Nutrition and Diet Therapy
 Terms
 Definition (bold the keywords)
 Enumeration
 Important Statements/ Theories
 Examples
 Advantage/Disadvantages
 From the Audio
(PDF)
SECTION 1: FUNDAMENTALS OF NUTRITION
CHAPTER 1: THE RELATIONSHIP OF NUTRITION
AND HEALTH
The United States was historically referred
to as the “melting pot” because it represented
people of many nationalities who immigrated
to this country in hopes of
finding a better life. The individuals in this
country bring all their cultural diversities with
them, including their cuisine. The diet that
individuals follow will determine, to a large
extent, their health, growth, and development.
Nutrition and diet choice form a logical
starting point for preventive health care
measures and education to improve quality of
life.
Wellness: way of life that integrates body, mind,
and spirit
Nutrients and Their Functions
Nutrients: chemical substances found in food
that are necessary for life and good health.
Essential Nutrients: nutrients found only in food
They are divided into six classes:
 Carbohydrates (CHO)
the nutrient class providing the major
source of energy in the average diet
 Fats (lipids)
highest calorie-value nutrient class
 Proteins
the only one of the six essential nutrient
classes containing nitrogen
 Vitamins
organic substances necessary for life
although they do not, independently,
provide energy
 Minerals
one of many inorganic substances
essential to life and classified generally as
minerals
 Water
major constituent of all living cells;
composed of hydrogen and oxygen
Carbohydrates (CHO), proteins, and fats (lipids)
furnish energy.
Proteins are also used to build and repair body
tissues with the help of vitamins and minerals.
Vitamins, minerals, and water help regulate the
various body processes such as:
 Circulation: the body process whereby
the blood is moved throughout the body
 Respiration: breathing
 Digestion: breakdown of food in the
body in preparation for absorption
 and Elimination: evacuation of wastes
The six nutrient classes are chemically divided
into two categories: organic and inorganic.
Organic nutrients: contain hydrogen, oxygen,
and carbon. (Carbon is an element found in all
living things.)
Inorganic nutrients: already in their simplest
forms when the body ingests them, except for
water
Foods that contain substantial amounts of
nutrients are described as nutritious or
nourishing
Nutritious: foods or beverages containing
substantial amounts of essential nutrients
Nourishing: foods or beverages that provide
substantial amounts of essential nutrient
Characteristics of Good Nutrition
Hunger: the physiological need for food.
Appetite: a psychological desire for food based
on pleasant memories.
When the body signals hunger, that is the
indication that there is a decrease in blood
glucose that supplies the body with energy. If
one ignores the signal and hunger becomes
intense, it is possible to make poor food choices.
The choices one makes will determine one’s
nutrition status. A person who habitually
chooses to eat, or not to eat, as a way of
 Nutrition and Diet Therapy
coping with life’s emotional struggles may be
suffering from an eating disorder.
Nutrition: is the result of the processes whereby
the body takes in and uses food for growth,
development, and the maintenance of health.
These processes include digestion, absorption,
and metabolism
Nutritional Status: one’s physical condition as
determined by diet
Nutrition helps determine the height and
weight of an individual. Nutrition also can affect
the body’s ability to resist disease, the length of
one’s life, and the state of one’s physical and
mental well-being
Good nutrition enhances appearance
and is commonly exemplified by shiny hair,
clear skin, clear eyes, erect posture, alert
expressions, and firm flesh on well-developed
bone structures. Good nutrition aids emotional
adjustments, provides stamina, and promotes a
healthy appetite. It also helps establish regular
sleep and elimination habit.
Malnutrition
Malnutrition: poor nutrition; can be caused by
overnutrition (excess energy or nutrient intake)
or undernutrition (deficient energy or nutrient
intake).
Supersizing: lead to portion distortion
Nutrient Deficiency: occurs when a person lacks
one or more nutrients over a period of time;
Classified as primary or secondary:
 Primary deficiencies: caused by
inadequate dietary intake
 Secondary deficiencies: caused by
something other than diet, such as a
disease condition that may cause
malabsorption, accelerated excretion,
or destruction of the nutrients.
Individuals at Risk from Poor Nutritional
Intake
Teenagers may eat often but at unusual
hours. They may miss regularly scheduled meals,
become hungry, and satisfy their hunger with
foods that have low nutrient density such as
potato chips, cakes, soda, and candy.
Foods with low nutrient density: provide an
abundance of calories, but the nutrients are
primarily carbohydrates and fats and, except
for sodium, very limited amounts of proteins,
vitamins, and minerals.
Teenagers are subject to peer pressure; that is,
they are easily influenced by the opinions of
their friends. If friends favor foods with low
nutrient density, it is difficult for a teenager to
differ with them.
Peer Pressure: pressure of one’s friends and
colleagues of the same age
Crash diets, which unfortunately are common
among teens, sometimes result in a form of
malnutrition. This condition occurs because
some nutrients are eliminated from the diet
when the types of foods eaten are severely
restricted.
Many factors influence nutrition in the
elderly. Depression, loneliness, lack of income,
inability to shop, inability to prepare meals, and
the state of overall health can all lead to
malnutrition.
Cumulative Effects of Nutrition
There is an increasing concern among
health professionals regarding the cumulative
effects of nutrition.
Cumulative effects: results of something that is
done repeatedly over many years.
It can cause:
 Nutrition and Diet Therapy
 Atherosclerosis: eating excessive
amounts of saturated fats, which leads to
heart attack; a form of arteriosclerosis
affecting the intima (inner lining) of the
artery walls
 Obesity: excessive body fat, 20% above
the average; may also contribute to
hypertension, type 2 (non-insulin-
dependent) diabetes, gallbladder
disease, foot problems, certain cancers,
and even personality disorders
When nutrients are seriously lacking in the
diet for an extended period, deficiency
diseases can occur:
Deficiency diseases: diseases caused by the
lack of one or more specific nutrients
 Iron deficiency: most common form of
deficiency in US; intake of iron is
adequate, but the body has no extra iron
stored
 Rickets: deficiency disease caused by
the lack of vitamin D and calcium;
causes malformed bones and pain in
infants and children
 Osteomalacia: sometimes called “adult
rickets”; a condition in which bones
become soft, usually in adults because of
calcium loss and vitamin D deficiency
 Osteoporosis: condition in which bones
become porous and excessively brittle
because there have been insufficient
mineral deposits, especially calcium
 Goiter: enlarged tissue of the thyroid
gland due to a deficiency of iodine and
vitamin A
Nutrition Assessment
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.
Nutrition Assessment: evaluation of one’s
nutritional condition; determining whether a
person is at risk requires completion of a nutrition
assessment
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.
(Caliper: mechanical device used to
measure percentage of body fat by
skinfold measurement; 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),
edema, or obesity, all of which reflect
nutrient deficiencies or excesses)
 Clinical examination: physical
observation
 Biochemical tests: laboratory analysis of
blood, urine, and feces; most commonly
used tests for nutritional evaluation:
o Serum Albumin Level: measures
the main protein in the blood and
is used to determine protein status
o Serum Transferrin Level: indicates
iron-carrying protein in the blood
o Blood Urea Nitrogen (BUN): may
indicate renal failure, insufficient
renal blood supply, or blockage of
the urinary tract
o Creatinine Excretion: indicates the
amount of creatinine excreted in
the urine over a 24-hour period;
can be used in estimating body
muscle mass
o Serum Creatinine: indicates the
amount of creatinine in the blood;
used for evaluating renal function
 Nutrition and Diet Therapy
 Dietary-social history: evaluation of food
habits, including client’s ability to buy
and prepare food
o 24-hour recall: listing the types,
amounts, and preparation of all
foods eaten in past 24 hours
o Food diary: written record of all
food and drink ingested in a
specified period
Neither method is totally accurate
because clients forget or are not always
totally truthful.
o Computer analysis: best way to
determine if nutrient intake is
appropriate; will reveal any
nutrient deficiencies or toxicities
Considerations for the Health Care
Professional
The practice of good nutrition habits
would help eliminate many health problems
caused by malnutrition. The health professional
is obligated to have a sound knowledge of
nutrition. One’s personal health, as well as that
of one’s family, depends on it.
The health professional must be able to
check the client’s tray quickly to see that it
contains the correct foods for the diet
prescribed. In many cases, diet therapy will
have to be a lifelong practice for the client. In
such cases, eating habits
will have to be changed, and the client will
need advice or instructions from a registered
dietitian and support from other health
professionals.
CHAPTER 2: PLANNING A HEALTHY DIET
(check more on the ppt for key
recommendations & tables)
Balanced Diet: includes all six classes of nutrients
and calories in appropriate amounts that
preserve and promote good health
Dietary Reference Intakes (DRIs): combines the
Recommended Dietary Allowances (RDAs),
Adequate Intake, Estimated Average
Requirements, and the Tolerable Upper Intake
Levels for individuals into one value
representative of the average daily nutrient
intake of individuals over time; would provide
enough information to plan balanced diets
U.S. Department of Agriculture (USDA) & U.S.
Department of Health and Human Services
(USDHHS): developed a system to help with the
selection of healthful diets
Dietary Guidelines for Americans: general goals
for optimal nutrient intake
MyPyramid: outline for making selections based
on Dietary Guidelines for America, 2005. From
the U.S. Department of Agriculture
Dietary Guidelines for Americans
Dietary Guidelines: provide science-based
advice and suggestions to promote health and
to reduce the risk for chronic diseases through
diet, sound nutrition, and physical activity
 Adequate nutrients within calorie needs
A basic premise of the Dietary
Guidelines is that recommended diets
will provide all the nutrients needed for
growth and health and that the nutrients
consumed should come primarily from
foods. Foods contain not only the
vitamins and minerals found in
supplements, but also hundreds of
naturally occurring substances, including
carotenoids, flavonoids and isoflavones,
and protease inhibitors that may protect
against chronic health conditions.
 Nutrition and Diet Therapy
 Weight management
Over the last 20 years the
prevalence of overweight in the general
population, and especially among
children and adolescents, has increased
substantially; it is estimated that as many
as 16% of children and adolescents are
overweight. Overweight and obesity of
both adults and children are of great
public health concern because excess
body fat leads to a higher risk of
premature death, type 2 diabetes,
hypertension, dyslipidemia,
cardiovascular disease, stroke,
gallbladder disease, and other chronic
diseases.
 Physical activity
Americans are relatively inactive.
Regular physical activity and physical
fitness make important contributions to
one’s health, sense of well-being, and
maintenance of a healthy body weight.
Physical activity: defined as any bodily
movement produced by skeletal
muscles resulting in energy expenditure.
Regular physical activity has been
shown to reduce the risk of certain
chronic diseases, including high blood
pressure, stroke, coronary artery disease,
type 2 diabetes, colon cancer, and
osteoporosis. Therefore, it is
recommended that adults engage in at
least 30 minutes of moderate-intensity
physical activity on most days of the
week.
Regular physical activity is also a
key factor in achieving and maintaining
a healthy body weight for adults and
children. It is recommended that males
over age 40 and females over age 50
check with their health care provider
before beginning aerobic activities
 Food groups to encourage
Increased intakes of fruits,
vegetables, whole grains, and fat-free or
low-fat milk products will have important
health benefits. Those who eat more
generous amounts of fruits and
vegetables as part of a healthful diet
may reduce the risk of chronic diseases,
including stroke and other
cardiovascular diseases, type 2
diabetes, and cancers in certain sites
(oral cavity and pharynx, larynx, lung,
esophagus, stomach, and colon-
rectum). In addition to fruits and
vegetables, whole grains are an
important source of fiber and other
nutrients. Consuming at least three or
more ounce-equivalents of whole grains
per day can reduce the risk of several
chronic disease and may help with
health maintenance
Legumes: plant food that is grown in a
pod; for example, beans or peas
 Fats
Fats and oils are part of a healthful
diet, but the type of fat makes a
difference to heart health, and the total
amount of fat consumed is also
important. High intake of saturated fats,
trans fats, and cholesterol increases the
risk of coronary heart disease due to high
blood lipid levels.
Fats supply energy and essential
fatty acids and serve as a carrier for the
absorption of the fat-soluble vitamins A,
D, E, and K and carotenoids
 Carbohydrates
Carbohydrates are part of a
healthful diet. Foods in the basic food
groups that provide carbohydrates—
fruits, vegetables, grains, and milk—are
important sources of many nutrients.
Dietary fiber: composed of nondigestible
carbohydrates.
Sugars and starches: supply energy to
the body in the form of glucose.
Sugars can be naturally present in
foods or added to the food. The greater
the consumption of foods containing
large amounts of added sugars, the
more difficult it is to consume enough
nutrients without gaining weight.
 Nutrition and Diet Therapy
 Sodium and potassium
On average, the higher one’s salt
(sodium chloride) intake, the higher
one’s blood pressure. Keeping blood
pressure in the normal range reduces
one’s risk of coronary heart disease,
stroke, congestive heart failure, and
kidney disease. When reading labels,
look for the sodium content; foods that
are low in sodium (less than 140 mg) are
low in salt.
Lifestyle changes: reducing salt intake,
increasing potassium intake, losing
excess body weight, increasing physical
activity, and eating an overall healthful
diet can prevent or delay the onset of
high blood pressure and can lower
elevated blood pressure.
 Alcoholic beverages
Alcoholic beverages supply
calories but few essential nutrients. As a
result, excessive alcohol consumption
makes it difficult to eat sufficient nutrients
within one’s daily calories and to
maintain a healthy weight. Alcoholic
beverages are harmful when consumed
in excess.
 Food safety
Avoiding foods that are
contaminated with harmful bacteria,
viruses, parasites, toxins, and chemical
and physical contaminants is vital for
healthful eatng. It is estimated that every
year about 76 million people in the
United States become ill from pathogens
in food.
MyPyramid
MyPyramid is applicable to Americans over
age 2. By introducing all Americans to MyPyramid
and its slogan, “Steps to a Healthier You,” the USDA
hopes to help people make informed and healthier
food choices
MyPyramid is the former Food Guide Pyramid
tipped on its side. The color bands in MyPyramid
represent the types of foods that should be
consumed, and the width of the band denotes the
approximate relative quantity
of each food that should be consumed. In addition,
MyPyramid incorporates the concept of physical
activity into its design.
Personalization of one’s diet is easier to
accomplish by accessing the MyPyramid.gov Web
site, where age, gender, and physical activity can
be keyed in and more specific nutrition guidelines
are provided. Twelve different pyramids are
available on the Web site using these parameters.
The 12 pyramids range from daily intake levels of
1,000 to 3,200 calories. By following the appropriate
pyramid, the individual should be able to maintain a
healthy body weight and decrease the risk of
nutritionrelated chronic diseases. Quantities are
stated in household measures such as cups and
ounces instead of the servings that were used in the
Food Guide Pyramid.
MyPyramid Features:
 MyPyramid Plan: Provides a quick
estimate of what and how much food
you should eat from the different food
groups by entering your age, gender,
and activity level.
 MyPyramid Tracker
(www.mypyramidtracker.gov): Provides
more detailed information on your diet
quality and physical activity status by
comparing a day’s work of foods eaten
with current nutrition guidance.
 Inside MyPyramid: Provides in-depth
information for every food group,
including recommended daily amounts
in commonly used measures, like cups
and ounces, with examples and
everyday tips. Included in this section are
recommendations for choosing healthy
oils, discretionary calories, and physical
activity.
 Start Today: Offers tips and resources that
include downloadable suggestions on all
the food groups and physical activity
and provides a downloadable
worksheet to track what you are eating.
MyPyramid has six color bands representing
five food groups and oils. The bands are wider
at the bottom, representing foods with little or
no solid fats, added sugars, or caloric
sweeteners, and become narrower at the top,
indicating that the foods that contain fats and
sugars should be limited. The five food groups
 Nutrition and Diet Therapy
represented along with oils have not changed.
They are the following:
 Grains—bread, cereal, rice, and pasta
group: the number of servings from grains
is established with the recommendation
that at least half of the servings should be
whole grains. Whole grains provide
dietary fiber, B vitamins, iron, and
magnesium. Enriched products also
contain B vitamins and iron, but if they
are not made from whole grains, they
contain little dietary fiber
 Vegetable group: The food intake
patterns have established the number of
daily servings per calorie level of
vegetable. All vegetables are included
in the vegetable group: green and leafy,
yellow, starchy, and legumes (Table 2-8).
Vegetables provide carbohydrates;
dietary fiber; vitamins A, B-complex, C, E,
and K; and iron, calcium, phosphorus,
potassium, magnesium, copper,
manganese, and sometimes,
molybdenum; This guideline, if followed,
also guarantees that one will receive a
variety of nutrients, phytochemicals, and
flavonoids
 Fruit group: All fruits are included in the
fruit group. They provide vitamins A and
C, potassium, magnesium, iron, and
carbohydrates, including dietary fiber. It
is recommended that one eat a variety
of fruit daily, following the food intake
patterns for quantity, and go easy on the
fruit juice. The calories in fruit juice add up
quickly, especially if one is thirsty and
drinks large amounts of juice. One
serving is three-quarters cup of fruit juice;
a half of a grapefruit; one whole raw
medium apple, orange, peach, pear, or
banana; a half cup of canned or
cooked fruit; and a quarter cup of dried
fruit.
if the milk is fortified, vitamin D.
Unfortunately, all contain sodium, and
whole milk and whole-milk products also
contain saturated fats and cholesterol.
Fat free milk has had the fats removed. It
is recommended that two to three
servings of these foods be included in
one’s daily diet. The serving size is one 8-
ounce glass of milk or the equivalent in
terms of calcium content.
 Meat, poultry, fish, dry beans, eggs, and
nuts group: All meats, poultry, fish, eggs,
soybeans, dry beans and peas, lentils,
nuts, and seeds are included in this
group. These foods provide proteins, iron,
copper, phosphorus, zinc, sodium iodine,
B vitamins, fats, and cholesterol. Caution
must be used so that the foods selected
from this group are low
in fat and cholesterol.
 Fats, oils, and sweets group: This group
contains butter, margarine, cooking oils,
mayonnaise and other salad dressings,
sugar, syrup, honey, jam, jelly, and sodas.
All of these foods have a low nutrient
density, meaning they have few nutrients
other than fats and carbohydrates and
have a high calorie content.

