknown. If they are used in the way the U.S. population usesartificial
sweeteners, they probably will not reduce the actual fat content inthe diet. They
may simply be additions to it. One concern among nutritionistsis that they will
be used in place of nutritious food that, in addition to fat, alsoprovides vitamins,
minerals, proteins, and carbohydrates.

DIETARY REQUIREMENTS
Although no specific dietary requirement for fats is included in the RDA
andDRIs, deficiency symptoms do occur when fats provide less than 10% of the
totaldaily calorie requirement. When gross deficiency occurs, eczema (inflamed
andscaly skin condition) can develop. This has been observed in infants who
werefed formulas lacking the essential fatty acid linoleic acid and in clients
main-tained for long periods on intravenous feedings that lack linoleic acid.
Also,growth may be retarded, and weight loss can occur when diets are
seriouslydeficient in fats.
 105

On the other hand, excessive fat in the diet can lead to obesity or heartdisease.
In addition, studies point to an association between high-fat diets andcancers of
the colon, breast, uterus, and prostate.
The Food and Nutrition Board’s Committee on Diet and Health recommends
that people reduce their fat intake to 30% of total calories. The American Heart
Association’s newest recommendation is to consume less or no more than7% of
saturated fats, 8% polyunsaturated fats, and 15% monounsaturated fats.At
present, 36% of calories in U.S. diets is derived from fats.

Composition of Fats:

A fat is the product of fatty acids bonded to a backbone structure, which is

often a glycerol which consists of a 3 carbon chain.
A triglyceride is specific type of fat formed by the combination of 3 fatty acids
with a glycerol backbone.
Triglycerides are a major constituent of vegetable oils as well as fats in the
body. A single food is usually a source of multiple different fatty acids.

Fatty Acid Nomenclature

Chemists, nutritionists, and lay-people describe fatty acids using different

naming systems. Nutritionists focus much more on Omega and Common names.

There are three naming systems used for fatty acids:

1. Delta nomenclature
2. Omega nomenclature
3. Common names

The Omega Nomenclature and common names are used more in the field of
nutrition than the delta nomenclature when describing specific fatty acids.

Delta Nomenclature

Chemists use Delta Nomenclature, but nutritionists are more focused on the
Omega system which focuses on the nutritional value of the fatty acid. For Delta
Nomenclature one needs to know 3 things:

1. Number of carbons in the fatty acid

 106

2. Number of double bonds

3. Number of carbons from the carboxylic acid (alpha) end to the first carbon
in the double bond(s)

Let’s consider the example in the figure below.

Figure: Delta Nomenclature

Fatty Acid with 18 carbons with a double bond at the ninth carbon atom. This is
also an Omega 9 fatty acid which will be explained below.

1. Number of carbons in the fatty acid = 18

2. Number of double bonds = 1
3. Number of carbons from the carboxylic acid end to the first carbon in the
double bond = 9

Omega Nomenclature

The Omega Nomenclature is almost exactly the same as the Delta

Nomenclature; the only difference is that carbons are counted from the methyl
(omega) end instead of the carboxylic acid end, and the omega symbol is used
instead of the delta symbol.

For Omega Nomenclature one needs to know 3 things:

1. Number of carbons in the fatty acid

2. Number of double bonds
3. Number of carbons from the methyl end (aka Omega end) to the first
carbon in the double bond closest to the methyl end
 107

We will again consider the same fatty acid.

Figure: Omega Nomenclature

Fatty acid where the double bond is at the ninth carbon from the end (omega)
1. Number of carbons in the fatty acid = 18
2. Number of double bonds = 1
3. Number of carbons from the methyl (aka omega) end to the first carbon in
the double bond closest to the methyl end = 9

If it is a saturated fatty acid, then the omega nomenclature is not added to the
end of the name. If it is an 18 carbon saturated fatty acid, then it would be
named 18:0.

This is written as shown in figure 2.332. Instead of an omega prefix, the prefix
n- (i.e. n-3) is also commonly used.

Common Names

The common names of fatty acids are something that, for the most part, have to
be learned/memorized. The common name of the fatty acid we have been
naming in this section is oleic acid.

The table below gives the common names and food sources of some common
fatty acids.
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Non - glyceride constituents of fats

In addition to triacylglycerols, a variety of components are found in dietary fats

which are important in maintaining health. These non-glyceride constituents of
fats may explain some of the inconsistencies in epidemiologic and experimental
studies.

Fat-soluble vitamins

Vitamin A and vitamin D occur prominently in butterfat and fish oils. Red palm
oil is a potent source of B-carotene, a provitamin A. In many developing
countries, especially in West Africa, crude palm oil is an important source of ß-
carotene, providing much of the vitamin A which is required by the populations.

The processing of edible oils, however, often results in the total removal of the
carotenoids present in the crude oil. For example, crude palm oil, a rich source
of carotenoids (500-700 ppm) may lose all of its carotenoids in the refining
process.

However, it is possible to use mild techniques for processing crude palm oil that
result in the retention of a major portion of the carotenoids while removing the
undesirable free fatty acids and peroxides of the crude oil. The resulting red
palm oil, with its high carotenoid content, could become an important dietary
component in the battle against vitamin A deficiency in many developing
countries and its use should be encouraged.

Many vegetable oils and the products made from them, contain appreciable
concentrations of vitamin E (tocopherols) which may be reduced by some
processing methods as well.

Ubiquinones

It is not known if ubiquinone Q9 is biologically active in humans, but

ubiquinone Q10 is active as a mitochondrial electron carrier. Ubiquinone 10,
together with a -tocopherol, appears to protect low density lipoproteins from
oxidation (Tribble et al., 1994).

Antioxidants

Substances other than vitamin E act as antioxidants, but tocopherol is the

principal fat-soluble antioxidant in the body and is found in lipoproteins,
especially LDL. It is found within membranes both inside and outside cells,
enhancing the cell's protection against free radical attack. Vitamin E enhances
immune function (Meydani et al., 1990) and can play a role in the repair of
 109

damaged membranes (Newmark and Mergens, 1981; Bright-See and Newmark,

1983).

It has been hypothesized that dietary antioxidants protect against a variety of

age-related conditions, including cardiovascular disease and cancer. The role of
tocopherol and other antioxidants in protecting unsaturated fatty acids from
oxidation gained attention with the recognition that oxidized LDL could be
involved in the atherosclerotic process (Jurgens et al., 1987). Oxidatively
modified LDL occurs in the atherosclerotic lesion and appears to be the link
between plasma LDL and the development of early lesions (Yla-Herttuala et al.,
1989). Further evidence that lipid oxidation could be a factor in atherosclerosis
came from the finding that the susceptibility of LDL to oxidation was correlated
with the severity of atherosclerosis in young male survivors of myocardial
infarction (Regnstrom et al., 1992).

Antioxidant supplementation of men with low antioxidant status and a high

intake of fat lessened the capacity of platelets to aggregate and to produce
thromboxane A2 (Salonen et al., 1991). In line with this finding, stored serum
samples of 16 European groups provided evidence of an inverse relationship
between plasma a -tocopherol levels and mortality rates from coronary heart
disease (Gey et al., 1991). When a cohort of male volunteers received
supplementation with cx-tocopherol, compared to a placebo, during a 3 month
period, this led to enhanced plasma and LDL a -tocopherol levels and decreased
susceptibility of LDL to oxidation (Jialal and Grundy, 1992). In two large
prospective studies, one among women (Stampfer et al., 1993) and another
among men (Rimm et al., 1993), intake of vitamin E, primarily in the form of
supplements, was associated with a substantially reduced risk of myocardial
infarction. Among men, intake of dietary carotenoids was associated with lower
risk as well, especially among individuals who had smoked cigarettes prior to or
during the study. Current evidence suggests that antioxidants play an important
role in the prevention of coronary heart disease, but further scientific support is
required.

Fat-soluble antioxidants, particularly carotenoids and tocopherol, have been

hypothesized to reduce the risk of various cancers. The best evidence indicates a
relationship between carotenoid intake and risk of epithelial malignancies,
particularly lung cancer (Steinmetz and Potter, 1991). Relatively few data exist
relating vitamin E intake to the risk of cancer, in part because of the difficulty of
assessing intakes of this nutrient. Nevertheless, blood levels of vitamin E (Knekt
et al., 1988) and vitamin E supplements (Gridley et al., 1992) have been
positively related to lower risk of several cancers. Also, vitamin A, both
preformed and from a carotenoid precursor, has been found to be inversely
related to the risk of breast cancer (Hunter et al., 1993).
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There is evidence from animal and epidemiological studies that [l-carotene and
possibly a -carotene, may have anti-cancer properties. Epidemiological studies
have consistently shown associations between high intakes of [l-carotene-
enriched foods with reduced risk of certain cancers (Connett et al., 1989; Le
Marchand et al., 1989; Peto et al., 1981).

Tocotrienols

Apart from their vitamin E activity, tocotrienols exhibit certain physiological

properties not observed with the tocopherols. When administered in the diet of
animals and humans, tocotrienol concentrates have been reported to manifest a
hypocholesterolemic effect (Burger et al., 1984; Qureshi et al., 1991 a, b; Tan et
al., 1991). It has been suggested that the cholesterol-lowering potential of the
tocotrienols may be mediated by their ability to decrease levels of hepatic
HMG-CoA reductase activity (Qureshi et al., 1986). In addition, tocotrienols
have been shown to influence certain hemostatic parameters (Qureshi et al.,
1991 a) and to reduce the occurrence of chemical-induced tumours in rats (Tan
and Chu, 1991; Gould et al., 1991).

Phytosterols

Plant sterols are not well-absorbed by humans and may inhibit cholesterol and
bile acid absorption. They can have appreciable effects on LDL cholesterol
levels, even at relatively low intakes (Grundy and Mok, 1977; Lees et al., 1977;
Heinemann, Leiss and von Bergmann, 1986). While the principal mechanism of
action of phytosterols has not been established, they can influence micellar
cholesterol solubilization (Child and Kuksis, 1986) as well as the rate of
cholesterol synthesis and degradation (Bober, Akerlund and Bjorkhem, 1989,
Ikeda and Sugano, 1983; Heinemann, Leiss and von Bergmann, 1986;
Heinemann et al., 1991).

A group of ferulic acid esters of triterpene alcohols and plant sterols has shown
hypocholesterolemic effects as well, perhaps by inhibiting cholesterol
absorption and enhancing sterol and bile acid excretion (Nicolosi, Ausman and
Hegsted, 1990, 1991 a, b). Oryzanol, a ferulic acid ester, constitutes as much as
20 percent of the non-saponifiable fraction of crude rice bran oil (Rogers et al.,
1993). In addition, ferulic acid is a potent antioxidant which stabilizes vegetable
oils.

Conclusions

Current data on antioxidants, specifically tocopherol, suggest a protective effect

against coronary heart disease in humans. However, these data do not yet
warrant specific recommendations for their intake. The hypothesis that oxidized
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LDL is an important atherogenic factor is generally regarded as attractive.

Although oxidized LDL has been detected in atherosclerotic plaque, solid
evidence that lipoprotein oxidation in humans is causally related to
atherosclerosis has not been reported yet.

A number of studies seem to support the hypothesis that antioxidants can

prevent oxidative modification of LDL. However, before these studies can be
extrapolated to atherosclerosis, several points should be considered: first,
demonstrating a protective effect in humans is difficult because the available
techniques are limited in their ability to measure ongoing lipid peroxidations;
second, the implications of the measurement of LDL oxidation in vitro for the in
vivo situation are not clear; and, third, the efficacy of the individual antioxidants
in the prevention of atherosclerosis has yet to be established in large
intervention studies.

Foods high in polyunsaturates should contain at least 0.6 mg tocopherol

equivalents per gram of polyunsaturated fatty acids. Higher levels may be
necessary for fats rich in fatty acids containing more than two double bonds.

The introduction of low-fat spreads and dressings reduces vitamin E intake. In

light of the emerging evidence on the importance of vitamin E, it may be
prudent to have the same amount of vitamin E per gram of product in such low-
fat products as occur in corresponding high-fat products.
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UNIT V

METABOLISM, ENERGY BALANCE AND BODY COMPOSITION

Energy Balance; body weight and body composition; health implications;

obesity, BMR and BMI calculations; Weight Control: Fat cell development;
hunger, satiety and satiation; dangers of unsafe weight loss schemes; treatment
of obesity; attitudes and behaviours toward weight control. Food and
Pharmaceutical grades; toxicities, deficiencies, factors affecting bioavailability,
Stability under food processing conditions.

Body weight and composition are an important area in the study of nutrition.
The current rapid increase in the prevalence of obesity in some country is
making headlines. Government, medical, public health, and nutritional
professionals are examining and developing strategies to stop or reverse this
trend of increased obesity. This chapter explores what we should weigh, our
body composition, and how to determine the proportions of fat and lean body
mass. Understanding the influences of genetics and hormones that regulate our
appetite, weight, and body composition will assist in developing and
implementing interventions.

ENERGY BALANCE:

The body is in energy balance when the energy intake is equal to the energy
output. Energy input (or intake) is simpler to define than energy output. Energy
intake is the sum of the energy in all of the food and beverages consumed. The
energy is derived from the oxidation or breakdown of carbohydrates, protein,
fats, and alcohol in our bodies. Energy output is more complex. Energy output
includes the energy involved in the absorption, metabolism, and storage of the
nutrients in the food we eat as well as the energy we spend as we breathe, our
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hearts beat, our bodies cool or warm, and we perform physical exercise. The
regulation of food intake, expenditure of energy, and the storage of energy are
very complex, and all aspects are not fully understood. Consistent imbalance of
energy results in either a gain or loss of body weight. If too little energy
(calories) is consumed to balance energy expended, the amount of tissue in our
body is reduced. The desired goal of a weight reduction is to lose adipose tissue,
but other tissue such as muscle can be lost. If the energy consumed is larger than
our expenditure, the adipose stores are increased; and if the positive balance is
large enough for a long enough time, we can become overweight or obese.
Remember that obesity is defined as an excess of body fat and that we use body
weight as a convenient proxy. For the nonathlete, body fat and body weight are
well correlated.

For the past 20 years or so, prevalence of overweight and obesity has increased
rapidly. Obesity is associated with an increased risk of morbidity and mortality.
Conditions associated with being overweight or obese include hypertension,
stroke, coronary artery disease, dyslipidaemia, type 2 diabetes, sleep apnoea,
osteoarthritis, and numerous others. Energy balance is an area of utmost
importance for those interested in the subject of nutrition and metabolism

Whether body weight is being maintained, increased, or decreased depends

primarily on the extent to which the energy requirements of the body (i.e., total
energy expenditure) have been met or exceeded by energy intake. Total energy
expenditure is composed primarily of:

 the resting energy expenditure (REE), or basal metabolic rate (BMR)

 the thermic effect of food (TEF)
 the energy expenditure physical activity or exercise
A fourth component, thermoregulation, is sometimes included. The average
division of energy expenditure among the components, each of which is
described in the diagram.
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BASAL METABOLIC RATE AND RESTING ENERGY

EXPENDITURE:

Basal metabolic rate (BMR) represents the rate at which the body expends
energy to sustain basic life processes such as respiration, heartbeat, renal
function, and blood circulation. It also includes the energy needed to remain in
an awake state, because the measurements are usually made shortly after the
person wakes. The word basal, as it is used in BMR, is often confused with the
term resting; however, basal is more precisely defined than is resting.

The measurement of oxygen consumed and carbon dioxide produced that is

used in calculating energy expenditure is made under closely controlled and
standardized conditions. A person’s basal metabolic rate is determined when he
or she is in a postabsorptive state (i.e., no food intake for at least 12 hours), is
lying down (supine), and is completely relaxed (motionless)—preferably very
shortly after awakening from sleep in the morning. In addition, the temperature
of the room in which the measurement takes place is made as comfortable as
possible (thermoneutral) for the person. Any factors that could influence the
person’s internal work are minimized as much as possible. For most people,
energy expenditure is slowest during sleep. BMR is usually converted to units of
kcal/24 hours and called basal energy expenditure (BEE). In contrast to BMR,
resting metabolic rate (RMR) is measured when the person is at rest in a
comfortable environment. Fasting for 12 hours is not required. Instead, the fast
for RMR is usually about 2 to 4 hours. RMR usually is slightly higher (about
10%) than BMR because of its less stringent conditions of measurement . RMR
is thought to account for about 65% to 80% of daily total energy expenditure .
BMR accounts for about 50% to 70% of daily total energy expenditure .