 Milk, yogurt, and cheese group: Milk,

yogurt, and cheese are excellent
sources of carbohydrate (lactose);
calcium, phosphorus, and magnesium;
proteins; riboflavin, vitamins A, B12, and,
 Nutrition and Diet Therapy
Food Labeling
Food Customs
U.S. Cultural Dietary Influences
Food Patterns Based on Religion or
Philosophy
Considerations for the Health Care
Professional
Summary
CHAPTER 3: DIGESTION, ABSORPTION, AND
METABOLISM
(check more on the ppt for the tables and
calculations)
Food: The body’s fuel
For the body to use its fuel, it must first
prepare the food and then distribute it
appropriately. It does this through the processes
of digestion and absorption.
Metabolism: The actual use of the food as fuel,
after digestion resulting in energy
carbohydrates, proteins, and fats is
changed
 Hydrolysis: the addition of water resulting
in the breakdown of the molecule
 Enzymes: organic substances that cause
changes in other substances; acts on
food substances, causing them to
breakdown into simple compounds
Digestive enzymes are secreted by the
mouth, stomach, pancreas, and small
intestine
 Catalyst: a substance that causes
another substance to react; speeds up
the chemical reactions without itself
being changed in the process
 Pancreas: gland that secretes enzymes
essential for digestion and insulin, which
is essential for glucose metabolism
The Digestive System:

Digestion
Digestion: the process whereby food is broken
down into smaller parts, chemically changed,
and moved through the gastrointestinal system;
breakdown of food in the body in preparation
of absorption; begins in the mouth and ends at
the anus
The Gastrointestinal (GI) tract: pertaining to the
digestive system; consists of the body structures
that participate in digestion

Digestion occurs through two types of action:

1. Mechanical Digestion: food is broken Basic Functions of the Digestive System
into smaller pieces by the teeth. It is then
moved along the gastrointestinal tract
through the esophagus, stomach, and
intestines; part of digestion that requires
certain mechanical movements such as
chewing, swallowing, and peristalsis
 Peristalsis: rhythmical
movement/contraction of the
intestinal/muscular walls; moves the
chyme along
2. Chemical Digestion: chemical changes
in foods during digestion caused by
hydrolysis; composition of
 Nutrition and Diet Therapy
Digestion in the Mouth
Digestion begins in the mouth, where the
food is broken into smaller pieces by the teeth
and mixed with saliva.
Bolus: food in the mouth that is ready to be
swallowed
Saliva: secretion of the salivary glands that
contains water, salts, and a digestive enzyme
Salivary Amylase: also called ptyalin; the
enzyme secreted by the salivary glands to act
on starch
The Esophagus
Esophagus: 10-inch muscular tube through
which food travels from the mouth to the
stomach; tube leading from the mouth to the
stomach; part of the gastrointestinal
system
Cardiac Sphincter: opens to allow passage of
the bolus into the stomach; the muscle at the
base of the esophagus that prevents the acidic
content of the stomach from flowing back into
the esophagus. When this sphincter
malfunctions, it causes acid reflux disease.
Digestion in the Stomach
Fundus: upper part of the stomach
Body of the stomach: middle area
Pylorus: end nearest small intestine
Gastrin: hormone released by the stomach
Gastric Juices: digestive secretions of the
stomach
Pepsin: an enzyme secreted by the stomach
that is essential for the digestion of proteins
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.
In children, there are two additional enzymes:
 Rennin: acts on milk protein and casein
 and Gastric Lipase: breaks the butterfat
molecules of milk into smaller molecules
Digestion in the Small Intestine
Duodenum: first (and smallest) section of the
small intestine
Jejunum: middle section comprising about two-
fifths of the small intestine
Ileum: last part of the small intestine
Secretin: hormone causing the pancreas to
release sodium bicarbonate to neutralize
acidity of the chyme
Cholecystokinin (CCK): hormone that triggers
the gallbladder to release bile
Bile: secretion of the liver, stored in the
gallbladder, essential for the digestion of fats
Pancreatic juice contains the following
enzymes:
 Pancreatic Proteases: enzymes secreted
by the pancreas that are essential for
the digestion of protein; protein-splitting
enzymes
 Pancreatic Amylase: the enzyme
secreted by the pancreas that is
essential for the digestion of starch;
converts starches (polysaccharides) to
simple sugars
 Pancreatic Lipase: enzyme secreted by
the pancreas that is essential for the
digestion of fat; reduces fats to fatty
acids and glycerol
The small intestine itself produces an intestinal
juice that contains the enzymes:
 Lactase: enzyme secreted by the small
intestine for the digestion of lactose
 Maltase: enzyme secreted by the small
intestine essential for the digestion of
maltose
 Sucrase: enzyme secreted by the small
intestine to aid in digestion of sucrose
 Peptidases: enzymes secreted by the
small intestine that are essential for the
digestion of protein; break down proteins
into amino acids
The Large Intestine
Large Intestine: also called as “Colon”; consists
of the cecum, colon, and rectum
Cecum: blind pouchlike beginning of the colon
in the right lower quadrant of the abdomen;
considered to be the beginning of the large
intestine
Appendix: a diverticulum that extends off the
cecum
 Nutrition and Diet Therapy
The major volatile fatty acids:
 Acetate
 Propionate
 Butyrate
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
Absorption: the passage of nutrients into the
blood or lymphatic system
Lymphatic System: transports fat-soluble
substances from the small intestine to the
vascular system
Absorption in the Small Intestine
Small Intestine: 22 feet long; Its inner surface has
mucosal folds, villi, and microvilli to increase the
surface area for maximum absorption.
Villi: fingerlike projections
Microvilli: tiny, hairlike structures in the small
intestines through which nutrients are absorbed
Capillaries: tiny blood vessels connecting veins
and arteries
Lacteals: lymphatic vessels in the small intestine
that absorb fatty acids and glycerol
Absorption in the Large Intestine:
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: part of food that the body’s
enzyme action cannot digest and
consequently the body cannot absorb
Dietary Fiber: examples include the outer hulls
of corn kernels and grains of wheat, celery
strings, and apple skins.
Feces: solid waste from the large intestine;
undigested food excreted
Metabolism
Metabolism: nutrients are changed into energy
through a complex process
Aerobic Metabolism: also called oxidation;
combining nutrients with oxygen within the cell
Anaerobic Metabolism: reduces fats without
use of oxygen
Krebs Cycle: a series of enzymatic reactions
that serve as the main source of cellular energy;
complete oxidation of carbohydrates, proteins,
and fats
Anabolism (building up): the creation of new
compounds during metabolism; released
energy is used to build new substances from
simpler ones
Catabolism (breaking down): the breakdown of
compounds during metabolism; released
energy is used to reduce substances to simpler
ones
Metabolism and the Thyroid Gland
Hormones: chemical messengers secreted by
a variety of glands
Thyroid Gland Secretions:
 Triiodothyronine (T3)
 Thyroxine (T4)
Hyperthyroidism: when thyroid gland secretes
too much T3 and T4 hormones
Hypothyroidism: too little T4 and T3 are secreted
Energy
Energy: constantly needed for the maintenance
of body tissue and temperature and for growth
(involuntary activity), as well as for voluntary
activity
Three groups of nutrients that provide energy:
 Carbohydrates: primary energy source
 Protein
 Fats:
 Nutrition and Diet Therapy
Energy Measurement
Kilocalorie (kcal): the unit used to measure the
fuel value of foods
Calorie: commonly known as “large calorie” &
in the metric system it is known as “kilojoule”;
represents the amount of heat needed to raise
the temperature of 1 kilogram of water 1
degree Celsius (C)
Bomb Calorimeter: device used to scientifically
determine the kcal value of foods

Basal Metabolic Rate

Basal Metabolism: energy necessary to carry on
all involuntary vital processes while the body is
at rest
The processes:
 Respiration
 Circulation
 Regulation of Body Temperature
 Cell Activity and Maintenance
Basal Metabolism Rate: also referred to as
Resting Energy Expenditure (REE) the rate at
which energy is needed for body maintenance
Lean Body Mass: percentage of muscle tissue;
muscle as opposed to fat tissue

Thermic Effect of Food:

The body requires energy to process
food (digestion, absorption, transportation,
metabolism, and storage); this requirement
represents 10% of daily energy (calorie) intake.
Multiply BMR by 0.10 and add to the BMR (REE)
before an activity factor is calculated
 Estimating BMR

Calculating Total Energy Requirements

Energy Requirement: number of calories
required by the body each day (24-hour period)

Energy Balance
Energy Balance: occurs when the caloric value
of food ingested equals the calories expended
Adipose Tissue: fatty tissue
 Nutrition and Diet Therapy
MODULE 1: INTRODUCTION TO NUTRITION
(Ma’am Aguba)
Nutrition
- study of food and how the body makes
use of it
- not only concerned with the quality or
quantity of food one eats but the process
by which one receives and utilizes the
food in the body for growth and renewal
as well as maintenance for different
body functions.
Functions of Nutrition
 Prevention of diseases or illnesses
 Adapting food patterns of individuals to
their nutritional needs within the
framework of their cultural, economic,
and psychological situation and style
 Modify nutritional factors for therapeutic
purpose
Nutrients
 Chemical substances found in food
 Used to provide heat and energy, build
and repair body tissues, and regulate
body processes.
 Found mainly in natural foods
Food
 Anything which when taken and
digested nourishes the body.
 Culturally acceptable substances that
supply heat and energy; build and repair
body tissues, and regulate body
processes.
 Composed of various compounds; both
organic (protein, lipids, carbohydrates,
and vitamins) and inorganic (water and
minerals)
Metabolism
 Derived from the Greek word
“metabolismos”; which means to
“change or alter”
 Chemical process of transforming foods
into complex tissue elements and of
transforming complex body substances
into simple ones, along with the
production of heat and energy.
MODULE 2: Scope of Nutrition as a Science
and Relationships with Other Arts & Sciences
Scope of Nutrition as a Science
1. Basic or Fundamental Nutrition
 Study of the physiological needs
in terms of specific nutrients
 Referred also as “Normal
Nutrition”
2. Nutrition of Growth and Development or
Child and Maternal Nutrition
 Study of nutritional principles and
application throughout the life
cycle or it can be concentrated
on infancy, childhood, pregnancy
and lactation, which are the most
vulnerable groups.
3. Medical Nutrition Therapy
 Also called as “Therapeutic
Nutrition/Clinical Nutrition
 Deals with the adequacy of
nutrient intake & diet to meet the
individual’s needs under
pathological conditions
4. Community Nutrition or Public Health
Nutrition
 Refers to ways and means of
supplying adequate diets in a
group of people starting with the
family or a community & it could
be nationwide or international.
5. Comparative Nutrition
 Study of species of specific
differences in their nutritional
needs
 Human Nutrition, Animal Nutrition,
Plant Nutrition
6. Other Areas of Specialization
 Nutrition in Dentistry
 Geriatric, Infant of Pediatric
 Nutrition for Chiropractics
7. Nutrigenomics
 Latest area of nutrition research
 science of how human genes
interact with nutrients & their
metabolism
 study of how DNA & one’s genetic
code affect nutritional status &
wellness
 Nutrition and Diet Therapy
 With increasing incidence of diet- 8. No food by itself has all the nutrients for
related disorders, researches in full growth and health
nutrigenomics may provide 9. Each nutrient has specific functions in the
answers that will guide dietitians in body
patient counseling 10. Most nutrients do their best function in
the body when teamed with other
The Scope of Nutrition and Interrelationship nutrients
with Other Fields

MODULE 3: Concepts in Nutrition

1. Adequate nutrition is essential to good

health
2. The nutrients in our body are in dynamic
equilibrium
3. Dietary intake and nutrient needs should
be individualized
4. Nutrient content in food is variable
5. An adequate diet is the foundation of
good nutrition and it should consist of a
wide variety of foods
6. The physiological functions of food are
attributed to the roles of nutrients
7. All nutrients needed by the body are
available in food
 Nutrition and Diet Therapy
THE RELATIONSHIP OF NUTRITION AND
HEALTH
Definition
Nutrition: branch of science that studies
nutrients in foods in relation to growth,
maintenance and health of body.
Food: fuel that sustains human life and it is for
virtually all the body processes.
Nutrients: components of food that are needed
by the body in adequate amounts in order to
grow, reproduce and lead a normal, healthy
life.
Essential Nutrients: nutrients found in food
Health: state of complete physical, mental and
social well-being and not merely the absence
of disease or infirmity.
SIX MAJOR NUTRIENTS
ORGANIC NUTRIENTS:
1. CARBOHYDRATES: PROVIDE ENERGY
2. FATS: PROVIDE ENERGY
3. PROTEINS: BUILD AND REPAIR BODY
TISSUES; PROVIDE ENERGY
4. VITAMINS: REGULATE BODY PROCESSES
INORGANIC NUTRIENTS:
5. MINERALS: REGULATE BODY PROCESSES
6. WATER: REGULATE BODY PROCESSES
DETERMINES WHEN TO EAT
Hunger: physiological need for food.
Appetite: psychological desire for food based
on the pleasant memories.
CHARACTERISTICS OF GOOD AND POOR
NUTRITION
Nutrition: result of the processes whereby the
body takes in and uses food for growth and
development, and the maintenance of health.
Malnutrition: condition that results when the
body does not receive enough nutrients; the
body cells do not receive an adequate supply
of the essential nutrients due to poor diet intake
and poor utilization.
Nutrient Deficiency: occurs when the person
lacks one or more nutrients over a period of
time.
INDIVIDUAL AT RISK FROM POOR
NUTRITIONAL INTAKE
 Individuals of all ages and from all walks
of life
 Persons with recent illness, hospitalization
or surgery
 Meet or exceeds energy intake but
consume foods that are low nutrient
quality
 Individuals with budget concerns the
preclude purchasing nourishing foods
 Lack access to healthy food due to
geographic location
 Individuals living in lower-income
neighborhoods
 Teenagers
 Pregnancy and young mothers to be.
 Elderly
DEFICIENCY DISEASES
Rickets: causes poor bone formation in children
and is due to insufficient calcium and vitamin D.
Osteomalacia (adult rickets): in young adults;
causes the bones to soften and may cause the
spine and legs to become bowed.
Osteoporosis: causes bones to become porous
and excessively brittle.
Goiter: enlarged tissue of the thyroid gland due
to a deficiency of iodine.
Classification of Nutrient Deficiency
Primary: caused by inadequate dietary intake
Secondary: caused by something other than
diet such as disease condition that may cause
malabsorption, accelerated excretion, or
destruction of the nutrients.
 Nutrition and Diet Therapy
NUTRITIONAL DEFICIENCY DISEASES AND Eczema Fat (Linoleic Acid)
CAUSES
Deficiency Diseases Nutrient(s) Lacking NUTRITION ASSESSMENT
Iron Deficiency Iron OLD SAYING: YOU ARE WHAT YOU EAT
Iron-Deficiency Iron “Good nutrition is essential for the attainment
Anemia and maintenance of good health.”
Beriberi Thiamin 1. Anthropometric Measurements
Night Blindness Vitamin A  Height/Weight and Measurement of
(Matang Manok) Head
Goiter Iodine  Chest and Skinfold with the use of
Kwashiorkor Protein Calipher
Marasmus All Nutrients 2. Clinical Examination
Osteoporosis Calcium & Vitamin D 3. Biochemical Test
Osteomalacia Calcium & Vitamin D,  Blood
Phosphorus,  Urine
Magnesium &  Stool test
Fluoride 4. Dietary-Social History: involves evaluation of
food habits.
Pellagra Niacin
 24-Hour recall: listing the types, amount
Rickets Calcium & Vitamin D
and preparation of all foods eaten in the
Scurvy Vitamin C
past 24 hours
Xerophthalmia Vitamin A
 Food History: written record of all food
(Blindness)
and drinks ingested in as specific period.

CLINICAL SIGNS OF NUTRIENT DEFICIENCIES Six Standardized Characteristics to

Clinical Signs Possible Deficiencies
Diagnose Adult Malnutrition
Pallor; Blue Half Iron, Copper, Zinc,
 Insufficient Energy Intake
Circles Beneath Eyes B12, B6 Biotin
 Weight Loss
Edema Protein
 Loss of Muscle Mass
Bumpy “Gooseflesh” Vitamin A  Loss of Subcutaneous Fat
Lesions at Corners of Riboflavin  Localized or Generalized Fluid
Mouth Accumulation (that sometimes mask
Glossitis Folic Acid weight loss)
Numerous “Black and Vitamin Spots and  Diminished Functional Status as
Blue” Tiny, Red “Pinprick” Measured by Handgrip strength.
Hemorrhages Under
Skin Additional Information:
Emaciation Carbohydrates,  Nutrition: fundamental part of an
Protein, Calories individual’s well-being.
Poorly Shaped Bones Vitamin D/ Calcium/  Positive diet and lifestyle changes
and Teeth Delayed promote vibrant health and can reduce
Appearance of Teeth the risk of chronic disease.
in Children  Health issues that result in nutrition
Slow Clotting Time of Vitamin K impairment, timely assessment and
Blood quality nutrition intervention can improve
Unusual Nervousness; Niacin, Diarrhea in outcomes.
Dermatitis some  The health professional is obligated to
Tetany Calcium, Potassium, have a sound knowledge of nutrition.
Sodium
Goiter Iodine
 Nutrition and Diet Therapy
 Parents must have a good basic
knowledge of nutrition for the sake of
their family.
 Anyone who plans and prepares meals
should value, have knowledge of and be
able to apply the principles of sound
nutrition practice.
 Clients will have questions and
complaints about their diets.
 Some clients must undergo diet therapy,
prescribed by their physicians that
becomes part of their medical treatment
in the hospital.
 Nutrition is currently a popular subject. It
is important to recognize that some
books and articles concerning nutrition
are not scientifically correct.
 Food ads can be misleading
 Nutrition information websites is not
always accurate or even factual.
 People with knowledge of nutrition
practices recognize Fads and distinguish
facts.

SUMMARY
 Nutrition is directly related to health, and
its effects are cumulative. Good nutrition
is reflected by good health.
 Poor nutrition can result in poor health
and even in disease and poor nutrition
habits contributes to atherosclerosis,
osteoporosis, obesity, diabetes, and
some cancers.
 To be well nourished, one must eat foods
that contain the six essential nutrients:
carbohydrates, fats, proteins, minerals,
vitamins and water. These nutrients
provide energy, build and repair body
tissues, and regulate body processes.
Severe lack of specific nutrients,
deficiency diseases develop. The best
way to determine deficiencies is to do
nutrition assessment.
 Sound knowledge of nutrition, the health
professional will be effective health care
provider and will be helpful to family,
friends and self.
 Nutrition and Diet Therapy
PLANNING A HEALTHY DIET FOOD GUIDE PYRAMID

Balance Diet: includes all six classes of nutrients

and calories in amounts that preserve and
promote good health.
Dietary guidelines: provide a science-based
advice to promote health and to reduce the risk
of chronic diseases through diet and physical
activity.
The Nutritional Guidelines for Filipinos (NGF): set
of dietary guidelines based on the eating
pattern, lifestyle, and health status of Filipinos.
The NGF contains all the nutrition messages to
healthy living for all age groups from infants to
adults, pregnant and lactating women, and the
elderly.

Nutritional Guidelines for Filipinos:

1. Eat variety of foods everyday to get the
nutrients needed by body
2. Breastfeed infants exclusively from birth  Food guide pyramid teaches the
up to six months, then give appropriate principles of eating a variety of food
complementary foods while continuing everyday in proper amounts of servings.
breastfeeding for two years and beyond  Rice and cereals take up the major bulk
for optimum growth and development in the diet while fats and oils take up the
3. Attain normal body weight through least volume and bulk.
proper diet and moderate physical  Vegetables have bigger space than
activity to maintain good health and fruits in volume and bulk.
prevent obesity  The Guide also teaches moderation in
4. Consume fish, lean meat, poultry, egg, some food items, while emphasizing the
dried beans or nuts daily for growth and importance of others.
repair of body tissues  The was renamed Daily Nutritional Guide
5. Eat more vegetables, fruits, and root Pyramid for Filipinos
crops
6. Eat foods cooked in edible/cooking oil Pinggang Pinoy
daily Healthy Food Plate for Filipino Adults
7. Consume milk, milk products, and other
calcium-rich foods, such as small fish and
shellfish, everyday for healthy bones and
teeth
8. Use iodized salt to prevent Iodine
Deficiency Disorders
9. Consume safe foods and water to
prevent diarrhea and other food-and-
water-borne diseases.
10. Be physically active, make healthy food
choices, manage stress, avoid alcoholic
beverages and do not smoke to help The first Pinggang Pinoy food guide
prevent lifestyle-related non- developed by the FNRI-DOST was the Pinggang
communicable diseases Pinoy for Filipino adults. Since individual’s energy
 Nutrition and Diet Therapy
and nutrient needs vary based on age and sex DIETARY STANDARDS
and level of physical activity, Pinggang Pinoy  Compilation of nutrient requirements or
food guides for the different population and allowances in the specific quantities.
physiologic groups (children, adolescents,  Tentative and may be changed due to
elderly, pregnant mother, and lactating newer findings from research unveils.
women) were also developed.  Quantitative tool in assessing the
Pinggang Pinoy is a new and easy-to- nutritional adequacy of diets
understand food guide that uses a familiar food  Also observe the principle of
plate model to convey the right food group INDIVIDUALIZATION.
proportions on a per-meal basis. This will help  DIETARY REQUIREMENTS INTAKE
Filipinos acquire healthy eating habits needed  RECOMMENDED DIETARY ALLOWANCE
to attain optimum nutrition. (RDAs)
 RECOMMENDED ENERGY AND NUTRIENT
(17% bahagi ng isda, karne at iba pa; INTAKE (RENI)
17% bahagi ng prutas;  DIETARY REFERENCE INTAKE (DRIs) – USA
33% bahagi ng gulay and Canada
33% bahagi ng kanin, lamang-ugat at iba pa
Tubig) STEPS IN CALCULATING AND PLANNING
DIETS
Male Adolescents (13-18 Y/O) 1. Determine the desirable body weight
 2 cups of rice DBW using Tannhauser Method (Broca’s
 1-2 cups of vegetables Index)
 2 small pieces of fish Equation:
 1 serving of fruit DBW = (HEIGHT – 100) – (10% (HEIGHT –
 12 or more glasses of water 100) )

Female Adolescents (13-18 Y/O) Example:

 1 1/2 cups of rice Calculate the DBW of an adult female
 1-1 1/2 cups of vegetables who stands 5’1” tall.
 1 small pieces of fish a. Convert height to centimeter
 1 serving of fruit 5’1” = (5 feet x 12 inches/foot) + 1 inch
 9 or more glasses of water = 5 x 12 = 60 + 1
= 61 inches x 2.54 cm/inch
Benefits of Pinggang Pinoy = 154.94 cm
 Easy-to-understand food guide
 Uses familiar food plate model to convey b. Deduct from the height the factor 100
the right food group proportions DBW (Kg) = 154.94 – 100
 A visual tool to help Filipinos adopt = 54.94
healthy eating habits at meal times
 Delivers important dietary and healthy c. To adjust body frame for Filipinos,
lifestyle messages Deduct additional 10%.
 Per-meal basis to meet the body’s DBW (Kg)
energy and nutrient needs of Filipino = 54.94 – (10% of 54.94)
adults = 54.94 – 5.494
 Answers the question of how much you = 49.446 or 49 kg
should eat in one meal in order to be
healthy  NDAP
 Males: 112lbs for 5ft +/- 4lbs for
every inch above or below 5ft
 Nutrition and Diet Therapy
 Females: 106lbs for 5ft +/- 4lbs for 3. Determine the amount of
every inch above or below 5ft Macronutrients for Diet Prescription
Determining the carbohydrate, protein
Example: and fat requirement based of
5’5” Male Acceptable Macronutrient Distribution
Range (AMDR) as suggested int the 2015
112 lbs PDRI.
5 x 4 = 20 lbs NUTRIENTS % of TER
112 lbs + 20 lbs = 132 lbs Carbohydrate 55-75
132 lbs / 2.2 = 60 kg Protein 10-15
Fats 15-30
DBW – 60 kg or 132 lbs
Example:
2. Estimate the Total Energy For a regular diet:
Requirement (TER) Allot 65% of TER for carbohydrates, 15%
TER is based on the estimate of energy protein and 20% fat
expenditure according to physical
activity level (PAL) and body weight (kg) Carbohydrate:
Equation: 1500 kcal x 0.65 = 975 kcal
TER (KCAL) = DBW x PAL Protein:
Activity Sample Kcal/Kg 1500 kcal x 0.15 = 225 kcal
Level Occupational Body Fat:
Category/ Activities Weight 1500 kcal x 0.20 = 300 kcal
Work
Intensity Calculate the number of grams of
Sedentary Resting with little or 30 carbohydrate, protein and fat by
no activity dividing the kcal for each nutrient by the
Light Minimal movement; 35/40 corresponding physiological fuel value (4
Light housework kcal for carbohydrates, 4 kcal for protein
Moderate Extended periods of 40/45 and 9 kcal for fat per gram).
walking, pushing, or
pulling or lifting or Carbohydrate :
carrying heavy 975 kcal / 4 kcal/g = 243.75 ~ 245g
objects Protein :
Very Extensive periods of 45/50 225 kcal / 4 kcal/g = 56.25 ~ 55g
Active or running, rapid Fat :
Vigorous movement, pushing 300 kcal / 9 kcal/g = 33.33 ~ 35g
or pulling objects
(requires strenuous Note: Round off total calories to the
efforts and nearest 50, and for carbohydrate,
extensive total protein and fats to the nearest 5 grams
body movements)
Example: Diet Prescription: 1500 kcal
A 50 kg adult person with sedentary activity Carbohydrate 245g, Protein 55g, Fat 35g