The term resting energy expenditure (REE) is used when RMR is extrapolated
to units of kcal/24 hours . Basal metabolism is a result of energy exchanges
 115

occurring in all cells of the body. The rate of oxygen consumption, however, is
most closely related to the actively metabolizing cells, that is, the body’s lean
body mass or fat-free mass . In aging, for example, fat increases at the expense
of fat-free mass, and BMR decreases. With maturation, the proportion of
supporting structures (i.e., bone and muscle) increases more rapidly than does
total body weight. Bone and muscle, though components of body cell mass,
have a much lower metabolic activity at rest than organ tissues but much greater
activity than adipose tissue. This difference in the rate of weight accretion
between the less active and the more active components of mass means a
decrease in the overall metabolic activity of cell mass and a concurrent decrease
in BMR per unit of body weight.

These changes that occur during maturation explain the lower REE of children
as compared to very young infants. A look at the metabolic activity among the
different components of the cell mass in an adult male illustrates its variability.
Under normal circumstances, about 5% to 6% of total body weight can be
attributed to the weight of the brain, liver, heart, and kidney, whereas about 30%
to 40% of body weight is attributable to muscle mass. At the same time, the
metabolic activity of these organ tissues accounts for about 60% of basal
oxygen consumption, whereas muscle mass accounts for only about 25%.
Tissues such as bone, glands, intestine, and skin account for 33% of body
weight and contribute 15% to 20% of metabolic activity. In contrast, fat usually
accounts for at least 20% of body weight but contributes only 5% of metabolic
activity. Thus, changes in BMR can occur whenever the proportions of body
tissues change in relation to one another.

BODY WEIGHT AND BODY COMPOSITION:

Body Weight: What Should We Weigh?

Recognition of body weight as an indicator of health status is probably

universal and as old as humanity itself. In fact, in 1846 English surgeon John
Hutchinson published a height-weight table based on a sample of 30-year-old
Englishmen and urged that future census taking include such information, which
he believed to be valuable in promoting health and detecting disease. Today,
scientists and health professionals recognize that the risk of many diseases—
including heart disease, stroke, diabetes mellitus, hypertension, osteoarthritis,
infertility, and some cancers (endometrial, colon, and kidney)—increases with
excess body fat. Because body fat is so difficult to measure, body weight is a
 116

good proxy in the nonathletic population. Furthermore, a low body weight may
indicate malnutrition or an eating disorder and may pose risks for other diseases,
such as osteoporosis. What represents too much weight or too little weight for a
given height? Unfortunately, recommendations from health experts vary.

BODY MASS INDEX:

Body mass index (BMI), first described in the 1860s and known as Quetelet’s
Index, is at present one of the most accepted approaches to assessing appropriate
weight for a given height. The body mass index is considered to indicate body
adiposity but does not measure body fat. Body mass index is calculated from a
person’s height and weight as shown in this formula:
𝑊𝐸𝐼𝐺𝐻𝑇
Body mass index =
𝐻𝐸𝐼𝐺𝐻𝑇 2

Weight measured in kilograms(kg) and height measured in meters(m) and raised

to a power of 2.

Body mass index is considered a good index of total body fat in both men and
women and has generally replaced calculations of percent relative body weight
and percent ideal body weight (see the section “Formulas”) for classifying
people as underweight or overweight. For adults, classification of weight based
on body mass index by the National Institutes of Health

Using the formula to calculate the BMI of a 5-foot 11-inch (or 71-in) man
weighing 165 pounds would involve two conversions before plugging numbers
into the body mass index formula. First, to convert weight in pounds (lb) to
weight in kilograms (kg), divide by 2.2 (because there are 2.2 lb per 1 kg): 165
lb ÷ 2.2 lb/kg = 75 kg. Next, convert height in feet and inches to meters (m).
 117

Because there are 39.37 in/m, divide the man’s height of 71 in by 39.37 in/m to
get 1.803 m. With weight in kilograms and height in meters, the formula can be
used: BMI = 75 kg ÷ (1.803 m)2 = 75 kg ÷ 3.25 m2 = 23.1 kg/m2.

Although the body mass index is a valuable tool for assessing weight, like many
other methods it does not determine body composition. Thus, people such as
athletes may have large amounts of lean body mass and a high body mass index
(and thus be considered overweight or obese by classification) but have a low
percentage of body fat.

The Composition of the Human Body:

The chemical composition of the human body was first described in 1859 in a
book that dealt with the chemical composition of food. Analytic chemistry was a
rapidly growing science at the time, and figures describing the chemical
composition of the different body tissues were compared with those of various
foods. Additional chemical composition data from whole-body analysis of
fetuses, children, and adults collected during the next few decades represent a
direct (rather than indirect) measure of body composition. The concept of the
reference man and woman was developed in the 1970s. These reference figures
provide information on body composition based on average physical dimensions
and provide a frame of reference for comparisons. The reference man and
woman and the change body composition and development with age is
provided.
 118

We focus on the fat mass and fat-free mass and the methods of measuring them.
The reference man has 3% essential fat, 12% storage fat (for a total of 15% body
fat), 44.8% muscle, 14.9% bone, and 25.3% other components. The reference
woman has 12% essential fat, 15% storage fat (for a total of 27% body fat), 36%
muscle, 12% bone, and 25% other components. Essential fat includes the fat that
is associated with bone marrow, the central nervous system, internal organs, and
the cell membranes. The essential fat in females also includes the fat in
mammary glands and the pelvic region. Evaluation of body composition has to
consider these gender differences. A common way to compare and evaluate the
body composition is to consider only two compartments, fat body mass and lean
body mass. Lean body mass includes muscle, bone, and the remainder of the
body weight. Fat mass is mostly triacyl glycerides and other lipid components,
with relatively small amounts of water or electrolytes. Lean body mass is much
more diverse. It is made up of muscle, bones, and the intra- and extracellular
fluids. The differences in the composition of the two compartments are the basis
for many of the methods determining body composition. These differences
include differences in density (weight for a given volume), the ability to conduct
an electrical current, the electrolyte content, and the X-ray density.

HEALTH IMPLICATIONS OF OBESITY:

Obesity is a complex health issue resulting from a combination of causes and

individual factors such as behaviour and genetics. Behaviours can include
physical activity, inactivity, dietary patterns, medication use, and other
exposures. Additional contributing factors include the food and physical activity
environment, education and skills, and food marketing and promotion.
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Obesity is serious because it is associated with poorer mental health outcomes

and reduced quality of life. Obesity is also associated with the leading causes of
death in the United States and worldwide, including diabetes, heart disease,
stroke, and some types of cancer.

Behaviour

Healthy behaviour include regular physical activity and healthy eating.

Balancing the number of calories consumed from foods and beverages with the
number of calories the body uses for activity plays a role in preventing excess
weight gain. The Physical Activity Guidelines for Americans external icon
recommends adults do at least 150 minutes a week of moderate intensity activity
such as brisk walking. In addition, adults need to do activities that strengthen
muscles at least 2 days a week.

A healthy diet pattern follows the Dietary Guidelines for Americans external
icon which emphasizes eating whole grains, fruits, vegetables, lean protein, low-
fat and fat-free dairy products, and drinking water.

A pattern of healthy eating and regular physical activity is also important for
long-term health benefits and prevention of chronic diseases such as type 2
diabetes and heart disease.

Community Environment

People and families may make decisions based on their environment or

community. For example, a person may not walk or bike to the store or to work
because of a lack of sidewalks or safe bike trails. Community, home, childcare,
school, health care, and workplace settings can all influence daily behaviours.
 120

Therefore, it is important to create environments that make it easier to engage in

physical activity and eat healthy foods.

Do Genes Have a Role in Obesity?

Genetic changes in human populations occur too slowly to be responsible for

the obesity epidemic. Nevertheless, how people respond to an environment that
promotes physical inactivity and intake of high-calorie foods suggests that genes
do play a role in developing obesity.

How Could Genes Influence Obesity?

Genes give the body instructions for responding to changes in its environment.
Variants in several genes may contribute to obesity by increasing hunger and
food intake.

Rarely, a clear pattern of inherited obesity within a family is caused by a

specific variant of a single gene (monogenic obesity). Most obesity, however,
probably results from complex interactions among multiple genes and
environmental factors that remain poorly understood (multifactorial obesity).

What about Family History?

Health care practitioners routinely collect family health history to help identify
people at high risk of obesity-related diseases such as diabetes, cardiovascular
diseases, and some forms of cancer. Family health history reflects the effects of
shared genetics and environment among close relatives. Families cannot change
their genes, but they can encourage healthy eating habits and physical activity.
Those changes can improve the health of family members—and improve the
health history of the next generation.

Consequences of Obesity
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Health Consequences

People who have obesity, compared to those with a healthy weight, are at
increased risk for many serious diseases and health conditions, including the
following:

 All-causes of death (mortality)

 High blood pressure (hypertension)
 High LDL cholesterol, low HDL cholesterol, or high levels of
triglycerides (Dyslipidemia)
 Type 2 diabetes
 Coronary heart disease
 Stroke
 Gallbladder disease
 Osteoarthritis (a breakdown of cartilage and bone within a joint)
 Sleep apnea and breathing problems
Economic and Societal Consequences

Obesity and its associated health problems have a significant economic impact
on the US health care system, direct and indirect costs. Direct medical costs
may include preventive, diagnostic, and treatment services. Indirect costs relate
to sickness and death and include lost productivity. Productivity measures
include employees being absent from work for obesity-related health reasons,
decreased productivity while at work, and premature death and disability.
 122

WEIGHT CONTROL:

Keeping a healthy weight is crucial. If you are underweight or overweight, or

have obesity, you may have a higher risk of certain health problems.

About two thirds of adults in the U.S. are overweight or have obesity. Achieving
a healthy weight can help you control your cholesterol, blood pressure and
blood sugar. It might also help you prevent weight-related diseases, such as
heart disease, diabetes, arthritis and some cancers.

Eating too much or not being physically active enough will make you
overweight. To maintain your weight, the calories you eat must equal the energy
you burn. To lose weight, you must use more calories than you eat. A weight-
control strategy might include

 Choosing low-fat, low-calorie foods

 Eating smaller portions
 Drinking water instead of sugary drinks
 Being physically active
 Eating extra calories within a well-balanced diet can help to add weight.
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FAT CELL DEVELOPMENT:

Lipid storage and release from fat cells in adipose tissue are key factors in the
regulation of the energy balance. During infancy and adolescence, adipose tissue
is growing by a combination of increase in fat cell size (to a lesser extent) and
(above all) the number of these cells. In adults, fat cell number is constant over
time in spite of a large turnover (about 10% of the fat cells per year) when body
weight is stable. A decrease in body weight only changes fat cell size (becoming
smaller), whereas an increase in body weight causes elevation of both fat cell
size and number in adults. An important source of renewal of fat cells during the
entire life span is the bone marrow. This is most apparent in obesity when
∼20% of all fat cells are derived from the bone marrow. Fat cell turnover is also
important for the size of fat cells. Low turnover may cause large fat cells which,
in turn, is linked to cardiovascular disease and type 2 diabetes. There is also a
rapid turnover of fat cell lipids, which constitute a single active pool and are
renewed about 6 times during the life span of individual fat cells. Overweight
and obesity are associated with decreased lipid turnover due to high input in
combination with low output of lipids from the fat cells. Low fat cell lipid
turnover is associated with insulin resistance and dyslipidemia. Thus, changes in
the turnover of fat cells and their lipid content are important for the development
of adipose tissue mass and its cellularity (fat cell size and number) and, in turn,
for metabolic disturbances.

13 important facts about fat cell development

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1. We are born with about 30 billion fat cells in our body.

2. The fancy name for fat cells is Adipocytes, or Lipocytes.
3. Our bodies contain 2 types of fat cells: brown and white.
4. The function of white fat cells is to store energy, and release when
needed by our bodies.
5. Brown fat, a.k.a. “baby fat” is used to generate heat.
6. Typically, Fat cell size increases with weight gain, not the number of fat
cells.
7. It is possible to replicate fat cells when the existing ones have reached
their maximum capacity of fat storage.
8. In children, and adolescents who are still growing, it is possible to
increase the number of fat cells that develop (Which, sadly explains how
the incidence of childhood obesity has risen dramatically).
9. In general, people with an excess number of fat cells find it harder to lose
weight, and keep it off than those who have enlarged fat cells.
10. Even with marked weight loss, the body never loses adipocytes. The cells
just lose fat content and get smaller.
11. Your goal should be to keep your fat cells from maxing out of their
capacity so they wont replicate. To shrink your cells you have to expend
more energy.
12. Fat cells and Muscle cells are two different types. You can’t turn one
into the other!!
13. You know that saying “Muscle weighs more than fat”? Well, it actually
means that muscle is denser than fat. So, that means its more compact. A
pound is a pound: they just look different.

HUNGER, SATIETY AND SATIATION:

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Hunger motivates the consumption of food. Satiety is the absence of hunger;

Satiation occurs during a meal. It’s that point at which you feel that you’ve had
enough to eat and don’t desire any more. Satiety, on the other hand, describes
your experience after a meal—how long before you start to feel hungry again.
Both satiation and satiety are influenced by a number of factors.

There are several theories about how the feeling of hunger arises. A healthy,
well-nourished individual can survive for weeks without food intake (see
fasting), with claims ranging from three to ten weeks. What Is An Unhealthy
Weight Loss?

The sensation of hunger typically manifests after only a few hours without
eating and is generally considered to be unpleasant. Satiety occurs between 5
and 20 minutes after eating.

DANGERS OF UNSAFE WEIGHT LOSS SCHEMES:

What Is an Unhealthy Weight Loss?

A weight loss of 1-2 pounds (0.45–0.9 kg) per week is the recommended, safe
weight loss rate for healthy vs. unhealthy weight loss. Losing more
than that in a week is considered to be unhealthy and can lead to
numerous health problems such as gallstones, muscle loss,
nutritional deficiencies, and a dysfunctional metabolism.

An unhealthy weight loss plan pushes you to lose a lot of weight quickly. But in
reality, your body will only be losing its muscles since fats require
more time to shed. Besides losing lean tissue, you will also end up
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losing water weight. A low carb diet prompts your body to burn
more glycogen – a form of stored glucose – to supplement the
energy deficiency. In the processes, large amounts of water are
produced, leading to the sudden bouts of weight loss. With this
prolonged unhealthy weight loss, you may start to experience loose
skin that hangs or droops and which has lost its elasticity weeks
after shedding a lot of pounds.

Unhealthy weight loss approaches and plans primarily focus on starving the
muscles. You’ll, therefore, be drinking, eating, or swallowing drugs
and diet pills that starve your muscles and healthy fat. Other plans
may also involve prolonged starvation and consumption of food
with zero nutritional value to your body. All these starves your
healthy fats reserves and your muscles.

Most of these plans fall into either of these categories:

Creams, Devices, And Magic Voodoo Spells

Diet Pills And Supplements
Laxative Teas
Starvation And Fasting Diets
Very Low-Calorie Diets (VLCDS)
Single Food Group Diets, e.g., All-Protein Diets Or An All Junk
Diet
Hyper-Normal Physical Activity Routines That Involves Working
Out For Hours And Hours
Losing weight too quickly, especially through starvation techniques places your
health at risk in the following ways:

Depriving Your Body Of Essential Nutrients

Most of these quick weight loss (healthy vs. unhealthy weight) plans may advocate
for the cutting out of entire food groups from your diet. This can
deprive your body of some critical vitamins, nutrients, and minerals
that you need to stay healthy.

As a result, you might start experiencing:

o Compromised Immune System

o Brittle Hair And Nails

o Decreased Energy
 127

o Extreme Fatigue

o You Could Become Really Dehydrated

o Joint pains due to weakened bones and osteoporosis

o Slowed Down Metabolism

What Is A Healthy Amount of Weight To Lose In A Month?

While the above tactics may lead to weight loss, their long term effects on your
body can be catastrophic. Adopting a healthy weight loss plan can
help you achieve the same results in a safe, healthier way. In fact,
you can lose up to 10 pounds in a month without exerting too much
pressure on your body systems. To be able to lose weight at such a
healthy rate, you should ensure that you:

o Enjoy a High-Protein Breakfast

o Consume Fiber Daily
o Exercise regularly and sleep well
o Cut back on sugar and starches
o Try a high-intensity interval training (HIIT)
TREATMENT OF OBESITY

The goal of obesity treatment is to reach and stay at a healthy weight. This
improves overall health and lowers the risk of developing complications related
to obesity.

You may need to work with a team of health professionals — including a

dietitian, behavioral counselor or an obesity specialist — to help you understand
and make changes in your eating and activity habits.

The initial treatment goal is usually a modest weight loss — 5% to 10% of your
total weight. That means that if you weigh 200 pounds (91 kilograms), you'd
need to lose only about 10 to 20 pounds (4.5 to 9 kilograms) for your health to
begin to improve. However, the more weight you lose, the greater the benefits.