TER = 50kg DBW x 30 kcal/kg DBW/day 4. Translate the Diet Prescription into
TER = 1500 kcal Exchanges
Energy and Macronutrients Composition
of Food Exchanges
 Nutrition and Diet Therapy
Exchange Table (Food)
Exchange Table (Meal)
FOOD LABELING
 Food label: any tag, brand, mark,
pictorial or other descriptive matter,
written, printed, stenciled, marked,
embossed or impressed on, or attached
to, a container of food or food product.\
 Was pass by Congress of the Nutrition
Labeling and Education Act (NLEA) in
1990, nutrition labeling regulations
became mandatory in May 1994 for
nearly all processed foods.
 Primary objective of changes was to
ensure that labels will be on most foods
and will provide consistent nutrition
information.
 Provide the consumer with more
information on the nutrient contents of
foods and how nutrients affects health
 Health claims allowed on labels are
limited and is set by the Food and Drug
Administration (FDA).
 Serving sizes are determined by FDA and
not the individual food processor
 Descriptive terms are standardized.
Example: Low fat means that each
serving contains 3g of fat or less.
Nutrition Label
 Nutrition Facts: formatted space in
Nutrition Label
Food label information includes:
 Total calories
 Calories from fats
 Total fat
 Saturated fat
 Trans fat
 Cholesterol
 Sodium
 Total carbohydrates
 Dietary fiber
 Sugars
 Protein
 Vitamin A
 Calcium
 Iron
 A new easier-to-understand food label is
nearing FDA approval.
 20 years has been updated
FOOD LABEL
The information in the main or top section
of the sample nutrition label can vary with each
food and beverage product; it contains
product-specific information:
1. Serving size
Serving Information
When looking at the Nutrition Facts label
 First take a look at the number of
servings in the package (servings
per container) and the serving
size. Serving sizes are standardized
 Nutrition and Diet Therapy
to make it easier to compare
similar foods; they are provided in
familiar units, such as cups or
pieces, followed by the metric
amount, e.g., the number of
grams (g). The serving size reflects
the amount that people typically
eat or drink.
It is not a recommendation of how
much you should eat or drink.
 Pay attention to the serving size,
especially how many servings
there are in the food package. For
example, you might ask yourself if
you are consuming ½ serving, 1
serving, or more.
2. Calories
Provide a measure of how much energy
you get from a serving of this food. In the
example, there are 280 calories in one
serving of lasagna.
To achieve or maintain a healthy body
weight, balance the number of calories
you eat and drink with the number of
calories your body uses. 2,000 calories a
day is used as a general guide for
nutrition advice. Your calorie needs may
be higher or lower and vary depending
on your age, sex, height, weight, and
physical activity level.
Remember: The number of servings you
consume determines the number of
calories you actually eat. Eating too
many calories per day is linked to
overweight and obesity.
3. Nutrient information
Nutrients to get less of: Saturated Fat,
Sodium, and Added Sugars.
Saturated fat, sodium, and added sugars
are nutrients listed on the label that may
be associated with adverse health
effects – and Americans generally
consume too much of them, according
to the recommended limits for these
nutrients. They are identified as nutrients
to get less of. Eating too much saturated
fat and sodium, for example, is
associated with an increased risk of
developing some health conditions, like
cardiovascular disease and high blood
pressure. Consuming too much added
sugars can make it hard to meet
important nutrient needs while staying
within calorie limits.
4. The bottom section contains a footnote
that explains the % Daily Value and gives
the number of calories used for general
nutrition advice.
HEALTH CLAIMS
 Calcium and Osteoporosis
 Sodium and Hypertension
 Diets low in saturated fat and cholesterol
and high in fruits, vegetables and grains
containing dietary fiber and coronary
heart disease
 Diets low in fats and high in fruits and
vegetables containing dietary fiber and
the antioxidants, and vitamin A and C
and cancer
 Diets low in fat and high in fiber-
containing grains, fruits and vegetables
and cancer
 Folic Acid and Neural Tube Defects
 Soy Proteins and Coronary Heart Disease
 Two additional criteria must also be met:
 A food whose label makes a health claim
must be naturally good source
(containing at least
 10% of the daily value) of at least one of
the following nutrients: protein, vitamin A,
vitamin C, iron, calcium or fiber.
 Health claims cannot be made for a
food if a standard serving contains more
than 20% of the daily value for total fat,
saturated fat, cholesterol or sodium.
TERMINOLOGY
The FDA has standardized Descriptors – term
used by the manufacturers to describe
products on food labels to help the consumer
select the most appropriate and healthful
foods.
 Nutrition and Diet Therapy
Examples:
 Low calorie: 40 calories or less per
serving.
 Calorie free: less than 5 calories per
serving.
 Low fat: food has no more than 3g of fat
per serving or per 100g of the food.
 Fat free: food contains less than 0.5g of
fat per serving.
 Low saturated fats: 1g or less of saturated
fat per serving.
 Low cholesterol: 20mg or less of
cholesterol per serving.
 Cholesterol free: less than 2mg of
cholesterol per serving.
 No added sugar: no sugar or sweeteners
of any kind have been added at any
time during the preparation and
packaging. When such a term is used,
the package must state that it is not low
calorie or calorie reduced (unless it
actually is).
 Low sodium: less than 140mg of sodium
per serving,
 Very low sodium: less than 35mg of
sodium per serving.
FOOD CUSTOMS
Food customs: food habits originating in small
section of a particular country.
Dietary Laws: rule to be followed in meal
planning is some religions.
Comfort Foods: foods that were familiar to them
during their childhood.
CULTURAL DIETARY INFLUENCES
FOOD PATTERNS is based on:
 Cultures
 Regions and countries.
FILIPINO CULTURAL DIETARY INFLUENCE
 Spanish
 Chinese
 Japanese
 Indian
 Western
 The Pacific Islands
FOOD PATTERNS BASED ON RELIGION OR
PHILOSOPHY
1. JEWISH
 Persons who adhere to the Orthodox
view consider tradition important and
always observe the dietary laws.
 Food prepared according to these laws
are called Kosher.
 Conservative Jews are inclined to
observe the rules only at home.
 Reform Jews consider their dietary laws
to be essentially ceremonial and so
minimize their significance.
These Law requires the following:
 Slaughtering must be done by a qualified
person in a prescribed manner. The meat
or poultry must be drained of blood, first
by severing the jugular vein and carotid
artery, then by soaking in brine before
cooking.
 Meat and meat products may not be
prepared with milk and milk products.
 The dishes used in the preparation and
serving of meat products must be kept
separate from those used for dairy foods.
 Dairy products and meat may not be
eaten together. At least six hours must
elapse after eating meat before eating
dairy products, and 30 minutes to one
hour must elapse after eating dairy
products before eating meat.
 The mouth must be rinsed after eating
fish and before eating meat.
 There are prescribed fast days: Passover
Week, Yom Kippur and Feast of Purim.
 No cooking is done on the Sabbath, from
sundown Friday to sundown Saturday.
Jewish dietary laws forbid the eating of the
following:
 The flesh of animals without cloven (split)
hooves or that do not chew their cud.
 Hindquarters of any animal
 Shellfish or fish without scales or fins.
 Birds of prey.
 Creeping things and insects.
 Leavened (contains ingredients that
cause it to rise) bread during Passover.
 Nutrition and Diet Therapy
 In general, the food served in rich.
Chicken and fresh-smoked and salted
are popular, as are noodles, eggs and
flour dishes. These diet can be deficient
in fresh vegetables and milk.
2. Roman Catholic
 The dietary restrictions of the Roman
Catholic religion have liberalized, meat is
not allowed on Ash Wednesday and
Good Fridays, Pope request believers to
abstain eating meat in other Fridays
during Lent.
3. EASTERN ORTHODOX
 Includes Christians from the Middle East,
Russia, Greece
 Interpretation of the dietary laws vary
meat, poultry, fish, and dairy products
are restricted on Wednesdays and
Fridays and during Lent and Advent.
4. SEVENTH-DAY ADVENTIST
 Seventh-Day Adventist in general are
Lacto-ovo vegetarians, which means
they use milk products and eggs but no
meat, fish or poultry.
 Use nuts, legumes and meat analogues
(substitutes) and tofu.
 Consider coffee, tea and alcohol to be
harmful.
5. MORMON (LATTER-DAY SAINTS)
 The only dietary restriction observed is
the prohibition of coffee, tea, and
alcoholic beverages.
6. ISLAMIC
 Adherents of Islam are called Muslim.
 Dietary Laws prohibits the use of pork and
alcohol.
 Meats must be slaughtered according to
specific laws (Halal).
 During the month of Ramadan, Muslims
do not eat or drink during daylight hours.
7. HINDU
 All life is sacred and animals contain the
souls of ancestors.
 Most Hindus are vegetarian.
 They do not use eggs because egg
represent life.
OTHER FOOD PATTERNS
1. VEGETARIANS
 There several vegetarian diets.
 The most common among them do not
include meat.
 Some include eggs, milk and cheese and
some do not.
 It is important to carefully planned these
diet could be nutritious and to include
appropriate combinations of essential
amino acids.
 Contributes to reduction of obesity and
reduced risk of high blood pressure, heart
disease, some cancer and diabetes.
 Vegetarians need to focus in ensuring to
get enough calcium, vitamin D, vitamin
B12, iron, zinc, and proteins.
Two types of vegetarians:
 Lacto-ovo Vegetarians: use dairy
products and eggs but no meat,
poultry or fish.
 Vegans: avoids all meat foods.
They use soybeans, chickpeas,
meat analogues, and
2. ZEN-MACROBIOTICS DIETS
 Macrobiotic diets is a system of 10 diet
plans
 Developed by Zen Bhuddism
 Adherents progress from lower number
diet to higher, gradually giving up food in
the following order: desserts, salads, fruits,
animal foods, soups and ultimately
vegetables, until only cereals – usually
brown rice – are consumed.
 Beverages are kept in minimum.
 Only organically grown foods are used.
 Food are grouped as yang (male) or yin
(female). A ratio of 5:1 yang to yin is
considered important.
 Most macrobiotic diets are nutritionally
inadequate and can be dangerous
because avid adherents promise
medical cures from the diets that cannot
be attained and medical treatment
maybe delayed when needed.
 Nutrition and Diet Therapy
DIGESTION, ABSROPTION, AND METABOLISM
DIGESTION
Process whereby food is broken down into
smaller pieces, chemically changed and
moved through gastrointestinal system.
 Gastrointestinal Tract: consists of the
structure that participate in digestion.
Secretes mucus to lubricates and
protects the mucosal tissues.
 Digestion: begins in the mouth and ends
at the anus.
Two Types of Digestion Action:
1. Mechanical
 Food is broken down into smaller
pieces by the teeth.
 It is moved to the GI tract through
the esophagus, stomach and the
intestines. This movement is due to
rhythmic contraction of the
muscular walls of the tract called
Peristalsis.
 Helps to prepare food for
chemical digestion by breaking it
into smaller pieces.
 Smaller pieces collectively have
more spaces than the large ones
and are readily broken down by
the digestive juices.
2. Chemical
 The composition of carbohydrates,
proteins and fats is changed.
 Hydrolysis: process of chemical changes
occur through the addition of water and
the results in splitting or broken down of
the food molecules.
 Food is broken down into nutrients that
the tissue can absorb or use.
 Hydrolysis involves digestive enzymes
that act on food substances causing to
break down into simple compounds.
 Enzyme: acts as catalyst that speeds up
the chemical reactions without itself
being change in the process.
 Digestive enzymes: secreted by the
mouth, stomach, pancreas and the small
intestines.
 Enzyme is named for the substances on
which it acts. Example: sucrase acts on
sucrose; maltase acts on maltose and
lactase acts on lactose.
Digestion in the Mouth
 Begins in the mouth where food is broken
down into smaller pieces by the teeth
and mixed with saliva.
 Each mouthful of food that is ready to be
swallowed is called bolus.
 Saliva is a secretion of the salivary glands
that contains water, salts, and digestive
enzyme called salivary amylase or
known as Ptyalin that acts on complex
carbohydrates (starch).
 A small amount of carbohydrates are
chemical change in the mouth.
 The final chemical digestion of
carbohydrates occurs in the small
intestine.
The Esophagus
 10-inch muscular tube through which
food travels from the mouth to the
stomach.
 The bolus food is moved down the
esophagus by peristalsis and gravity.
 The cardiac sphincter known as Lower
Esophageal Sphincter opens to allow
passage of the bolus into the stomach.
And prevents the acid content of the
stomach to back flow to the esophagus.
 If the sphincter malfunctions, it causes
acid reflux disease.
Digestion in the Stomach
Three Parts of Stomach:
1. Fundus: upper portion of the stomach.
2. Middle Area: body of the stomach.
3. Pylorus: end nearest to the small
intestine.
 Food enters the fundus and moves to the
body of the stomach, where the muscles
in the stomach wall gradually knead the
food, tear it and mix it with gastric juices
and the intrinsic factor necessary for the
absorption of vitamin B12 before if
propelled forward in slow, controlled
movements.
 The food becomes a semiliquid mass
called Chyme.
 Nutrition and Diet Therapy
 Chyme enters pylorus causing it
distention and the release of the
hormone gastrin, which increases the
release of gastric juices.
 Gastric juices are digestive secretion of
the stomach that contains hydrochloric
acid, pepsin and mucus.
 Hydrochloric acid:
 activates the enzyme pepsin
 Prepares protein molecules for
partial digestion of pepsin
 Destroy most of the bacteria in the
food ingested
 Makes iron and calcium more
soluble.
 As the hydrochloric acid is
released, a thick mucus is
secreted to protect the stomach
from this harsh acid
 Two additional enzyme for children
1. Rennin: acts on milk protein,
2. Casein and gastric lipase: breaks the
butterfat molecules of milk into smaller
molecules.
 Functions of the Stomach:
 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
Digestion in the Small Intestine
 Chyme moves through the pyloric
sphincter into:
 First section of the small intestine is
the duodenum
 Midsection of the small intestine is
the jejunum
 Last section of the small intestine is
the ileum.
When the food reaches the small
intestines:
 The hormone Secretin causes the
pancreas to release sodium bicarbonate
to neutralize the acidity of the chyme.
 Gallbladder is triggered by the hormone
cholecystokinin (CCK) that is produced
by intestinal mucosal glands when fat
enters to release bile.
 Bile is produced in the liver but stored in
gallbladder.
 Bile emulsifies fat after it is secreted into
the small intestine.
 The action enables the enzymes to digest
fats more easily.
 Chyme triggers the pancreas to secrete
its juices into the small intestine.
 Pancreatic Juices contains the following
enzymes:
 Pancreatic proteases: protein-
splitting enzymes produced by the
pancreas.
 Trypsin
 Chymotrypsin
 Carboxypeptidases
 Pancreatic Amylase: converts starches
(polysaccharides) to simple sugars.
 Pancreatic Lipase: reduces fat and fatty
acids and glycerol.
 Small Intestines: produces an intestinal
juices that contains enzymes lactase,
maltase and sucrase.
 Lactase: splits lactose
 Maltase: splits maltose
 Sucrase: splits sucrose
Into simple sugars.
 Peptidases: enzymes that break
down protein into amino acids.
The Large Intestine
 Large intestine or colon: consist of the
cecum, colon and rectum.
 Cecum: pouch-like beginning of the
colon in the right lower quadrant of the
abdomen.
 Appendix: diverticulum that extends off
the cecum.
 The cecum is separated from ileum by
the ileocecal valve and is the beginning
of the large intestine (Colon)
 FUNCTIONS OF LARGE INTESTINE
(COLON)
 Absorb water and salts from
undigested food.
 Nutrition and Diet Therapy
 Has a muscular wall that can
knead the contents to enhance
absorption.
 One of the end-products of
fermentation is volatile fatty acids.
 Major Volatile Fatty Acids
1. Acetate
2. Propionate
3. Butyrate
 Absorbed from large intestine and used
as source of energy
 The digested food enters the ascending
colon and moves through the transverse
colon and to the descending colon, the
sigmoid, the rectum and finally the anal
canal.
ABSORPTION
Passage of nutrients into the blood or lymphatic
system
 The lymphatic vessels carry fat-soluble
particles and molecules that are too
large to pass through the capillaries into
the bloodstream.
 Nutrients must be in simplest forms to be
absorb.
 Carbohydrates is broken down into
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 intestines and some occurs in the
large intestine.
 Water is absorbed in the stomach, small
intestine and large intestine.
 Glucose, fructose, galactose, amino
acids, minerals and water-soluble
vitamins are absorbed by the capillaries
in the small intestine.
 Fructose and galactose are carried to
the liver and converted to glucose.
 Lacteals absorb glycerol and fatty acids
(end products of fat digestion) and the
fat-soluble vitamin.
 When the chyme reaches the large
intestine, most digestion and absorption
have occurred.
 Its walls secrete mucus as a protection
and from the acidic digestive juices in
the chyme.
 The major task of the large intestine:
1. absorb water
2. Synthesize some B vitamins and
vitamin K (essential for blood clotting)
3. Collect food residue
 Food residue: part of food that
body’s enzyme cannot digest
and cannot absorb.
 Such residue is called dietary
fibers.
 Examples:
Outer hulls of corn kernels
Grains of wheat
Celery strings
Apple skins
 It is important that the diet
contains adequate fiber
because it promotes the
health of the large intestine by
helping to produce softer
stools and more frequent
bowel movements.
ELIMINATION
 Undigested food is excreted as feces by
way of rectum.
 The urge to defecate happens when the
rectum becomes distended because of
accumulating waste residue. body
waste comprises a variety of substances
including dietary fibers, connective tissue
from undigestible meat, fats bound by
minerals, bacteria, pigments, mucus and
water.
 Over-all transit time from food ingestion
to elimination range from 16-27 hours.
 Healthy people absorbed:
 99% carbohydrates
 95% fats
 92% protein
METABOLISM
Process by which the body changes food and
drink into energy.
 Aerobic Metabolism or Oxidation:
process of combining nutrients with
oxygen within the cell.
 Anaerobic Metabolism: reduces fats
without the use of oxygen.
 Nutrition and Diet Therapy
 Krebs Cycle: complete oxidation of
carbohydrates, protein and fats.
 Governed primarily by the hormones
secreted by the thyroid glands.
Two hormones Secreted by thyroids
glands
1. Triiodothyronine (T3)
2. Thyroxine (T4)
 Hyperthyroidism: condition in which the
body secretes too much of these
hormones T3 and T4. It means the body
metabolizes its food to quickly and will
result to weight lose.
 Hypothyroidism: happens when the
thyroid secretes too little of T3 and T4. Its
means the body metabolizes slowly and
the body become sluggish and
accumulates fat.
 Energy is needed for the maintenance of
body tissue and temperature and for
growth (involuntary activity) and for
voluntary activity (example: walking,
running, swimming and gardening)
 Energy comes from carbohydrates,
protein and fats. But the primary source
of energy is carbohydrates.
Energy Measurement
 Kilocalorie unit: used to measure energy
value of foods.
 Kilojoule: metric system.
 1 kcal: equivalent to 4.184 or 4.2 Kilojoule.
 Bomb Calorimeter: device use to
determined energy values of food
 The inner part of a calorimeter
holds a measured amount of
foods.
 The outer part holds water. The
food is burned and its caloric
value is determined by the
increase in the temperature of the
surrounding water.
BASAL METABOLIC RATE
 Basal metabolism: energy necessary to
carry on involuntary vital processes while
the body is at rest.
 These processes are respiration,
circulation, regulation of body
temperature and cell activity and
maintenance.
 Basal Metabolic Rate (BMR): rate at
which energy is needed only for body
maintenance.
 Referred also as Resting Energy
Expenditure (REE).
 Determined by medical test. The
test is given is when the body is at
rest and performing only the
essential involuntary functions.
 Factors that affect BMR are lean
body mass, body size, sex, age,
hereditary, physical conditions
and climate.
 Lean body mass is muscle opposed to fat
tissue. There is more metabolic activity in
muscle tissue than in fat or bone tissue.
 Muscle requires more calories than fat or
bone tissue.
 People with large body frames require
more calories than people with small
frames.
 People with large frame have more body
mass to maintain and move.
 Men require more energy than women.
Men are larger and have more body
mass than women.
 Children require more calories per pound
body weight than adults because they
growing. As people age, the lean body
mass declines and the basal metabolic
rate declines.
 Hereditary is also a determining factor;
example: appearance of one’s BMR
may resemble that of the parent.
 Physical Condition; example: women
require more calories during pregnancy
and lactation than at other times.
 The basal metabolic rate increases
during fever and decreases during
period of starvation or severely reduced
calorie intake.
 People living and working to extremely
cold or warm climates require more
calories to maintain normal body
temperature than they would in a more
temperature climate.
 Nutrition and Diet Therapy
ESTIMATING BASAL METABOLIC RATE
Dietitian commonly use the Harris-Benedict
equation to determine the BMR (REE) of person
above the age of 18. This equation uses height,
weight and age as factors and result in a more
individualizes estimate of the REE than other
methods.
 For men: BMR = 66.5 + (13.75 x weight in
kg) + (5.003 x height in cm) - (6.75 x age)
 For women: BMR = 655.1 + (9.563 x weight
in kg) + (1.850 x height in cm) - (4.676 x
age)

W: weight in kilograms (kg) weight in pounds /

2.2 = Kg
H: height in centimeters (cm) height in inches x
2.54 = cm
A: age in years

Example:
Compute for the BMR of a female age 30 who
stands 5’6” and weighs 180lbs.

Women = 655.1 + (9.563 x 82kg) + (1.850 x

167.64) – (4.676 x 30)
= 655.1 + 784.166 + 310.134 – 140.28
= 1,749.4 – 140.28 = 1,609.12 or 1,609
 Nutrition and Diet Therapy
CARBOHYDRATES  Glucose: aka dextrose
 Form of carbohydrates to
Carbohydrates which all other forms are
 Provide major source of energy of our converted and
body metabolized
 Provides 80-100% of calories  Found naturally in corn
 Composed of carbon (C), hydrogen (H), syrup and some fruits and
oxygen (O) vegetables
 Central nervous system
Functions: and rbc’s and brain uses
 Provides energy only glucose as energy
 Protein-sparer
 Normal fat metabolism  Fructose: aka levulose/fruit sugar
 Provides dietary fiber  Found with glucose in
many fruits and honey
Food Sources  Sweetest
Cereals monosaccharides
 Wheat
 Corn  Galactose
 Bread  Product of digestion of milk
 Cereal  Not found naturally
 Pasta
 Rye 2. Disaccharides: pairs of three sugars;
 Oats sweet and must be changed to simple
sugars by hydrolysis before they can be
Vegetables absorbed
 Potatoes  Sucrose
 Beets  Composed of glucose and
 Peas fructose
 Starchy-beans (lima beans)  Form of carbohydrates
 Green leafy vegetables present in granulated,
powdered, in brown sugar,
Fruits and in molasses
 Apple  One of the sweetest and
 Orange cheapest sugars
 Rambutan  Sources: sugar cane, sugar
 Papaya beets, and sap from maple
tree
Sugars
 Table sugar
 Syrup  Maltose
 Honey  Intermediary product in
 Desserts hydrolysis of starch
 Candies  Produced by enzyme
action during digestion of
Classification starch in body
1. Monosaccharides: simplest form of  Created during
carbohydrates; sweet and require no fermentation process that
digestion and absorbed directly from produces alcohol
bloodstream from small intestine
 Nutrition and Diet Therapy
 Found in some infant Cellulose: primary source
formulas, malt beverage of dietary fiber
products, and beer  Found in the skin of
 Less sweet than glucose fruits, the leaves and
and sucrose stem of vegetables
and legumes
 Lactose  No energy value
 sugar found in milk.  Provides bulk for
 distinct from most sugar stool
because it is not found in Some hemicellulose: found
plant mainly in whole-grain
 helps body absorb calcium cereal.
 less sweet than Lignin: woody part of
monosaccharide and vegetables such as carrots
other disaccharides and asparagus or the small
seeds of strawberries.
Lactose Intolerance: unable to digest lactose  They are not
and suffer from bloating, abdominal cramps, carbohydrate.
and diarrhea after drinking milk or consuming a
milk-based food such as processed cheese. It is  Soluble: partially dissolve in
caused by insufficient lactase, the enzyme water
required for digestion of lactose. Gums
Special Low-Lactose Milk Products Pectins
Some hemicelluloce
3. Polysaccharides: aka complex Mucilages
carbohydrates; composed of many  Soluble in water and
monosaccharides (simple sugar) form a gel that helps
Three Polysaccharides provide bulk for the
 Starch intestines
 polysaccharide found in  Bind cholesterol thus
grains and vegetables reducing the
 storage form of glucose in amount of blood
plants can absord.

 Glycogen Functions of Fibers

 storage form of glucose in  Helpful to clients with
body diabetes mellitus because
 stored in liver and muscles it help lower blood glucose
Glucagon: hormone that helps levels
liver convert glycogen to glucose  Prevents colon cancer by
as needed for energy moving waste materials
through the colon faster
 Fibers than normal thereby
Dietary Fibers: aka roughage; reducing the colon’s
indigestible because it cannot be exposure to potential
broken down by digestive carcinogen
enzymes.  Helps prevent constipation,
Two types of fibers: hemorrhoids and
 Insoluble: does not readily diverticular disease by
dissolve in water
 Nutrition and Diet Therapy
softening and increasing
the size of stool.