All weight-loss programs require changes in your eating habits and increased
physical activity. The treatment methods that are right for you depend on your
 128

obesity severity, your overall health and your willingness to participate in your
weight-loss plan.

Dietary changes

Reducing calories and practicing healthier eating habits are vital to overcoming
obesity. Although you may lose weight quickly at first, steady weight loss over
the long term is considered the safest way to lose weight and the best way to
keep it off permanently.

There is no best weight-loss diet. Choose one that includes healthy foods that
you feel will work for you. Dietary changes to treat obesity include:

● Cutting calories. The key to weight loss is reducing how many calories
you take in. The first step is to review your typical eating and drinking
habits to see how many calories you normally consume and where you can
cut back. You and your doctor can decide how many calories you need to
take in each day to lose weight, but a typical amount is 1,200 to 1,500
calories for women and 1,500 to 1,800 for men.
● Feeling full on less. Some foods — such as desserts, candies, fats and
processed foods — contain a lot of calories for a small portion. In contrast,
fruits and vegetables provide a larger portion size with fewer calories. By
eating larger portions of foods that have fewer calories, you reduce hunger
pangs, take in fewer calories and feel better about your meal, which
contributes to how satisfied you feel overall.
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● Making healthier choices. To make your overall diet healthier, eat more
plant-based foods, such as fruits, vegetables and whole grains. Also
emphasize lean sources of protein — such as beans, lentils and soy — and
lean meats. If you like fish, try to include fish twice a week. Limit salt and
added sugar. Eat small amounts of fats, and make sure they come from
heart-healthy sources, such as olive, canola and nut oils.
● Restricting certain foods. Certain diets limit the amount of a particular
food group, such as high-carbohydrate or full-fat foods. Ask your doctor
which diet plans are effective and which might be helpful for you. Drinking
sugar-sweetened beverages is a sure way to consume more calories than
you intended. Limiting these drinks or eliminating them altogether is a
good place to start cutting calories.
● Meal replacements. These plans suggest replacing one or two meals with
their products — such as low-calorie shakes or meal bars — and eat
healthy snacks and a healthy, balanced third meal that's low in fat and
calories. In the short term, this type of diet can help you lose weight. But
these diets likely won't teach you how to change your overall lifestyle. So
you may have to stay on the diet if you want to keep your weight off.
Be wary of quick fixes. You may be tempted by fad diets that promise fast and
easy weight loss. The reality, however, is that there are no magic foods or quick
fixes. Fad diets may help in the short term, but the long-term results don't appear
to be any better than other diets.

Similarly, you may lose weight on a crash diet, but you're likely to regain it
when you stop the diet. To lose weight — and keep it off — you must adopt
healthy-eating habits that you can maintain over time.

Exercise and activity

Increased physical activity or exercise is an essential part of obesity treatment:

● Exercise. People with obesity need to get at least 150 minutes a week of
moderate-intensity physical activity to prevent further weight gain or to
maintain the loss of a modest amount of weight. You probably will need to
gradually increase the amount you exercise as your endurance and fitness
improve.
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● Keep moving. Even though regular aerobic exercise is the most efficient
way to burn calories and shed excess weight, any extra movement helps
burn calories. Park farther from store entrances and take the stairs instead
of the elevator. A pedometer can track how many steps you take over the
course of a day. Many people try to reach 10,000 steps every day.
Gradually increase the number of steps you take daily to reach that goal.
ATTITUDES AND BEHAVIOURS TOWARD WEIGHT CONTROL

A behavior modification program can help you make lifestyle changes and lose
weight and keep it off. Steps to take include examining your current habits to
find out what factors, stresses or situations may have contributed to your
obesity.

● Counseling. Talking with a mental health professional can help address

emotional and behavioral issues related to eating. Therapy can help you
understand why you overeat and learn healthy ways to cope with anxiety.
You can also learn how to monitor your diet and activity, understand eating
triggers, and cope with food cravings. Counseling can be one-on-one or in a
group.

.
Weight-loss medication

Weight-loss medications are meant to be used along with diet, exercise and
behavior changes, not instead of them. Before selecting a medication for you,
your doctor will consider your health history, as well as possible side effects.

The most commonly used medications approved by the U.S. Food and Drug
Administration (FDA) for the treatment of obesity include:
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● Bupropion-naltrexone (Contrave)
● Liraglutide (Saxenda)
● Orlistat (Alli, Xenical)
● Phentermine-topiramate (Qsymia)
Weight-loss medications may not work for everyone, and the effects may wane
over time. When you stop taking a weight-loss medication, you may regain
much or all of the weight you lost.

Endoscopic procedures for weight loss

These types of procedures don't require any incisions in the skin. After you are
under anesthesia, flexible tubes and tools are inserted through the mouth and
down the throat into the stomach. Common procedures include:

● Endoscopic sleeve gastroplasty. This procedure involves placing stitches

in the stomach to reduce the amount of food and liquid the stomach can
hold at one time. Over time, eating and drinking less helps the typical
person lose weight.
● Intragastric balloon for weight loss. In this procedure, doctors place a
small balloon into the stomach. The balloon is then filled with water to
reduce the amount of space in the stomach, so you'll feel full eating less
food.
Weight-loss surgery

Also known as bariatric surgery, weight-loss surgery limits the amount of food
you're able to comfortably eat or decreases the absorption of food and calories.
However, this can also result in nutritional and vitamin deficiencies.

Common weight-loss surgeries include:

● Adjustable gastric banding. In this procedure, an inflatable band

separates the stomach into two pouches. The surgeon pulls the band tight,
like a belt, to create a tiny channel between the two pouches. The band
keeps the opening from expanding and is generally designed to stay in
place permanently.
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● Gastric bypass surgery. In gastric bypass (Roux-en-Y), the surgeon

creates a small pouch at the top of the stomach. The small intestine is then
cut a short distance below the main stomach and connected to the new
pouch. Food and liquid flow directly from the pouch into this part of the
intestine, bypassing most of the stomach.
● Gastric sleeve. In this procedure, part of the stomach is removed, creating
a smaller reservoir for food. It's a less complicated surgery than gastric
bypass.
Weight-loss success after surgery depends on your commitment to making
lifelong changes in your eating and exercise habits.

Other treatments

Other treatments for obesity include:

● Hydrogels. Available by prescription, these edible capsules contain tiny

particles that absorb water and enlarge in the stomach, to help you feel full.
The capsules are taken before meals and are passed through the intestines
as stool.
● Vagal nerve blockade. This involves implanting a device under the skin of
the abdomen that sends intermittent electrical pulses to the abdominal
vagus nerve, which tells the brain when the stomach feels empty or full.
● Gastric aspirate. In this procedure, a tube is placed through the abdomen
into the stomach. A portion of the stomach contents are drained out after
each meal.

FOOD AND PHARMACEUTICAL GRADES

Food grade – These materials meet the standards for safe human
ingestion and can safely come into direct contact with food products
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Pharmaceutical grade – These are raw materials that meet the pharmaceutical
standards for manufacturing. They are highly pure and contain no binders,
fillers, or other unknown substances

Food items, additives and supplements are tested for purity to a different
standard than drugs – pharmaceuticals. For instance, food grade serine, which is
less expensive, can have up to 100 ppm (parts per million) of mold
whereas pharmaceutical grade serine is limited to no more than 10 ppm. That is
10 times “purer,” or 10 times less impurity allowed in pharmaceutical grade
serine. Stringent testing, to make sure something used as a “drug” is pure and
safe, costs more money. This makes sense … drugs are often taken in a higher
quantity, taken daily, possibly many times a day, and often for an extended
period of time, if not for life

In any event, the "Food grade", is a specific use, just not a "Medical specific
use", or a "Pharmaceutical specific use". Consumption of food is normally
accepted as an oral entrance to the stomach and intestinal tract. As opposed to a
"Nicotine patch", which is consumed dermally, or a "Nasal spray", which is
consumed through the nose, throat and lungs.

The "Pharmaceutical grade", may or may-not have a specific use outlined, but it
will indicate purity and known reactivity for that purity or processing. Most
pharmaceutical grade chemicals are used in small doses, or specific doses, for
short periods of time, or long periods of time. The directions indicate use for
that level of processing, not the processing itself. Not all pharmaceutical grade
items require a prescription, or a doctors care, but many do require those
additional restrictions for use. The package would indicate the appropriate use
and restrictions.