 Optimal recommendation for fiber

intake: 20/35g/day
 Recommended intake amount of fruit: 2
cups and 2 ½ cups vegetables for a day
who needs to consume 2000 calories
 Fiber intake should be increase gradually
and should accompanied by an
increase intake of water.
 Eating too much fiber in a short time can
produce discomfort, flatulence
(abdominal gas) and diarrhea.
 Insoluble fiber has binders (phytic acid or
phytate) which is found in outer covering
of grains and vegetables.
 Nutrition and Diet Therapy
LIPIDS (FATS)  Safflower
 Sesame seeds
Fats  Corn
 Organic compound called LIPIDS  Peanut
 Derived from lipos, a Greek word for fat.  Canola oils
 Greasy substances that are not soluble in  Soybeans
water  Margarine
 Soluble in some solvent such as ether,  Salad dressing or mayonnaise which is
benzene and chloroform from vegetable oil
 Provides a more concentrated source of  Nuts, seeds, avocados, coconut and
energy than carbohydrates cocoa butter
 Each gram of fat contains 9 calories Plant fats do not raise cholesterol and
 Fat-rich foods are more expensive than are good for the heart.
carbohydrate-rich foods.
 Like carbohydrates, fats is composed of Types of Fats
carbon, hydrogen, and oxygen but with 1. Visible
lower proportion of oxygen. Fats that are purchased and used as fats
such as butter, margarine, lard and
FUNCTIONS cooking oils.
 Provides energy 2. Invisible
 Carry fat-soluble vitamins Found in other food such as meats,
 Supply essential fatty acids cream, whole milk, cheese, egg yolk,
 Protect and support organs and bones fried foods, pastries, avocados and nuts
 Insulate from cold
 Provide satiety after meals & delays CLASSIFICATION OF LIPIDS
onset on hunger  Found in food and the human body.
 Protein sparing because its availability  Most lipids in the body are 95%
reduces the need to burn protein for triglycerides.
energy  They are in the body cells and circulate
 Contributes flavor and palatability to diet in the blood.

FOOD SOURCES OF FATS: present in both 1. TRIGLYCERIDES: composed of three (tri)

animal and plant foods. fatty acids attached to a framework of
The animal foods that provide the richest glycerol.
sources of fats are: Glycerol: derived from a water-soluble
 Red meats carbohydrate.
 Higher-fat poultry cuts with skin such as 2. PHOSPHOLIPIDS
thigh and wings 3. STEROLS
 Whole, Low-fat and reduced fat milk
 Cream FATTY ACIDS: organic compounds of carbon
 Butter atoms to which hydrogen atoms are attached.
 Cheese made of cream
 Egg yolks CLASSIFICATION OF FATTY ACIDS
 Fatty fish such as tuna and salmon 1. Essential
Essential Fatty Acids (EFA) are necessary
The plant foods containing the richest sources of fats that human cannot synthesize.
fats are:  Must be obtained from food.
Cooking oils made from:  Long-chain poly-unsaturated
 Olives fatty acids derived form
 Sunflower  linoleic acid (OMEGA-6)
 Nutrition and Diet Therapy
 linolenic acid (OMEGA-3)
2. Non-Essential
The body can manufacture a modest
amount provided EFAs are present.
 Omega-9 fatty acid
CLASSIFICATION OF FATTY ACIDS
SATURATED FAT
 Each of the fatty acids carbon atoms
carries all the hydrogen atoms possible
 Animal food contain more saturated
fatty acids than unsaturated.
 Example include meat, poultry, egg
yolks, whole milk, whole milk cheese,
cream, ice cream, and butter.
 Foods containing a high proportion of
saturated fats are usually solid at room
temperature.
 Recommended that one consume no
more than 10% of total daily calories as
saturated fats.
 Considered a contributory factor in
atherosclerosis.
MONOUNSATURATED FATS
 There is one place among the carbon
atoms of its fatty acids where fewer
hydrogen atoms attached than
saturated fats.
 Examples of foods containing
monounsaturated fats are olive oils,
peanut oil, canola oil, avocados and
cashew nuts.
 Research indicates that
monounsaturated fats lower the amount
of low-density lipoproteins (LDL): bad
cholesterol in the blood but only when
they replace saturated fats in one’s diet.
 They have no effect in high-density
lipoproteins (HDL): good cholesterol.
 It is recommended to consume 20% of
total daily calories of monounsaturated
fats.
POLYUNSATURATED FATS
 There are two or more places among the
carbon atoms of its fatty acids where
there are fewer hydrogen atoms than
saturated fats.
 The point of which carbon-carbon
double bonds occur in polyunsaturated
fatty acid is the determining factor in
how the body metabolizes it.
Two Major Fatty Acids
1. Omega-3 Fatty Acids
 Helps lower the risk of heart
disease
 Found in fish oils, an increase
intake of fatty fish is
recommended.
2. Omega-6 Fatty Acids (Linoleic Acid)
 Has a cholesterol-lowering
effect
 Examples of foods containing
polyunsaturated fats includes cooking oil
from sunflower, safflower, sesame seeds,
corn oil, soybeans. Soft margarines
whose major ingredients are liquid
vegetable oil; and fish.
 Polyunsaturated fats should not exceed
10% of total daily calories.
TRANS-FATTY ACIDS
 Poduced when hydrogen are atoms are
added to monounsaturated or
polyunsaturated fats to produce a
semisolid product like margarine and
shortening.
 Major source of trans fatty acids in the
diet are baked good and food eaten in
restaurants.
 Trans fatty acids raise LDL but decrease
HDL.
 Eating trans fatty can increase your risk of
developing heart disease and stroke.
 Trans-Fatty acids were required to be
listed on the label in 2006.
 Trans fat are associated with a higher risk
of developing type II diabetes.
HYDROGENATED FATS
 Polyunsaturated vegetable oils to which
hydrogen has been added
commercially to make them solid at
room temperature.
 Process is called Hydrogenation.
 It turns polyunsaturated vegetable oils
into saturated fats.
 Margarine is made this way.
 Nutrition and Diet Therapy
STEROL
CHOLESTEROL: a sterol
 Not a true fat but a fatlike substance that
exists in animal foods and body cells
 Does not exist in plant foods
 Essential for the synthesis of bile, sex
hormones, cortisone, and vitamin D and
is needed by every cell in the body
 Body makes 800-1,000 mg of cholesterol
each day in the liver
 Common part of one’s diet because it is
found in abundantly in egg yolk, fatty
meats, shellfish, butter, cream, cheese,
whole milk and organs meats (liver,
kidney, brains and sweetbreads)
 Contributing factor in heart disease due
to high serum cholesterol known as
Hypercholesterolemia that is common
among persons with atherosclerosis.
 Atherosclerosis: cardiovascular disease
in which plaque (fatty deposit of
containing cholesterol and other
substances) forms inside of the arterial
wall, reducing the space for blood flow.
 When the blood cannot flow
through the artery near the
heart, a heart attack occurs. If
it is near the brain, a stroke
occurs.
 Cholesterol in the blood should not
exceed 200mg/dl of blood
 Reduction in the amount of total fat,
saturated fats and cholesterol and an
increase of in the amount
monounsaturated fats in the diet, weight
loss, and exercise will help to lower serum
cholesterol levels.
 Soluble fibers is helpful in lowering blood
cholesterol because the cholesterol
binds in fibers and is eliminated through
feces, preventing it to be absorbed in the
small intestine.
 Development of plaque is cumulative, it
is advisable to avoid or limit its
development is to limit the cholesterol
and fat intake throughout life.
“Good and bad” Cholesterol
Not a type of cholesterol, but the way the body
transport cholesterol in blood
LDL: “bad” cholesterol
HDL: “good” cholesterol
Harmful effects, its deposits in artery walls;
atherosclerosis
Children do not synthesize cholesterol in the
body
LIPOPROTEINS: carrier of fats in the blood
CLASSIFICATION OF LIPOPROTEINS
1. Chylomicrons: first lipoproteins identified
after eating.
 Largest lipoproteins and the
lightest in weight
 Composed of 80-90% triglycerides
 Lipoprotein Lipase: acts to
breakdown the triglycerides into
free fatty acids and glycerol.
Without this enzyme, fat could not
get into the cells.
2. VLDL (Very-Low Density Lipoproteins):
primary made by liver cells and are
composed of 55-65% triglycerides.
 Caries triglycerides and other
lipids to all cells.
 As the VLDL’s loses triglycerides, it
picks up cholesterol from other
lipoproteins in the blood and it
becomes LDL.
3. LDL (Low Density Lipoproteins):
approximately 45% cholesterol with few
triglycerides.
 Carries most of the blood
cholesterol from the liver to the
cells.
 Elevated blood levels greater
than 130mg/DL are thought to be
a contributing factors in
atherosclerosis.
 Known as the “bad cholesterol”
4. HDL (High Density Lipoproteins): carries
cholesterol from the cells to the liver for
eventual excretion.
 The Level at which low HDL
becomes a major risk factor for
heart disease is set at 40mg/DL.
 Research indicates that an HDL
level of 80 mg/DL or more is
 Nutrition and Diet Therapy
considered protection against frying. Manufacturers have used
heart disease. carbohydrate-based compounds for
 The “Good Cholesterol” years as thickeners. Oatrim does provide
Exercising, maintaining a DBW, calories but significantly less fat.
and giving up smoking are ways
to increase HDL. DIETARY REQUIREMENTS
 20-30% of TER
PHOSPHOLIPIDS  Infants 30-40%
LECITHIN  PUFA 10% TER
 Fatty substance classified phospholipids.  MUFA 10-15%
 Found both in plant and animal foods  SFA 7-10%
and is synthesized in the liver.  Cholesterol - 200 - 240 mg/day
 Natural emulsifier that helps transport fat
in the bloodstream.
 Use commercially to make food
products smooth.

DIGESTION AND ABSORPTION OF FATS

 Chemical digestion of fats occurs mainly
in the small intestine where gastric lipase
emulsifies fats that are found in cream
and egg yolk.
 In the small intestine, bile emulsifies the
fats and the enzyme pancreatic lipase
reduces them to fatty acids and glycerol
which the body absorbs through villi.

METABOLISM AND ELIMINATION

 Fat metabolism is controlled by liver,
 It hydrolyzes triglyceride and form new
ones from the hydrolysis as needed. The
metabolism of fats occurs in the cells
where fatty acids are broken down to
carbon dioxide and water, releasing
energy. The portions of fat that is not
needed for immediate use is stored as
adipose tissue.

FAT ALTERNATIVES
 Olestra: example of a fat alternative
made from sugar and fatty acids.
 Simplesse: made from either egg white
or milk proteins and contains 1.3 kcal/g.
it can be used only in cold foods such as
ice cream because it becomes thick or
gel when heated. Not available for
home use.
 Oatrim: carbohydrate-based and
derived from fiber. Oatrim is heat-stable
and can be used in baking but not in
 Nutrition and Diet Therapy
PROTEINS CLASSIFICATIONS OF PROTEINS
Complete Partially Incomplete
PROTEINS Complete
 The word protein is a Greek word derived Contains all Contains all Lacks one or
and means “of first importance” the EAA the EAA but more EAA
 Composed of carbon, hydrogen, All animal in limited Cannot
oxygen and nitrogen. proteins amounts to sustain life nor
 Composed of chemical known as except support support
“amino acids” gelatin growth growth
 Amino acids is the building blocks of Gliadin, Zein, gelatin
proteins. hordein
 20 essential amino acids
CLASSIFICATION OF AMINO ACIDS
FUNCTIONS OF PROTEINS Essential AA
 BUILDS AND REPAIRS TISSUE  Body cannot make at all or cannot make
 REGULATES BODY FUNCTIONS in sufficient quantity to meet its needs
 PROVIDES ENERGY  Isoleucine, leucine, lysine, methionine,
phenylalanine, threonine, tryptophan,
FOOD SOURCES valine
 Proteins are found both in animal and
plant foods. Semi-essential AA
 The animal food sources provides the  Thpse whose rate of synthesis in the body
highest quality of complete proteins. It is inadequate to support or growth and
includes meat, fish, poultry, eggs, milk are therefore needed by young animals
and cheese.  Arginine, Histidine; very essential for
 The plant food sources provides the children
incomplete proteins and are of a lower
biological quality than those found in Non-essential AA
animal foods. Even though, plant foods  Can be synthesized in body in sufficient
are important food sources of protein amounts
when a variety of are consumed within  Alanine, asparagine, aspartic acid,
the day. cysteine, cysteine, glutamic acid,
Examples are nuts, sunflower seeds, glutamine, glycine, hydroxyproline,
sesame seeds, legumes such as proline, serine, tyrosine
soybeans, navy beans, pinto beans, split
beans, chick peas and peanuts. Grains NITROGEN BALANCE
like wheat, barley, corn, and rice.  One gram nitrogen: 6.25g dietary protein
 Plant proteins is used to produce  At nitrogen equilibrium: N intake=N
textured soy proteins and tofu – known as output
“Analogues”.  At positive N balance:
 Meat alternatives (analogues) are made  N intake > N output
from soy protein and other ingredient  Growth, pregnancy, rehabilitation
mixed together to create various kind of from illness
meat.  At negative N balance
 N intake < N output
 Illness, Malnutrition
 Nutrition and Diet Therapy
PROTEIN EXCESS
 Burden on liver for ammonia
detoxification & kidneys for nitrogen
excretion
 Obesity
 Depressed calcium absorption
 Hypercholesterolemia
 Heart diseases (meat sources are high in
saturated fats correlated but no
independent effect)
 Cancer (correlation of cancer & protein
intake from meats)
 Weight control (protein-rich sources are
high fat sources) weight gain
Protein Energy Malnutrition (PEM): type of
malnutrition that is defined as pathological
conditions arising from coincident lack of
dietary protein and energy (calories) in varying
proportions
Features of Marasmus and Kwashiorkor in
Children
DIGESTION AND ABSORTION
 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 into
polypeptides.
 After the polypeptides reach the small
intestines, the pancreatic proteases
continue the chemical digestion.
 Intestinal peptidases finally reduce the
proteins into amino acids.
 After digestion, the amino acids in the
small intestine are absorbed by the villi
and carried by the blood to all body
cells.
METABOLISM AND ELIMINATION
 All essential amino acids must be present
to build and repair the cells is needed.
 When the amino acids are broken down,
the nitrogen-containing amine group is
stripped off. The process is called
deamination.
 Deamination produces ammonia, which
is released into the bloodstream by the
cells.
 The liver picks up the ammonia then
converts it to urea and return it to the
bloodstream for the kidney to filter out
and excrete.
 The remaining parts are used as energy
or are converted to carbohydrate or fat
and stored as glycogen or adipose
tissue.
DIETARY REQUIREMENT
 10-15% of TER
 Safe protein intake level for adults
(balance losses of nitrogen)
 Safe protein intake level for children
(based on reference protein (egg or
milk) adjusted for protein quality of
Filipino rice-based diets of 70% protein
digestibility corrected AA score
 Nutrition and Diet Therapy
VITAMINS niacin (B3), pantothenic acid(B5), pyridoxine
 Group of organic substances that are (B6), folate (B9), cobalamin (B12) and biotin
present in food in minute quantities but
are distinct from carbohydrates, lipids Functions
and proteins; essential for normal health Some vitamins act as precursors to or become
and growth components of coenzymes. They are required in
 Non-caloric micronutrients several stages in metabolic pathways to extract
 Also known as “accessory growth energy from carbohydrate, lipid and protein
factors”
 Of all essential nutrients, vitamins were
discovered last
 Vitamin was originated by Casimir Funk
in 1912 when he was searching for
constituent in rice bran which could cure
beri-beri
 Vitamine was coined from “vita”
meaning necessary for life and
“amine” denoting that the anti-
beriberi factor contained nitrogen
 Not all dietary factors were
amines, hence the final letter “e”
was dropped

General Characteristics
 Unlike macronutrients, they are not
catabolized as source of energy and are
not used for structural purposes. Many
vitamins serve as cofactors and
coenzymes.
 Most vitamins cannot be used in form in
which they are absorbed
 Some vitamins absorbed from diet
must first be converted into active
form like vitamin A
 Some must undergo
transformation before performing
their functions, like biotin that is
covalently bound to the biotin-
requiring enzymes
Coenzyme: small organic molecule that
associates closely with certain enzymes; many B
vitamins form integral part of conezymes
Cofactor: small, inorganic/organic substance
that facilitates action of enzyme
Classification according to Solubility
Fat-soluble Vitamins: vitamins A, D, E and K
Water-soluble Vitamins: vitamin C and the B-
complex vitamins: thiamin (B1), riboflavin (B2),
Terms associated with Vitamins:
 Provitamins/precursors: compounds that
can be changed to active vitamins
 Carotenes & cryptoxanthin:
precursors of Vitamin A
 7-dehydrocholesterol: precursor
of Vitamin D. With the aid of UV
light, it is converted to Vitamin D in
skin and to active form in kidney
 Antivitamins/antagonists: substances
chemically related to true vitamins but
cannot perform biologic function of true
vitamins
 Example is avidin present in raw
and dried egg white that prevents
utilization of biotin
 Preformed Vitamins: naturally-occurring
that are in active form and ready for its
biological role
 Pseudovitamins/Vitamin-like
substances: fail to meet all necessary
 Nutrition and Diet Therapy
criteria to be classified as vitamins but still  Needed only levels (>10x the
have some properties of vitamins by complex RENI)
 Avitaminosis: condition resulting from organisms
lack of vitamin in its later stage when  Some toxic
more defined signs and symptoms occur at relatively
such that nutritional deficiency disease is low levels (6-
recognizable 10x the RENI)
 Hypervitaminosis: “vitamin toxicity”;
condition resulting from excessive FAT-SOLUBLE VITAMINS
accumulation of vitamin in body 1. Vitamin A
 Synthetic vitamins: man- Other Names:
made/synthesized in laboratory  Retinoic acid
 Vitamers: multiple forms of vitamins (as  Retinal
analogues or isomers)  Retinol
 Vitamers of Vitamin B6: pyridoxine,  Dehydroretinol
pyridoxal, pyridoxamine  Anti-infective vitamin