The "Medical grade", will have a specific use, refinement level, dose, treatment
time, etc... This does not indicate purity, only the desired purity for the specific
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application. "Rubbing alcohol", if it were a medical grade, might have only 10%
purity, or it could be 100% purity, depending on the described specific use.
Most medical grade items are used under a doctors care, or only administered by
a doctor.

Food grade and Pharmaceutical grade, are the only two potentially safe grades
to use for anything mixed and sold for human consumption. (Consumption is
not only done through the mouth. You consume through skin, glands, ducts,
pores, etc... Consume is just a way to describe "whole absorption". As opposed
to cosmetic absorption, which is partial, and only tested dermally, in most
instances.)

Any consumable grade, will be devoid of most dangerous toxins, or have

specific limitations of use with the level of known contained toxins.
Pharmaceutical grade is usually a higher purity than Food grade. Food grade is
also usually a lower concentration, and often able to be consumed in larger
quantity, and for a longer period of time. (Many pharmaceutical items can be
consumed for long periods, but usually state any limits. Foods do not usually
state limits.)

FYI: For non-prescription chemicals, that are not regulated, you should be able
to ask any pharmacist to order them for you. They don't only sell prescription
chemicals behind the counter. Some things just don't sell fast enough to
purchase and store on the shelves. Some things they don't want certain people to
purchase without recording the buyers name, since there is potential for abuse of
many chemicals.

TOXICITIES
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Universally, the general population is exposed to a variety of "toxic" substances.

Some of these are from manufactured goods and some from air and water
pollution. Toxins are also normally found in many foods; however, unless the
exposure is overwhelming, we are many times (even unknowingly) protected by
the foods we eat. A judicious choice of food will counteract noxious agents.
Therefore, the diet can be a major factor in determining who does and who does
not show toxic symptoms following exposure. This review will cover three
aspects. The first will be on protectors against metal toxicity. For example,
whereas humans can consume fish that have absorbed mercury from
contaminated bay water, selenium can act as a natural antagonist for mercury
poisoning. (Naturally, too much selenium itself can be detrimental!) Some
vegetables can accumulate cadmium from contaminated soil, and zinc from a
variety of nuts is an antagonist of cadmium toxicity. Nitrites in preserved meats
can be converted into nitroamines by saliva or mild stomach acid. Vitamin C
found in oranges and bell peppers can inhibit that conversion. In addition,
calcium antagonizes both lead and aluminum toxicity. The second aspect is on
oxidants and antioxidants. Oxidative stress can lead to some cancers,
atherosclerosis, and adverse effects of aging. Antioxidants are the best
protectors of the damage caused by reactive oxygen species (ROS). The most
effective antioxidants are found in highly colored fruits and vegetables such as
carrots, tomatoes, and berries, called carotenoids. Flavonoids (polyphenols),
another class of effective antioxidants that negate ROS, may or may not be
colored. The third aspect is on gaps in current knowledge. Many foods naturally
contain chemicals that are, in larger concentrations, quite toxic or carcinogenic.
Biotransformations (detoxification mechanisms) involving type I and type II
enzymes are known. Some foods do modify these enzymes either positively or
negatively. Grapefruit contains a substance that inhibits an isoform of P450,
making some cardiac drugs, as substrates, more toxic. There is inadequate
information on what specific components are in a variety of foods that are
associated with cancer prevention. The experimental carcinogenic compound
(and suspected as a human carcinogen) found in overcooked, burnt, and fried
meats and fish, namely IQ (2-amino-3-methyl-3H-imidazo[4,5f]quinoline, will
be used as a prototype for what needs to be known about foods that will affect
toxins.
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DEFICIENCIES

Any currently treated or untreated nutrient deficiency or disease. These include,

but are not limited to, Protein Energy Malnutrition, Scurvy, Rickets, Beriberi,
Hypocalcemia, Osteomalacia, Vitamin K Deficiency, Pellagra, Xerophthalmia,
and Iron Deficiency

Nutrient deficiencies or diseases can be the result of poor nutritional intake,

chronic health conditions, acute health conditions, medications, altered nutrient
metabolism, or a combination of these factors, and can impact the levels of both
macronutrients and micronutrients in the body. They can lead to alterations in
energy metabolism, immune function, cognitive function, bone formation,
and/or muscle function, as well as growth and development if the deficiency is
present during fetal development and early childhood. The Centers for Disease
Control and Prevention (CDC) estimates that less than 10% of the United States
population has nutrient deficiencies; however, nutrient deficiencies vary by age,
gender, and/or race and ethnicity (1). For certain segments of the population,
nutrient deficiencies may be as high as one third of the population (1). Intake
patterns of individuals can lead to nutrient inadequacy or nutrient deficiencies
among the general population. Intakes of nutrients that are routinely below the
Dietary Reference Intakes (DRI) can lead to a decrease in how much of the
nutrient is stored in the body and how much is available for biological functions.
DRIs are based on age and sex and include Recommended Dietary Allowance
(RDA), Adequate Intake (AI), Estimated Average Requirement (EAR) and
Tolerable Upper Intake Level (UL). DRIs are established by the National
Academies of Science, Engineering and Medicine and include the following
definitions:

• RDA - Indicates the average daily intake of particular nutrients to meet the
requirements of 97- 98% of healthy people.

• AI - Established to assume adequate intake when there is insufficient evidence

to develop an RDA. 0

• EAR - The average daily intake of a nutrient that is thought to meet the needs
of 50% of healthy individuals. EARs are used to assess the adequacy of nutrient
intakes among populations rather than the individual.

• UL - The highest nutrient intake that is considered to be safe and does not lead
to adverse health effects in the general population
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(2). Macronutrient deficiencies include deficiencies in protein, fat, and/or

calories, and can lead to stunting, pronounced wasting (marasmus) or a
disproportionately large abdomen (a sign of kwashiorkor). Marasmus is a
disease of severe wasting due to a prolonged inadequate intake of protein,
carbohydrate, and fat. Kwashiorkor is a disease that results from a prolonged
inadequate intake of protein. Essential fatty acid deficiencies, which would
include omega-3 fatty acid deficiency, are thought to be rare among the general
population (3, 4). Signs of an essential fatty acid deficiency may include a dry
scaly rash, decreased growth in infants and children, lowered immune response,
and impaired wound healing

(3). Micronutrient deficiencies would include deficiencies in vitamins and

minerals in the body. According to National Health and Nutrition Examination
Survey (NHANES) data, the most common nutrient deficiencies from 2003-
2006 in the general United States population were vitamin B6, iron, vitamin D,
vitamin C, and vitamin B12

(1). Because NHANES does not assess the status of all vitamins and minerals,
there may be other micronutrient deficiencies that are present in the population
without an estimated prevalence. According to NHANES data from 2005-2012,
a significant proportion of women who participate in WIC have inadequate
nutrient intakes of vitamin E (96-100%). Additionally, greater than 50% of
pregnant women participants reported inadequate intakes of iron and between
10-50% reported inadequate intakes of magnesium, folate, zinc, vitamin A,
vitamin C, and vitamin B6

(5). Micronutrient deficiencies during pregnancy are not only a concern for the
mother, but are of great concern to the developing fetus that is at risk of certain
birth defects related to inadequate levels of certain nutrients including B
vitamins, vitamin K, magnesium, copper, and zinc

(6). Iodine deficiency during pregnancy can lead to irreversible adverse effects
on fetal growth and development. Iodine deficiency is the leading cause of
intellectual disability worldwide. According to NHANES data from 2005-2008,
56.9% of the pregnant women surveyed had urinary iodine concentrations below
the established threshold of 150mcg/L. This finding suggests that greater than
half of pregnant women have insufficient intakes of iodine
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(7). Because intake patterns of pregnant women can exclude or limit specific
food groups, it is not uncommon to have multiple nutrient deficiencies during
pregnancy

(8). For example, iron deficiency usually does not occur alone, but it often
occurs in conjunction with other vitamin and mineral deficiencies

(9). Intakes of nutrients were also found to be low among postpartum and
breastfeeding women participating in WIC. Among women who were
breastfeeding and participating in WIC, more than 50% had inadequate intakes
of vitamin A, and 10-50% had inadequate intakes of magnesium, zinc, vitamin
C, vitamin B6, folate, copper, and calcium (5). Greater than 50% of postpartum
women who were not breastfeeding were found to have inadequate intakes of
magnesium, vitamin A, and calcium, while 10-50% had inadequate intakes of
vitamin C, folate, copper, zinc, thiamin, vitamin B6, vitamin B12, iron, and
riboflavin (5). According to NHANES data from 2011-2012, formula fed infants
had an average usual intake of choline that was below the AI for that nutrient;
however, intakes of other vitamins and minerals were estimated to be adequate
(5). Intakes of vitamin D, iron, and zinc among breastfed infants can be of
concern if appropriate and timely complementary foods and/or vitamin and
mineral supplements are not provided to the infant. According to NHANES data
from 2009-2012, at least 10% of infants receiving human milk between 6 and 12
months of age had inadequate intakes of iron and zinc

Populations who may be at greater risk of nutrient deficiencies or diseases

include:

• Individuals who have intakes below the established RDA, AI, or EAR for the
nutrient.

• Individuals who experience food insecurity

. • Individuals who are experiencing homelessness.

• Women who have a short interpregnancy interval.

• Individuals who have recently left their previous country of residence.

• People with a gastrointestinal disease that can limit absorption of nutrients

(i.e. celiac disease or Crohn’s disease) or individuals with a history of
gastrointestinal surgery (including gastric bypass). For example, individuals
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who have had a portion of their stomach removed or their distal ileum removed
during a weight-loss or other surgery are at a greater risk of developing a
vitamin B12 deficiency (13)

. • Individuals with other medical conditions that influence nutrient status (i.e.
cystic fibrosis, renal disease, genetic disorders).

• Individuals on medications that are known to interact with the absorption or

excretion of certain vitamins and minerals

. • People with substance use disorders (including alcohol) may be more likely
to have deficiencies due to poor intake and/or the effects of the substance.
People who have high intakes of alcohol are at greater risk of developing a
magnesium deficiency (14, 15)

. • People who smoke are more likely to have a vitamin C deficiency due to the
increase in oxidative stress.

FACTORS AFFECTING BIOAVAILABILITY

The term bioavailability refers to the proportion or fraction of a nutrient,

consumed in the diet, that is absorbed and utilized by the body. According to a
micronutrient lecture by Dr. Suzanne Cole at the University of Michigan,
bioavailability is influenced by several factors including diet, nutrient
concentration, nutritional status, health, and life-stage. Diet-related factors
affecting foods include the structure of food, the chemical form of a particular
nutrient, interactions between various nutrients and foods, and the processing or
treatment of a particular food.

What does this mean?

One example of food structure influencing bioavailability or the utilization of

nutrients is with plant foods. The rigid cell wall of plant cells can make the
nutrients in plants less bioavailable or usable when eaten. Health or life-stage
similarly affect bioavailability because individuals absorb and use nutrients
differently depending on their age, general health status and if they have any
acute or chronic health conditions. Eating certain foods together can also
influence how the body absorbs various micronutrients because some
components of foods interact with other foods, leading to less absorption than
expected.
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How does this affect nutrient absorption?

Structure of food

Nutrients from plant foods or other foods that take longer to digest such as corn
or meat are less bioavailable than nutrients in foods with less complex tissue
structures. Foods of this type must be broken down or cooked in order for
certain micronutrients to be available for absorption.

Health or life-stage

There is a normal decline in gastric acid as we age, so younger individuals can

have a higher bioavailability of micronutrients than older individuals. This
means our ability to absorb micronutrients is reduced as we age.

Chemical form

Heme iron is more readily available for absorption than non-heme iron. Heme
iron is found in foods like meat, fish or poultry and non-heme iron is found in
plants. Recommendations for iron intake for vegetarians are higher than for
those who eat meat because the non-heme iron in plants is less bioavailable.

Interactions with compounds in foods

Antioxidants like phytates or polyphenols can bind with

certain micronutrients in the gastrointestinal tract and prevent absorption into
the body. Phytates are found in the outer layer of plants and can bind with
minerals like zinc, calcium or iron, which prevents their absorption in the
intestines. Polyphenols are a compound found in plants that can also interfere
with mineral absorption in the intestines.

What can we do?

● To increase the bioavailability of nutrients in foods with rigid tissue

structures, chop or mince the food before consumption. For example, in
order to get the most folate (a water-soluble B vitamin) from spinach,
mince or chop the leaves.
● If you are a vegan or vegetarian and not consuming foods with heme iron
(fish, meat, poultry), increase your consumption of foods that are good
sources of non-heme iron like nuts, beans, vegetables, and fortified grain
products.
● Antioxidants like phytates and polyphenols are reduced in the processing
or treatment of foods. Examples include pounding grains to remove the
bran, soaking grains in water and discarding the water (phytate is water-
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soluble), or cooking foods like beans to reduce polyphenols. While

antioxidants are important dietary components, consider balancing
consumption of both raw and cooked foods to ensure maximum
micronutrient absorption.
● Consume foods that work together to increase absorption of certain
micronutrients. Eating citrus foods or foods high in vitamin C with foods
high in iron increases the absorption of both heme and non-heme iron.
This also prevents minerals from binding with phytate or polyphenols in
the gastrointestinal tract.

STABILITY UNDER FOOD PROCESSING CONDITIONS

Stability of food item means how long that item can be stored without visible
changes or a change in its taste, flavor etc.. If a food item is kept under normal
conditions, visible changes may occur. The changes may be physical or
chemical.

These deteriorative changes are mainly occurred due to the changes in its
composition. Maintaining the quality of food products is the main challenge for
food manufacturers. Texture and flavor of food products can be changed over a
period of time. These changes may be unacceptable for human consumption.

Stability of different food products depends on the processing and storage

conditions. Spoilage of food products is due to various environmental
factors like temperature, water activity, light intensity, processing, packaging
and storage conditions. So, it is very important to control environmental
conditions.

Flavour stability is not only focused on single flavour molecules but on a whole
food product. Different flavour compounds and their reactivity with other
molecules is also essential when it comes to flavour stability.

Processing conditions and storage conditions of the product also matters.

Different chemical changes take place in food during processing as well as
during storage period. The main concern is the flavour stability i.e. to maintain
flavour intensity throughout the processing stages and shelf life of the food
product.

The major factors which affect the stability of a flavour are:

Heat treatment – It is said that heat is a friend as well as the enemy of flavouring
compounds. There are several reactions induced by heat which
includes carmalization, maillard reaction etc., helpful for flavour development.
During processing, volatilization takes place, which is a loss of flavour (volatile
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component), as many flavouring substances have a lower boiling point

compared to other ingredients of the product. Volatilization reduces overall
flavour impact; it makes the overall flavour system off balance. In presence of
heat, other ingredients that interact with flavour components affect the products
taste & aroma.

Oxidation – The oxidation of lipids/fat leads to the development of off-flavour

in a food product, such as extruded products, processed meat products.
Developments of these undesirable flavours destabilize the original flavour of
the product. These changes mostly occur during long storage periods of food
products. Some citrus flavours get degraded due to oxidation. Low pH condition
leads to degradation reaction of many citrus compounds.

Packaging materials – The packaging material may interact with the flavour
constituents of the food, which could cause the loss of desirable food flavour
and absorption of undesirable off-flavour from components of the packaging.
Direct contact with the food with packaging material causes exchange or
transfer of volatiles into food products. Factors like processing and sealing
temperature, sterilization techniques, printing ink residues, adhesives, and
barrier property of packaging materials can also affect flavour stability.