Fat-soluble Water-soluble Vitamins Chemistry of Vitamin A

Vitamins  Stable to heat (at ordinary
 Soluble in fat  Soluble in water cooking temperature), acid and
and fat  Minimal storage alkali
solvents of dietary  Destroyed by oxidation and
 Intake in excesses(except destruction(when become
excess of vitamin B12) rancid) or light
daily need  Deficiency  Exists in three forms; retinol,
stored in the symptoms often retinal/retinaldehyde, and
body to develop retinoic acid that are found in
 Deficiency rapidly animal tissues.
symptoms  Excreted in urine Retinyl esters: formed when retinol
slow to when plasma combines with an organic acid.
develop levels exceed Retinyl esters, retinol and retinal
 Small renal threshold are interconvertible; all forms can
amount  Must be be converted to retinoic acid, “a
excreted in supplied in the terminal product”.
bile diet everyday  Carotenes: precursors of vitamin A
 Not  Generally do and occur in two structural forms:
absolutely not have alpha carotene and beta
necessary in precursors carotene that are present in
the diet  Contain C,H,O,N plants (as provitamin, carotenoid
everyday and other cases precursor). Beta-carotene can
 Have Co or sulphur undergo oxidative cleavage to
precursors or  Absorbed into two molecules of retinol.
pro-vitamins blood through  Retinol: biologically active
 Contain only portal vein form; found in animals
elements  Needed by  Retinol equivalent (RE): unit of
C,H and O simple and measure;
 Absorbed complex International units (IU) or
into the organismsToxic united states Pharmacopeia
lymphatic only at units: to measure for vitamin A
system megadose activity
 Nutrition and Diet Therapy
RE= preformed vitamin A + the
amount obtained by converting
the precursor to the active form
RE = 1ug retinol (3.33 IU)
1 RE= 6 ug beta carotene (10 IU)
1 RE= 12 ug other carotenoids
Formulas for converting microgram and
IU to RE
Forms of Vitamin A and their Functions
Retinol: reproduction, major transport &
storage form of vitamin
Retinal: active in vision; intermediate in
conversion of retinol to retinoic acid
Retinoic Acid: acts like hormone,
regulating cell differentiation, growth
and embryonic development
Absorption, Transportation, and
Utilization
 Preformed vitamin A: retinol and
retinyl esters
 Beta carotene from plants is
converted to retinol
 Carotenoid: common dietary
source
 Retinol from food can be
absorbed as such by intestinal
wall cells.
 Retinyl esters are hydrolyzed to
free retinol and an organic acid.
 Absorption is facilitated by bile
 Retinyl palmitate: predominant
retinyl ester in food
 6 ug beta carotene are needed
to produce vitamin A activity of 1
ug retinol.
 75 % of preformed dieary vitamin
A is absorbed; for dietary beta
carotene and other carotenoids,
only some 5-50% is absorbed
 Re-esterified to retinyl esters
 Incorporated into chylomicrons
for transport through lymphatic
system
 Stored in liver (90%) and adipose
tissue
 Intracellular retinol-binding
proteins (RBPs): cellular retinoic
acid-binding protein attach to
retinol and retinoic acid,
respectively; transfer to cell
nucleus where they can effect
gene expression
 When in needs, it is released from
liver, transported to blood by
forming complex with transport
protein called RBP
 Nutrition and Diet Therapy
Functions of Vitamin A Cell Differentiation: process by which
 Normal vision immature cells develop specific
 Maintains cornea and converts functions different from those of original
light impulses in retina that are characteristic of their mature
 When light strikes cornea and cell type
reaches retina, the retinal Epithelial Cells: cells on surface of skin
changes from cis to trans and mucous membranes
conformation; rhodopsin is Epithelial Tissue: layer of body that serves
bleached; releases retina, then as selective barrier between body’s
goes back to its cis transformation interior and environment
and forms rhodopsin Mucous Membranes: membranes,
 Maintenance and repair of composed of mucus-secreting cells, that
healthy epithelial cells line surfaces of body tissues
 Improve immune system
 Normal skeletal and tooth
development
 Normal reproduction

Cornea: transparent membrane

covering outside of eye
Retina: layer of light-sensitive
nerve cells lining the back of
inside of eye; consists of rods and
cones
Pigment: molecule capable of
absorbing certain wavelengths of
light so that it reflects only those
that we perceive as certain color
Rhodopsin: light-sensitive pigment
of retina; contains retinal form of
Vitamin A and protein opsin
 Rhod: red (pigment)
 Opsin: visual protein
Opsin: protein portion of visual
pigment molecule

Interaction with other nutrients

 Vitamin E is needed to cleave
beta carotene to retinol
 Protein status affects vitamin A
metabolism (transport and use of
vitamin are dependent on vitamin
A-binding proteins)
 Zinc deficiency interferes with
vitamin A metabolism through;
 Nutrition and Diet Therapy
1. Reduction in synthesis of
plasma proteins, particularly
Retinol-Binding protein (RBP).
2. Decreased transport of retinol
from liver stores
 Iron is needed to metabolize
vitamin A from its liver stores
Deficiency of Vitamin A
 Eye defects: nyctalopia,
hemeralopia, Bitot’s spots,
xerosis,xeropthalmia
 Impaired growth and
development
 Depressed immune function
 Keratinization of tissues
 Hypovitaminosis A: characterized
by cessation of bone growth,
painful joints, cracks in teeth and
atrophy of dentin
Night Blindness: slow recovery of vision
after flashes of bright light at night or
inability to see in dim light; early symptom
of Vitamin A deficiency
Xerophthalmia: progressive blindness
caused by severe Vitamin A deficiency
 Xero: dry
 Ophthalm: eye
Xerosis: abnormal drying of skin and
mucous membranes; sign of Vitamin A
deficiency
Keratomalacia: softening of cornea that
leads to irreversible blindness; seen in
severe Vitamin A deficiency
Keratin: water-insoluble protein; normal
protein for hair and nails
Keratinization: accumulation of keration
in tissue; sign of Vitamin A deficiency
Toxicity of Vitamin A
 Hypervitaminosis A: manifested
by headache, dizziness, nausea,
dry and itchy skin, hemoglobin
losses, cessation of menstruation
and induced bleeding
 Hypercarotenemia: yellow
pigmentation of skin
 Teratogenic may cause birth
defects
 Nutrition and Diet Therapy
Recommended Intake of Vitamin A
 For the recommended intake
please refer to the PDRI (2015
Edition)
 Requirements increase in the
following conditions:
 Alcoholism
 Diseases of pancreas
 Respiratory illness
 Chronic nephritis
 Measles
 Intestinal parasites
 Acute protein deficiency
 Prolonged use of
neomycin
 Sulfate and cortisone
 Steatorrhea – fatty stools
2. Vitamin D
Food Sources of Vitamin A
 Provitamin A (carotene): green
leafy vegetables such as
kangkong, saluyot, camote
leaves and ampalaya leaves;
yellow fruits and vegetable such
as squash, carrots, ripe mango
and papaya.
 Preformed vitamin A: liver, organ
meats, egg yolk, fish liver oils,
butter, fortified margarine
Assessment of Vitamin A Status
 In valuating vitamin A status,
serum retinol is commonly used.
Serum retinol levels are relatively
constants unless in conditions of
severe deficiency or excessive
intake to the point that the
vitamin can no longer be
complexed for storage in the liver.
 The criteria used in determining
serum retinol status is presented:
Age Deficient Acceptable Marginal
All <10ug/dL >30UG/dL 10-30ug
ages /dL
Other Names:
 Antirachitic factor
 Cholecalciferol (vitamin D3)
 Ergocalciferol (vitamin D2)
 Calcitriol
 Calcidiol
 Calciferol
Chemistry of Vitamin D
 Exists in two forms in foods; as a
cholecalciferol (vitamin D3) from
animal products and as
ergocalciferol (vitamin D2) from
vitamin D –fortified foods; generic
name of two forms is calciferol
 Considered both vitamin and
hormone (can be synthesized by
body)
 Vitamin D3: produced in skin by
ultraviolet radiation (sunlight) to 7-
dehydrocholesterol, metabolite
of cholesterol.
 One IU of vitamin D=0.025 ug pure
cholesterol.
Absorption, Transportation, & Utilization
 Dietary vitamin D is absorbed in
small intestine with aid of bile and
incorporated within chylomicrons.
 Cholecalciferol from skin mixes
with blood and is transported by
 Nutrition and Diet Therapy
vitamin D-binding protein and Functions of Vitamin D
goes to liver  Regulates calcium (and
 Cholecalciferol, reaching liver phosphorous) homeostasis :
from any of two sources is involved in bone formation and
hydroxylated to 25- maintenance
hydroxyvitamin D (25-OHD), also  Regulates specific genes by
known as 25- affecting chromosomal
hydroxycholecalciferol transcription rate
 Further hydroxylation of 25-OHD,  Some of the target tissues include
takes place in the kidney tubules brain, pancreas, skin, muscles and
with the formation of 1,25- cartilage and reproductive
dihydroxycholecalciferol [1,25 organs; these may be beneficial
(OH)2D3], the active vitamin D3 in treating cancer
and goes to intestine where it
stimulates synthesis of proteins Interaction with Other Nutrients
needed to transport calcium  Vitamin D metabolism is
across intestinal mucosa interrelated with calcium,
 Kidneys start to form active phosphorous and parathyroid
vitamin D when parathyroid hormone, and calcitonin
hormone blood level rises as result  The active vitamin stimulates
of decrease in blood calcium or absorption of Ca and P
phosphorus level  Low vitamin D levels result in a
 Ca and P absorption in intestine; decreased formation of the
1,25 (OH) D3 stimulating active vitamin leading to bone
mobilization of Ca and P from calcium resorption
bone and bringing about renal  High phosphorus deactivates the
reabsorption of Ca are the effects production of active vitamin D
of the activation of vitamin D  Vitamin K is needed in formation
of calcium-binding proteins
present in target tissues activated
by vitamin D

Deficiency of Vitamin D
 Rickets (in children):
characterized by soft and fragile
bones, enlarged joints, bowed
legs, and deformities of chest,
spine and pelvis
 Osteomalacia (in adults):
aggravated by calcium
deficiency characterized by
softening of bones
 Osteoporosis: loss of calcium from
bones causing reduced bone
density
 Nutrition and Diet Therapy
disorders (Tropical sprue, Crohn’s
disease, diverticulosis, gastric
resection), liver and renal disease,
parathyroid disorder, those taking
anticonvulsant drugs sedative
and tranquilizers, preschoolers,
and the elderly.
 Factors that may limit sun
exposure and, therefore vitamin D
synthesis:
 Geographic Location
 Season of the year
 Time of day
 Air pollution
 Clothing
 Tall buildings
 Indoor living
 Sunscreens
 Food Sources: Fish liver oils, butter,
clams, oysters, eggs, sardines,
vitamin D-fortified foods (milk,
margarine)

3. Vitamin E
Other Names:
 Tocopherol
 Antisterility factor
Toxicity of Vitamin D  Antioxidant vitamin
 Hypervitaminosis D: calcification
of kidneys and lungs, nausea, Chemistry of Vitamin E
weight loss, and polyuria.  Include alpha , beta, gamma and
delta tocopherols, and the
Recommended Intake of Vitamin D unsaturated alpha, beta, gamma
 For the recommended intake, and delta tocotrienols.
please refer to the  Alpha tocotrienol: most
Recommended Energy and widespread and biologically
Nutrient Intake Philippines (2002 active
Edition).  Stable in high temperatures and
 Ability of the body to synthesize acids.
vitamin makes it difficult to  Readily oxidized in presence of
estimate minimal dietary rancid fats or lead and iron salts.
requirements. Daily intake of 100  Unstable to alkali, ultraviolet light
IU is adequate to protect against and oxygen.
rickets and promote normal bone  Vitamin content of food is
growth, provided that the diet is expressed as tocopherol
also sufficient in Ca and P. equivalents (TEs), with TE
 People at-risk of vitamin D corresponding 1 mg of alpha –
deficiency included the tocopherol.
alcoholic, those with insufficient
sun exposure, those with intestinal
 Nutrition and Diet Therapy
Absorption, Transportation, & Utilization
of Vitamin E
 Absorbs 40-60% of dietary vitamin
E 
 Absorption rate decreases as
vitamin consumption increases
 Absorbed from gut with aid of bile
salts
 Enters lymphatic system carried
within chylomicrons
 Transported by lipoprotein to be
stored in liver
 Stored in adipose tissue and liver
 Normal plasma tocopherol
concentrations are between 0.6
and 1.6mg/100mL; drops rapidly
as when withdrawn from the diet
 Excreted in feces and skin
Function of Vitamin E
 Maintenance of intracellular
membrane integrity by being an
antioxidant (substance that
prevents oxidation of other
substances) and free-radical
scavenger; thus, cells membranes
are protected against lipid
peroxidation.
 When vitamin A is deficient,
vitamin E lowers rate at which
vitamin A is depleted from liver
Requirements for vitamin E
increase with increased intake of
PUFA
Deficiency of Vitamin E
 Vitamin E deficiency is quite rare.
It has manifested only in
premature infants and among
individuals with defective fat
absorption
 Symptoms include RBC breakage
(hemolysis), anemia,
degeneration, weakness,
difficulty walking, severe pain-calf
muscles, retinopathy (defective
functioning of the retina) among
premature infants.
 Fibrocystic breast disease and
abnormality in blood flow of legs
(intermittent claudication)
Toxicity of Vitamin E
 May interfere with blood clotting
action of vitamin K; may cause
haemorrhage

Interaction with other Nutrients Recommended Intake of Vitamin E

 Vitamin E and selenium (a  The safe level of intake for vitamin
component of glutathione E for adults is 12 mg/day. High
peroxidase) both function to intakes of PUFAs mean increased
protect cells from destructive vitamin E intake
effects of oxygen radicals  The term “safe” rather than
 Vitamin E and sulfur-containing “recommended” is used since
amino acids, together with zinc, value is derived from data for US
manganese and copper are population whose mean PUFA
interrelated intake can be presumed to be
 The sulfur-containing higher than that of Filipinos
amino acids are needed because the major in the Filipino
for synthesis of glutathione diet is medium-chain saturated
that serves as reducing fat-rich coconut oil.
agent in glutathione-
peroxidase reaction Food Sources of Vitamin E
 Zinc, manganese and  Plant oils (corn, soy, cottonseed,
copper activate the and safflower), green and leafy
enzymes important in vegetables, whole grain
regulating oxygen radicals. products, liver, egg yolk, nuts and
seeds
 Nutrition and Diet Therapy
4. Vitamin K  Needed in gamma-carboxylation
Other Names: of certain glutamate residues
 Anti-hemorrhagic vitamin/factor allowing firm binding of calcium
 Coagulation factor
 Menadione
 Menaquinone
 Phylloquinone
 Paphtoquinone

Chemistry of Vitamin K
 Belongs to a group of chemicals
called quinones. These include
phylloquinone (K1): present in
plant foods,
menaquinone (K2): found in
animal tissues and synthesized by
intestinal bacteria and
synthetic substance menadione
(K3)
 Yellow-colored, heat-resistant but
easily destroyed by alkalis, strong
acids, light and oxidizing agents

Absorption, Transport, & Utilization of

Vitamin K
 Solubilized by its incorporation into
micelles before it is absorbed. Bile
and pancreatic secretions are
also needed
 Phylloquinone is absorbed by
active transport, while
menaquinone is absorbed by
passive transport
 About 40-70% of dietary vitamin K
is absorbed
 Absorbed in intestinal wall cells,
incorporated into chylomicrons
and is taken up by liver
 Incorporated into very low-density
lipoproteins and eventually
carried to extrahepatic tissues by
low-density lipoproteins
Function of Vitamin K
 Essential for synthesis of several
proteins involved in blood clotting
 Participates in synthesis of bone
protein
Interaction with Other Nutrients
 Antagonistic effect of vitamin A
and E
 Excess vitamin A interferes
with absorption of vitamin
K
 The antagonistic effect of
vitamin E is still not clear. It
has been established
whether the antagonism
occurs in the level of
absorption or metabolism
 Vitamin D functions are related to
calcium metabolism while vitamin
K-dependent proteins are
capable of binding calcium
 Nutrition and Diet Therapy
Deficiency of Vitamin K
 Hemorrhagic disease: delayed
clotting time due to fat
malabsorption, loss or lack of
microorganism which synthesize
vitamin K