Storage condition – Different storage conditions of the product also affect

flavour stability as some ingredients can be temperature sensitive. If a food
product is not stored properly, it might affect its overall flavour perception of
the product. To avoid that, proper storage conditions should be always
mentioned on the packaging.
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FOOD AND NUTRITION

UNIT1
2 Marks
1. Define nutrition with its types?
2. What is a macronutrient? Why are some nutrients essential and others not?
3. Differentiate Essential and Non Essential nutrient?
4. Describe the role of nutrition agencies?
5. Write a note on Conditional essentiality.
6. Write a note on glycogen.
7. What are proteins?
8. Write a note on vitamins
9. Write a note on dietary lipis.
10. Define Food with suitable examples?
11. Describe the functions of food.
12. Mineral salts are required by our body in a very little amount, but are Inessential for our
growth and health. Justify.
13. What are the food sources of Iron, Calcium and Iodine.
14. Deficiency symptoms of Vitamin D in human beings
15. Sources of iron and Iodine rich foods
16. Specific dynamic action of food
17. Functions of Vitamin C
18. What is Community nutrition
19. What is nutrient utilization?
20. Brief about food plan?
21. Define the term Nutrition and calorie?
22. Define vitamins and minerals with examples?
23. Role of Water in food chart and blood?
24. Types of lipids and their role in diet?
25. Mention two advantages of making a food plan malnutrition with example
6 Marks
1. Give two food sources and three functions each of the following nutrients:
(a) Vit A (b) Vit B2 (c) Vit C
2. How nutrients are metabolized? Explain
3. Signify the role of calcium and iron in the body.
4. Write about the classification of Proteins?
5. What are Minerals ? Discuss about the major and minor Minerals.
6. Name the B-Complex Vitamins. Briefly state the sources and functions of each these
Vitamins.
7. What is the importance of calcium, iron and phosphorus in our body ?
8. Differentiate between the different types of Carbohydrates with examples.
9. Signify the role of dietary fibre in our diet.
10. Write a note on nutritional agencies
11. Theory and definition
 144

10 Marks
1. Write a detailed notes classification of nutrients?
2. How would you classify carbohydrates? Explain giving examples of each. What are
effects of deficiency and excess of carbohydrates in diet?
3. Functions of the various nutrients in body
4. Classify lipids with suitable examples.
5. Classify vitamins and explain the functions and sources of Vitamin D and C.
6. Define the terms fats and fatty acids. Explain the types of fatty acids and give the
functions of fats.
7. How water balance is maintained in the body? Give the functions of water
8. Define the term cholesterol. Give the sources and functions of cholesterol. Why they
need to be maintained?
9. Describe the composition, sources and functions of protein.
10. What are Vitamins ? Classify Vitamins and show their significance in our diet
11. Discuss about nutritional policies and their implementation
12. Write an essay on Sports nutrition?
13. Comparative requirements and nutritional requirement of different age groups

UNIT 2
2marks
1. What is Dehydration?
2. What is “Energy balance”?
3. What is Rehydration?
4. What is BMR?
5. What is water balance?
6. Define Calorie
7. What is the role of the hypothalamus in maintaining water balance in the body?
8. What organs in the body help you maintain a water balance?
9. What is meant by the term fluid balance?
10. How does ADH affect the kidneys?
11. What are the four ways that the body loses water?
12. What is positive and negative fluid balance?
13. What are the main components of energy balance?
14. What requires energy expenditure?
15. What is meant by the energy balance equation?
16. What is energy expenditure?
17. What is the thermic effect of food?
18. What is the definition of physical activity?
19. What are the Factors that influence basal metabolic rate?
20. 'Slow metabolism' causing weight gain.-Justify
 145

6 Marks
1. Write a note on basal metabolism
2. Write a note on water intoxication.
3. Brief on factors affecting BMR
4. Discuss energy balance equation and BMR
5. Write a note on water intake and losses
6. Describe various organs involved in water balance
7. Write a note on dehydration
8. Write a note on BSA
9. Write a note on water in diet
10. Excess energy in humans-Discuss
10 Marks
1. Briefly explain the role of water in our body.
2. Discuss physical activitry and energy balance?
3. What is BMR and explain the factors affecting it.
4. Define Energy. Discuss the varioius factors affecting energy requirements.
5. What are the health hazards associated with water balance?
6. Water balance is important for maintaining good health. Discuss.
7. Define invisible source of water. How water balance is maintained in the body?
8. Define energy and discuss the factors affecting energy requirements.
9. What are the health hazards associated with energy balance?
10. Explain BMR as part of energy metabolism and the factors affecting them.

UNIT - III
2 Marks
1. Which type of food forms the 'staple' food of mankind. Why ?
2. Discuss about the sources of Carbohydrates in an Indian diet.
3. What is a balanced diet?
4. Why fat is considered as a useful constituent of our daily diet ?
5. Define and classify proteins. Suggest methods to improve their quality.
6. Whate is RDA?
7. What is called an eating disorder?
8. RDA of Energy for different age groups?
9. What is Night eating syndrome?
10. What is geriatrics?
11. Define diet formulation
12. Define diet disorder
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6marks
1. Define balance diet and list the importance of it.

10marks
2. Balance diet is essential for well being. Define and discuss the factors responsible for
making a balanced diet.
3. Nutritive value of food gets reduced by certain faulty practices. Suggest procedures to
improve nutritive value of foods.
4. Suggest methods to improve quality of protein for a sports person.
5. Discuss the importance of food in maintaining good health.
6. Explain factors affecting meal plan.
7. Explain the concept of RDA and the factors that influence it.
8. Classify menu planning according to three food group system and discuss any five factors
affecting meal planning.
9. “Balanced diet is important to live a healthy life”. How far do you agree with this
statement?
10. What is balanced diet? Classify foods into various groups.
11. How do you benefit by eating :
(a) eggs (b) Fresh fruits (c) Milk (d) Vegetables

UNIT 4
2 Marks
1. Define malnutrition.
2. What are the Symptoms and Signs of Malnutrition?
3. What are the Complications of Malnutrition?
4. Is malnutrition a disease?
5. Is obesity a form of malnutrition?
6. Define over nutrition
7. What does undernutrition lead to?
8. What is chronic undernutrition?
9. What are the effects of malnutrition on the body?
10. What are the causes of malnutrition?
11. What is its effect of overnutrition on the body?
12. What are the causes of overnutrition?
13. What is the difference between undernutrition and overnutrition?
14. Give the types of malnutrition
15. Define under nutrition
16. Define immunity
17. What is nutrition infection?
18. Define nutrition education
19. Write a note on Night blindness
20. Write a note on beri-beri
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6 Marks
1. Write a note on Niacin deficiency
2. Write a note on malnutrition
3. Give the types of malnutrition
4. Brief on the causes of malnutrition
5. Give a note on nutrition education
6. Write a note on nutrition infection
7. Write a note on undernutrition and overnutrition
8. Write a note on Night blindness
9. Write short notes on Rickets,Goitre and Anaemia
10. Write a note on Micronutrient deficiency diseases

10 Marks
1. Write in detail about malnutrition and its types
2. What is malnutrition? Describe about its multi factorial causes
3. Decribe epidemiology of under nutrition and over nutrition
4. Write in detail about nutrient deficiency diseases
5. Describe nutrition infection and immunity
6. Write in detail about nutrition education to the society
7. Briefly classify protein indicating the deficiency diseases caused by it.
8. Define the following terms: (a) Nutrition (b) Health (c) Malnutrition (d) Obesity (e) SDA
9. Define the following:
(a) Night blindness (b) Ricket (c) Reproductive failure (d) Beri Beri

UNIT -5
2 Marks
1. What is MUFA and PUFA?
2. What is obesity?
3. Name the conditions that lead to obesity.
4. Visible symptoms of good health
5. Define nutrients
6. Define hormones
7. Define enzymes
8. What are disorders?
9. Define faddism
10. What are toxic substances?
11. Define metabolism
12. What is a metabolic disorder?
13. What is a fad diet?
14. Define 'Crash Dieting'
15. Define anthropometry
16. What dangerous chemicals are in our food?
17. What is a diet survey?
18. What are the components of the blood?
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19. What is considered an eating disorder?

20. What does inborn error of metabolism mean?
6 Marks
1. Give a brief note on inborn error of metabolism.
2. Write a note on assessment of nutritional status
3. What are the importances of anthropometry?
4. Write a note on nutritional assessment and its importance
5. Brief on the blood and its role
6. Write a note on Body building foods and protective food.
7. Brief on diet surveys
8. Write a note on faddism
9. Write a note on dangerous chemicals are in our food?
10. Write a note on eating disorders and its causes

10 Marks
1. Define the following terms :
(a) Health
(b) Energy
(c) Malnutrition
(d) Polysaccharides
(e) Anaemia
2. Detail on blood and its components
3. Write short notes on nutrients, hormones and enzymes
4. Describe potentially toxic substances in human food
5. Describe on food fad and faddism
6. Write in detail on nutritional assessment and related disorders
7. Cooking affects the nutritive value of food. Suggest methods of nutrient conservation
8. Critically evaluate the growth of fast foods in India.
9. What measures should be taken in mass food production to retain maximum nutritive
value of food?
10. Differentiate between the following :
(a) Unsaturated fat and saturated fat.
(b) Visible fat and hidden fat.
(c) Night blindness and rickets.
(d) Water soluble vitamin and fat soluble vitamin.
(e) Body building foods and protective food.