Toxicity of Vitamin K
 Hypervitaminosis K: condition
brought about by uncontrolled
use of menadione synthetic
vitamin K that results:
 Hemolytic anemia (RBC
hemolysis)
 Accumulation of bilirubin in
blood (hyperbilirubinemia);
and
 Kernicterus wherein bile
pigment accumulates in
gray matter of central
nervous system leading to
brain damage

Recommended Intake of Vitamin K

 Ability of the body to synthesize
vitamin makes it difficult to
estimate minimal dietary
requirements. Daily intake of 100
IU is adequate to protect against
rickets and promote normal bone
growth, provided that diet is also
sufficient in Ca and P.
 Breastfeed infants should receive
vitamin K supplementation at birth
according to nationally
established guidelines
 At-risk individuals include:
 New born infants
 Those with renal
insufficiency; and or
 Those being treated
chronically with antibiotics

Food Sources of Vitamin K

 Green leafy vegetables,
cauliflower, carrots, tomatoes,
egg yolk, pork liver, seaweeds
 Nutrition and Diet Therapy
MINERALS
 Inorganic element that remains ash
when food is burned
Classification
 Macronutrient minerals: essential for
human nutrition; present in amounts
greater than 5g; includes calcium (Ca),
sodium (Na), phosphorous (P), potassium
(K), sulphur (S), chloride (Cl) and
magnesium (Mg)
 Micronutrient minerals: essential for
human nutrition; present in amounts less
than 5g; includes iron (Fe), iodine (I), zinc
(Zn), selenium (Se), manganese (Mn),
copper (Cu), molybdenum (Mo), cobalt
(Co), and chromium (Cr)
 Minerals for which essentiality has not yet
been established although there is
evidence of their participation in certain
biologic reactions; includes silicon (Si),
vanadium (V), tin (Sn), barium (Ba),
nickel (Ni), arsenic (As), boron (Bo),
fluoride (F), bromine (Br), strontium (Sr)
and cadmium (Cd)
 Minerals found in body that have not
been assigned metabolic role yet;
includes gold (Au) silver (Ag) aluminium
(Al), mercury (Hg), bismuth (Bi), gallium
(Ga), lead (Pb), antimony (Sb), lithium (Li)
and 20 others
General Functions
1. Components of essential body
compounds
 Ca and P in bones and teeth
 Cl hydrochloric acid
 I in the hormone thyroxine
 Co in Vitamin B12
 Zn in insulin
 S in methionine
 Fe in haemoglobin
2. Cofactors in biologic reactions
a. Some minerals act as cofactors binding
to specific enzymes to catalyse chemical
reactions. Iron, zinc and copper form
complexes with enzymes called
metalloenzymes.
b. Some ions act as cofactors for proteins
that are not enzymes, while others
covalently bond to proteins to influence
their activities
c. Proteins are activated by
phosphorylation where phosphate ion
(PO43-) attaches to specific part of
protein
d. The protein Hb incorporates iron that
binds to oxygen
e. Facilitation of absorption, digestion and
transport
 Sodium facilitates absorption of
carbohydrates
 Calcium facilitates absorption of
Vitamin B12.
f. Maintenance of acid-base balance
 Acid-forming minerals: chloride,
sulfur and phosphorus can
combine with H
 Alkali-forming minerals: sodium,
potassium, magnesium and
calcium can combine with OH
g. Maintenance of water balance
 Electrolytes (Na, K, Cl) greatly
influence movement of water
among fluid compartments
h. Transmission of nerve impulses
 Exchange of Na and K across cell
membrane is responsible for
transmission of nerve impulse. The
release of acetylcholine is
regulated by calcium
i. Regulation of muscle contraction
 Ca stimulates muscle contraction,
and Na, K and Mg exert relaxing
effect
MACROMINERALS
1. Calcium
A. Description
 Most abundant mineral in body
 Calcium makes up 1.5-2% of
body weight
 About 99% of mineral is present in
bones, teeth and hard tissues
 Most of it is in form of complex salt
called hydroxyapatite
Ca10(PO4)6(OH2), with smaller
 Nutrition and Diet Therapy
amounts being associated with
carbonate and citrate
 Remaining 1% (about 1/3 of which
is bound to protein) not contained
bones and teeth is present in
blood, extracellular fluids and
within the cells of soft tissues where
it regulates many important
metabolic functions
 It must be maintained within
narrow range of 9-11 mg/dL for
proper functioning of cells
B. Functions of Calcium
a. Physiological Functions:
1. Bone formation: development of
bone, which contains Ca and other
minerals, start in fetal life and is
continuously being reshaped and
remolded throughout life according
to body needs and stresses.
This bone remodeling takes place in 2
types of cells, namely:
a. Osteoblasts: continually form new
bone matrix
b. Osteoclasts: balance this activity
by absorbing bone tissue
Adequate calcium: needed to permit
optimal gains in bone mass and
density in pre-pubertal and
adolescent years.
2. Teeth formation: Ameoblasts,
specialized tooth forming cells in
gums, deposit Ca and other
constituents to form teeth
b. Metabolic Functions:
1. Blood coagulation. Ionized Ca stimulates
release of thromboplastin from blood
platelet which catalyzes the conversion
of prothrombin to thrombin. In turn,
thrombin catalyzes conversion of
fibrinogen in blood plasma to fibrin or
blood clot (blood coagulum)
2. Transmission of nerve impulses
3. Regulation of contraction-relaxation of
heart muscle (heartbeat)
4. Regulation of cell membrane
permeability by controlling passage of
fluid through cell walls
5. Activation of enzymes such as ATP, lipase
and some protein-splitting enzymes
6. Maintenance of acid-base and
electrolyte balance
7. Immunity
8. Facilitates absorption of Vitamin B12
9. Protection against carcinogens, e.g.
radiostrontium
10. Protection against lead poisoning
C. Factors Influencing Calcium Absorption
1. Better absorption during increased
needs (growth, pregnancy, lactation)
2. Vitamin D enhances, increasing
permeability of intestinal membrane to
calcium and activating system
3. Low gastric PH (acidic) favors absorption
4. Hypochlorhydrin (alkaline) precipitates
calcium
5. Increase meat intake increases calcium
excretion
6. If increase ratio of lactose to calcium-
forming of soluble complex transport to
intestinal wall
7. Ratio of calcium: P
8. Oxalates (alagaw, alugbati, spinach)
decrease calcium absorb by forming
insoluble salts
9. Phytates (cereals, wheat, oats)
10. Excess fats: insoluble soaps (in fatty
stools) with calcium
11. Laxatives food increase bulk, decrease
calcium absorption
12. Lack of exercise, loss of bone calcium
and ability to replace it
13. Mental stress/emotional instability
14. Alcohol intake decrease calcium
15. Caffeine decreases urinary calcium
excretion
D. Calcium in Bones
a. in bone formation: calcium salts form
crystals “hydroxyapatite” on matrix of
protein collagen
b. in bone mineralizing: crystals become
denser, gives strength and rigidity to
bones
c. in remodeling: bones gain and lose
minerals, example: withdrawal, deposits,
osteoporosis
 Nutrition and Diet Therapy
d. in teeth formation: slower rate than bone
formation and fluoride hardens and
stabilizes the crystal of teeth
Calcium in Body Fluids
a. 1% but vital in different functions
b. activates calmodulin (inactive protein):
relays messages from cell surface to
inside of the cell and maintains blood
pressure
Calcium in Disease Prevention
 Lowers blood pressure if adequate
calcium intake since calcium supersedes
effects on high sodium intake
Calcium Balance (intestines, bones,
kidneys)
 Osteoblasts: builds
 Osteoclasts: breaks
If increase blood calcium, thyroid gland
secretes calcitonin.
Calcitonin: inhibits vitamin D activation,
prevents calcium reabsorption in kidneys and
inhibits osteoclasts from breaking down bones
If decrease in blood calcium- parathyroid
glands secrete parathormone.
Parathormone: stimulates vitamin D activation,
stimulates calcium reabsorption in kidneys and
stimulates osteoclast
E. Recommended intake
 Refer to PDRI 2015
 Allowances take into account need to
protect children in whom skeletal needs
are much more important determinants
of calcium requirement than are urinary
losses and in whim calcium
supplementation has been found to
have beneficial effect in children
accustomed to low calcium intakes
F. Conditions with increased risk for Ca
deficiency
a. Vitamin D deficiency
b. Long term dietary inadequacy
c. High protein diets
d. High fiber diets
e. Fat malabsorption/steatorrhea
f. Achlorhydria
g. Immobilization/sedentary lifestyle
h. Decreased gastrointestinal (GI) transit
time
i. Stress
j. Long-term use of thiazide diuretic
G. Populations with increased risk for Ca
deficiency
a. Teenagers
b. Older women
c. Pregnancy and lactation
H. Food sources
Dilis (dried and fresh), alamang (dried
and fresh), dried fish; shellfish and
crustaceans, milk, cheese, ice cream,
soybeans, mongo and other dried
beans, leafy vegetables
I. Effects of deficiency
a. Stunted growth and retarded
calcification of bones and teeth
b. Rickets: due to lack of Ca or P, lack of
vitamin D, or an imbalance in Ca : P ratio
c. Osteoporosis: absolute amount of bone
in skeleton has been diminished but
which in remaining bone mass is of
normal composition)
d. Osteomalacia: decalcification of bone
where there is reduction in mineral
content of bone but not in total amount
of bone
e. Tetany: reduction in circulating ionized
Ca resulting in increased excitability of
nerve and spasmodic and uncontrolled
contractions of muscle tissues
f. High blood pressure
g. Colon Cancer
J. Effects of toxicity
a. Hypercalcemia: condition characterized
by excess of Ca in blood and soft tissues;
occurs in infants with high intake of
vitamin D
b. Calcium rigor: state of tonic muscle
contraction that results when Ca level
rise above normal due to abnormality in
parathyroid functioning
c. Hypercalcuria/renal calculi
 Nutrition and Diet Therapy
K. Interrelationship with other nutrients b. Ability of body to synthesize vitamin
a. Vitamin D, phosphorous, sodium, protein makes it difficult to estimate minimal
and fiber affect Ca absorption and dietary requirements. Daily intake of 100
metabolism IU is adequate to protect against rickets
b. Magnesium (another divalent cation) and promote normal bone growth,
competes with Ca for absorption and is provided that diet is also sufficient in Ca
needed for secretion of PTH and P
c. Malabsorption of fat can interfere with c. Quantities of calcium and phosphorous
Ca absorption due to the formation of are more important than their ratios
soaps
E. Conditions and populations with
2. Phosphorous increased risk for phosphorous
A. Description deficiency
a. Phosphorous is second to calcium in Those with celiac disease, sprue,
abundance in human body hyperthyroidism, insulin injections,
b. Constitutes about 1% of total body alcoholics and premature infants
weight, largely in form of phosphate
(PO4) F. Food sources
c. 85% of mineral is found in bones, 14% in Meat, fish, poultry, glandular organs, egg
cells in soft tissues and 1% in extracellular yolk, milk, cheese, beans, nuts and seeds,
fluid whole grain cereal

B. Function G. Deficiency
a. Calcification of bones and teeth a. Rare but may cause tetany and
b. Metabolism of energy by all cells hypertension
c. Important in absorption and transport of b. Develops in alcohol abuse, alcoholism,
nutrients kidney disorders, prolonged vomiting or
d. Essential component of nucleic acid diarrhea.
(DNA and RNA), adenosine triphosphate c. Interrelationship with other nutrients
(ATP), adenosine diphosphate, d. Sodium is essential to ensure optimum
coenzymes and some vitamins phosphorous absorption.
e. Major component of cell membranes e. Increase in Mg consumption decreases
and intracellular organelles phosphorous absorption
f. Regulation of acid-base balance
H. Interrelationship with other nutrients
C. Absorption and metabolism a. Sodium is essential to ensure optimum
a. Released by action of intestinal enzymes phosphorous absorption
phosphatases b. Increase in Mg consumption decreases
b. Absorbed into blood with help of Vitamin phosphorous absorption
D. Blood phosphorous level is regulated
by parathyroid gland that interacts with 3. Magnesium
Vitamin D to control absorption of A. Description
mineral a. Half of body’s magnesium is in bones
c. Factors affecting Ca absorption and b. 1% is in extracellular fluid
metabolism are same with phosphorous
B. Functions
D. Recommended intake a. Involved in bone mineralization
a. For recommended intake, please refer to b. ATP metabolism
the PDRI c. Synthesis of proteins, fats and glucose
and cells transport system
 Nutrition and Diet Therapy
d. Muscle contraction c. Mg can influence the balance between
e. Clotting extracellular and intracellular K. the
f. Immune function mechanism of action is still not clear
g. Prevents dental caries
h. Nerve transmission of impulses 4. Sulfur
A. Description
C. Absorption and metabolism a. Present in every cell in body, particularly
a. Absorption of Mg from food ranges from in cartilage and keratin of skin, nails and
20% to 70% hair.
b. Transported by specific carrier and b. Occurs in number of forms in body: as
vitamin D sensitive transport system sulfur within organic compounds such as
c. Rate of absorption is decreased by the amino acids, sulfur within ions, sulphate
same factors that affect Ca. ion (SO42-), and the sulphite ion (SO32-).
d. Absorption is influenced by PTH. c. Any excess sulfur is excreted in urine

D. Recommended intake B. Functions

For recommended intake, please refer to a. Constituent of sulfur-containing amino
PDRI. Recommended intake is based on acids (methionine, cysteine and cystine)
a requirement of 4mg/kg body b. Constituent of vitamins thiamine,
weight/day for adults to achieve a pantothenic acid and biotin, vitamin-like
positive magnesium balance. lipoic acid, insulin, heparin, glutathione,
coenzyme A
E. Food sources c. Participates in detoxification reactions
Nuts, legumes, whole grains, dark green d. Constituent of structural tissues
leafy vegetables, seafood, chocolate, mucopolysaccharides and sulfate in
coco lipids
e. Needed in energy metabolism and
F. Deficiency disease: Low Magnesium enzyme activation
Tetany
a. Symptoms associated with low plasma C. Recommended intake
Mg levels: irritability, nervousness and There is no recommended intake for
convulsions due to overstimulated nerves mineral. Since all protein food provides
and increased muscular contraction. sulfur, need for mineral is met when
b. Mg deficiency rarely occurs because of protein intake is adequate
efficiency in which kidneys reabsorb
mineral D. Food sources
All protein-containing foods
G. Conditions and populations with
increased risk for Mg deficiency E. Deficiency
Vomiting, diarrhea, alcoholism, protein Deficiency in sulfur occurs only when
malnutrition, diuretic use, malabsorption, there is severe protein deficiency
renal disease, diabetes, parathyroid
disease, stress and postsurgical patients F. Toxicity
Toxicity occurs only if sulfur-containing
H. Toxicity amino acids are taken in excessive
Overconsumption of mineral is not likely amounts
to cause toxicity except in persons with
renal insufficiency 5. Sodium
a. Interrelationship with other nutrients A. Description
b. Mg is antagonistic to Ca
 Nutrition and Diet Therapy
About 50% of total body sodium is found
in extracellular fluids, 40% in skeleton and
10% inside cells.
B. Functions
a. Maintenance of normal extracellular
fluid balance
b. Maintenance of normal pH value of
extracellular fluids
c. Needed in absorption of glucose and in
transport of other nutrients
d. Aids in nerve impulse transmission and
muscular contraction
C. Absorption and metabolism
a. Absorbed in small intestine and is
transported by blood throughout body
b. Blood passes kidneys; it is filtered out and
then partially reabsorbed into blood to
maintain normal blood sodium levels
c. Concentration of sodium in extracellular
fluid is determined by reninangiotensin-
aldosterone system and sympathetic
nervous activity
d. Aside from urinary losses, sodium is also
lost via skin
D. Recommended intake
For recommended intake, please refer
PDRI
E. Food sources
Salt, soy sauce, processed foods
F. Deficiency
Muscle cramps, mental apathy, loss of
appetite, persistent vomiting or diarrhea,
heavy sweating, or diuretic therapy can
deplete body sodium resulting in
hyponatremia (low sodium blood levels)
G. Toxicity
Edema, acute hypertension,
osteoporosis
Consume less than 2300 mg (approximately
1tsp of salt) of sodium per day
6. Potassium
A. Description
Concentrated in intracellular fluids,
about 250g
B. Functions
a. Cell integrity
b. Participates in many biochemical
reactions inside cell, particularly those
involved in release of energy from food
and synthesis of protein and glycogen
c. Maintains normal fluid balance
d. Maintains acid-base balance
e. Aids in nerve impulse transmission and
muscular contractions
f. Acts along with Mg as muscle relaxant
opposing muscle-contracting stimulus of
Ca
g. Important in release of insulin by
pancreas
h. For regulation of heart rhythm
C. Absorption
a. Distributed in blood from intestine mainly
by diffusion
b. Enters cell against concentration
gradients and therefore requires active
transport mechanism
c. Potassium is excreted into urine
D. Recommended intake
For recommended intake, please refer to
the PDRI.
E. Food sources
Fresh foods, particularly fruits, vegetables
and legumes
F. Deficiency - Hypokalemia
a. Muscular weakness, paralysis, confusion
b. Prolonged vomiting or diarrhea, regular
use of certain drugs (diuretics, steroids
and laxatives), severe protein-energy
malnutrition, and surgery could result in
potassium deficiency.
c. Causes: chronic kidney failure, severe
vomiting, excess insulin administration,
diuretic drugs, excessive sweating,
asthma drugs
G. Toxicity
 Nutrition and Diet Therapy
Muscular weakness, vomiting, cardiac MICROMINERALS
arrest, hyperkalemia 1. Iron
A. Description
1. Chloride a. Adult male contains 40-50 mg of iron per
A. Description kilogram body weight, while adult
a. Comprises about 0.15% of adult weight female contains 35-50 mg
b. Widely distributed b. More than two thirds of body is in form of
c. Concentration is high in cerebrospinal functional iron (perform specific role),
fluids, GI secretions and gastric juices which is bound within Hb molecule or
within myoglobin in muscle tissues
B. Functions c. Non-functional iron (storage form): found
a. Maintains normal fluid and electrolyte in liver, spleen and bone marrow
balance
b. Constituent of hydrochloric acid B. Functions
c. Helps maintain acid-base balance in a. As part of protein Hb and myoglobin, iron
body fluids binds to oxygen molecules and transport
O2 through blood (in Hb) or stores O2
C. Absorption within muscles in myoglobin
a. Readily absorbed in the GI tract b. As part of Hb, it is involved in formation of
b. Excreted in the urine and sweat. red blood cells (RBCs)
c. Cofactor of non-heme enzymes and
D. Food sources other proteins
Salt, soy sauce, meat, seafood, milk,
eggs, processed foods C. Absorption and Metabolism
a. Available to body either in
E. Deficiency heme form: present only in animal
A diet deficient in chloride does not products
normally occur nonheme form: iron in plant foods
b. Absorption occurs primarily in duodenum
F. Toxicity symptoms and jejunum
Vomiting causing dehydration c. Variety of factors influence iron
absorption
Summary of associated disorders resulting 1. Size of dose: the higher the intake of iron,
from deficiency or excessive intake of the lower the percentage of iron absorb
macrominerals 2. Body needs: deficient in iron absorb
more the mineral
3. Form of iron: ferrous form Fe2+ is better
absorb than ferric form Fe3+

d. Factors enhancing the absorption of non

heme iron:
1. Increase acidity
2. Animal tissue protein

e. Factors inhibiting absorption of non

heme iron:
1. Low gastric acidity
2. High dietary calcium and phosphorous
intake
3. High manganese intake
 Nutrition and Diet Therapy
4. Dietary fiber F. Food sources
5. Certain proteins Liver and glandular organs, fish, egg yolk,
6. Phytates and oxalates shell fishes, leafy vegetables, except
7. Polyphenols amplaya, leaves, soy beans

f. After absorption, iron is carried to blood G. Deficiency

bound to protein transferrin Microcytic, hypochromic anemia, results
g. Stored in liver in form of ferritin and in low Hb stores, fatigue, weakness,
hemosiderin pallor, poor resistance to cold
h. 90% of iron is released in breakdown of temperature, apathy
cells
H. Toxicity
D. Recommended intake Caused by poor quality sources cookery;
a. For recommended intake, please refer to excessive excretion due to blood loss;
PDRI (2015). The recommended intake inadequate form due to lack of B12
for Filipinos is based on amount of dietary caused by lack of IF.
iron needed to meet absorbed iron a. Hemosiderosis/siderosis: condition with
requirements. This would correspond to large deposits of iron deposit,
amount needed to cover basal losses hemosiderin in liver (use of supplement
plus growth for children and menstrual failure to regulate iron absorption)
losses for women of reproductive age b. Hemochromatosis: genetic disorder that
adjusted for bio availability of iron in enhances absorption
typical complete meals consumed by
Filipinos I. Issues
b. For infants, it is assumed that iron a. Iron and cancer: iron may be involved in
provided by breast milk is adequate to causing cancer by damaging DNA
meet iron needs of infants exclusively fed through its free radical activity
human milk from birth to six months b. Heart disease: attack of free radicals on
c. Consumption of iron rich foods and iron ferritin activates oxidative role of iron
fortified foods, recommended for against LDL
women from adolescence onwards
d. Iron supplementation, recommended to Possible Side Effects of Iron Supplements
meet needs of pregnant and lactating  Upset stomach
women  Nausea
e. Estimated iron requirement during first  Diarrhea
trimester of pregnancy and first six  Faintness
months of lactation are actually higher  Vomiting
than requirements for menstruating non-  Dark stools
pregnant and non-lactating to allow for  Constipation
build-up of iron stores during these
periods 2. Zinc
A. Description
E. Interrelationship with other nutrients a. Commonly found as divalent ion
Vitamin C enhances iron absorption by b. Amount of mineral in adult ranges from
acting as reducing agent and forms 1.5-3g
chelate with non heme ferric iron at acid c. Occurs in all cells, tissues, organs, fluids
pH. The chelate remain soluble in small and secretion but is mainly concentrated
intestine, thus improving intestinal (about 90% of body zinc in muscle bone)
absorption of non heme iron
 Nutrition and Diet Therapy
d. Over 95% is bound within various D. Recommended intake
metalloenzymes of cells and cell For recommended intake, please refer to
membranes. PDRI
e. Most of zinc in blood is in RBCs, which
contain zinc containing enzyme E. Interrelationships with other nutrients
carbonic anhydrase needed to convert a. Zinc2+ absorption: impaired by following
carbon dioxide to bicarbonate ions divalent cations: Cd2+, Cu2+, Ca2+, and
(HCO3) Fe2+.
b. Cations compete with one another for:
B. Functions 1. Facilitating binding ligands in intestinal
a. Component of more than 200 enzymes, lumen
participating in wide variety of 2. Receptor sites in enterocytes; or
metabolic processes such as synthesis 3. Intracellular binding ligands with
and degradation of carbohydrates, mucosal cells
lipids, proteins and nucleic acids
b. Interacts with insulin facilitating uptake of F. Food sources
glucose by cells of adipose tissue Zinc from animal foods is more readily
c. Needed for normal development and absorbed than that in plant foods.
maintenance of body’s immune system Sources include meat, poultry, fish, grains
d. Important in stabilizing membranes and vegetables.
structure and in guarding it against
peroxidative damage G. Deficiency Symptoms
e. Important in night vision Deficiency manifestations are diverse:
f. Important in mobilizing Vitamin A from hair loss, dermatitis and skin changes,
liver stores growth retardation, impaired taste
g. Facilitates wound healing and blood acuity, delayed wound healing,
clotting decrease dark adaptation (night
blindness), immunologic abnormalities,
C. Absorption and metabolism and delayed sexual maturity.
a. Absorbed in small intestine and is carried
into blood and goes to pancreas where H. Toxicity symptoms
it is used in formation of some digestive Following are some adverse effects of
enzyme prolonged intake of dietary zinc
b. Absorbed zinc binds to metallothionein: supplements:
sulfur-rich protein that binds with metals a. Zinc-induced copper deficiency anemia
such as zinc b. Depressed levels of white blood cell
c. Binds with another protein (cysteine-rich c. Increased low-density lipoprotein and
intestinal protein) to transport mineral to decreased high-density lipoprotein
blood cholesterol
d. Zinc that is carried within blood plasma is d. Decreased serum ferritin and
bound with different carrier proteins, haematocrit levels
such as albumin and transferrin
e. Liver takes up some 30-40% of absorbed Zinc-Deficiency Symptom (The Stunted Growth
zinc, while rest is distributed throughout of Dwarfism)
different organs and tissues. Growth retardation: known as dwarfism; rightly
f. Zinc loss from body is via body surface, ascribed to zinc deficiency because it is
kidney and GI tract. Most of zinc is partially reversible when zinc is restored to diet
excreted in feces.
 Nutrition and Diet Therapy
3. Copper
A. Description
a. Occurs in cuprous (Cu+) and cupric
(Cu2+) states
b. Involved in oxidation-reduction reactions
c. Body’s copper content ranges form 50-
120mg
d. Highest concentration of mineral is in
liver, with less amounts in heart, kidneys,
spleen and brain
e. Copper in blood and tissues is normally
bound to proteins
B. Functions
Copper: essential as activator of key
enzymatic reactions. Some copper-
containing enzymes and reactions they
catalyse are:
a. Cytochrome c oxidase: catalyzes
oxidation of cytochrome c, a, and a3
complex by oxygen in respiratory chain
b. Ceruloplasmin:
(a) oxidizes ferrous ions
(b) transports copper to Tissue sites and
(c) acts as scavenger of free radicals
and superoxide ions
c. Superoxide dismutase: toxic oxygen
removal
d. Lysyl oxidase: collagen synthesis
e. Dopamine beta-hydroxylases:
neurotransmitter synthesis
f. Tyrosine oxidase: melanin synthesis
C. Absorption and metabolism
a. About 25-40% of dietary copper is
absorbed from all parts of GI tract,
including stomach and large intestine
b. Binds with proteins such as
metallothionein, which slows down Cu
absorption into blood
c. Removed from plasma by liver from
where it is excreted into bile or used in
synthesis of ceruloplasmin, copper-
containing enzyme
d. Released from liver under control of
adrenal gland. The body utilizes some of
plasma copper in synthesis of superoxide
dismutase in bone marrow
e. Excreted in both feces and urine
D. Recommended intake
Recommended intake for mineral has
not been determined in Philippines. The
US RDA (2001) for copper: 10mg/day or
900ug/day
E. Interrelationship with other nutrients
a. High intake of iron or vitamin C
decreases absorption of copper
b. Zinc decreases copper absorption
c. Calcium is antagonistic to copper
d. Copper from complexes with
molybdenum and sulfur, decreasing
copper absorption
F. Deficiency
a. Copper deficiency: seen among
children with protein-deficiency and
iron-deficiency anemia. Deficiency
symptoms include decreased serum
copper and anemia, impaired glucose
tolerance, poor wound healing, immune
defects and central nervous system and
cardiovascular disorders.
b. Menke’s Kinky Hair Syndrome: inherited
condition characterized by low serum
copper and ceruplasmin levels. This
disease prevents release of Cu into
general circulation
G. Toxicity
Wilson’s disease: hereditary condition;
associated with chronic copper toxicity
due to failure to excrete copper in bile
4. Iodine
A. Description
a. Body contains 20-30mg of iodine that is
concentrated in thyroid gland
b. Dietary iodine is mainly in form of iodine
B. Functions
a. As part of thyroid hormones, it is essential
in regulating body’s growth,
development and metabolic rate
b. Essential in conversion of carotene to
Vitamin A
c. Protein synthesis
d. Carbohydrate absorption
e. RBC production
 Nutrition and Diet Therapy
f. Nerve muscle function b. Cretinism: developmental defect in
infants characterized by mental
C. Absorption and metabolism retardation, deaf-mutism, and
a. Absorbed mainly in small intestine, neuromuscular defects
distributed in extracellular fluids c. Myxedema: form of cretinism, seen in
b. Reduced first to absorbable iodide ions adults and characterized by dry thick
c. One third of absorbed iodide in blood skin, puffy face and eyelids, enlarged
plasma is taken up by thyroid gland for tongue, husky voice, decreased
synthesis of thyroid hormones: thyroxine reproductive ability and mental
(T4) and triiodothyronine (T3) deterioration
d. The rest of iodide is excreted mainly in
urine, while some amounts are lost via H. Toxicity
skin and feces Hyperthyroidism: aka Grave’s Disease/
Exophthalmic Goiter
D. Recommended intake
a. For recommended intake, please refer to Simple Goiter: goiter caused by iodine
PDRI (2015). The recommended intake deficiency; thyroid gland enlarges
for adults corresponds to intake Goiter: enlargement of thyroid gland due to
necessary to maintain plasma iodide iodine deficiency, malfunction of gland, or
level above critical limit to be associated overconsumption of goitrogen.
with onset of goiter Goitrogen: substance that enlarges thyroid
b. Pregnant and lactating mothers as well gland and causes toxic goiter. Goitrogens
as adolescents are at risk of developing occur naturally in such foods as cabbage, kale,
deficiency of iodine brussels sprouts, cauliflower, broccoli, and
kohlrabi
E. Interrelationship with other nutrients Cretinism: congenital disease characterized by
a. Goitrogens (from cabbage, kale, mental and physical retardation and
cauliflower, broccoli, turnips, brussel commonly caused by maternal iodine
sprouts and mustard greens): substances deficiency during pregnancy
that interfere with iodine metabolism
inhibiting hormonogenesis 5. Selenium
b. The following goitrogens may affect A. Description
iodide uptake by thyroid gland, a. Found in minute amounts of body,
organification of iodide or hormone concentrated in other glandular organs,
release from thyroid cells; halide ions blood, and muscles
such as Bromide (Br), astatide (At), and b. The two forms of Se mainly present in
thiocyanate (SCN). Cassava contains food:
cyanogen glucosides, with thiocyanates Selenomethionine: synthesized by plants
as metabolites. Selenocysteine: synthesized by animals

F. Food source B. Function

Iodized salt, seafoods, seaweeds As part of enzyme “glutathione
peroxidase”: calatlyzes breakdown of
G. Deficiency toxic hydroperoxides making mineral an
a. Iodine deficiency disorders (IDD): goiter, essential component of body’s
hypothyroidism, impaired mental antioxidant defense system
function, spontaneous abortions,
stillbirths, congenital abnormalities and C. Absorption and metabolism
increased infant mortality a. Bound to proteins (globulins and
lipoproteins)
 Nutrition and Diet Therapy
b. Taken up by RBCs, liver, heart, spleen,
nails and tooth enamel
c. Major routes of Se excretion: urinary (50-
60% of total amount excreted) and fecal
(40-50% of total excretory output)
D. Recommended intake
a. For recommended intake, please refer to
PDRI
b. FAO/WHO recommends 31 ug/day to
provide adequate reserves based on
satisfactory levels of plasma selenium
and glutathione peroxidase activity
E. Interrelationship with other nutrients
a. Se is vitamin E sparer
b. Se protects against toxicity of Cd, Hg,
and Ag
c. The potency of selenomethionine is
reduced in methionine deficiency
F. Food sources
Seafoods, liver, meats, whole grain and
airy products are good sources
G. Deficiency
a. Clinical manifestations: muscle pain and
weakness, cardiomyopathy, and loss of
pigmentation (pseudo-albinism)
b. Keshan disease: selenium deficiency
condition that causes heart
enlargement;
Heart disease associated with selenium
deficiency named for one of the
provinces of China where it was studied.
It is characterized by heart enlargement
and insufficiency; fibrous tissue replaces
muscle tissue that normally composes
middle layer of walls of heart
H. Toxicity
a. Loss of hair and nails, dental carries,
dermatitis, peripheral neuropathy,
irritability and fatigue and lesions of skin
and nervous system
b. Selenosis: selenium poisoning that can
be caused by excessive intake of Se
usually provided in supplements. Se is
toxic at levels 20-30 times requirements
6. Manganese
A. Description
Body contains 29mg concentrated Mn in
liver, pancreas, kidneys, skin, muscles
and bones
B. Functions
a. As cofactor of various enzymes, involved
in glucose and fatty acid metabolism
b. Required for normal development of
skeleton and connective tissues
c. Required by mitochondrial superoxide
dismutase: catalyzes conversion of
superoxide to hydrogen peroxide. The
HOOH formed by superoxide is
decomposed by catalase
d. Needed in utilization of thiamine
e. Needed in release of lipid from liver
f. Urea synthesis.
g. Amino acid inter-conversion
C. Absorption and Metabolism
a. Carried by manganese binding protein
transferrin
b. 3-4% of body’s intake is absorbed, and
99% of body’s losses of Mn are fecal with
some 0.7% via skin and 0.1% via urine
c. Primary route of excretion is bile
D. Recommended intake
No recommendations indicated in PDRI
E. Interrelationship with other nutrients
a. Mn absorption decreases with high
intakes of Fe
b. Ca and Zn may affect bio availability of
Mn
F. Food sources
Whole grain cereals, nuts, legumes, tea
and green leafy vegetables
G. Deficiency
Manganese deficiency does not usually
develop unless mineral is deliberately
eliminated from diet. High iron and
calcium may prevent absorption
 Brain: epilepsy, schizophrenia
 Head: loss of hair pigmentation
 Nutrition and Diet Therapy
 Stomach: impaired glucose
transport
 Lungs: blood clotting disorders,
decreased antibody formation,
immunodeficiency
 Sex organ: diminished
reproductive ability, reproduced
production of sex hormones,
impaired sperm formation
 Bone: growth disorders
 Nerve: impaired nerve stimulus
transmission on muscles
H. Toxicity
a. Caused reduction of Hgb regeneration
and causes increase absorption in liver,
kidney and spleen
b. Prolonged exposure to dust-containing
manganese causes extreme weakness
apathy, anorexia and fatigue
7. Molybdenum
A. Description
Present in all parts of body in minute
amounts concentrated in liver, bones,
pancreas and kidney
B. Function
a. Participates on oxidation reduction
reactions
b. Cofactor for three enzymes (which
catalyse redox reaction) – xanthine
oxidase, aldehyde oxidase and sulphite
oxidase
1. Xanthine oxidase: can hydroxylate
purines, pteridines, pyrimidines,
heterocyclic nitrogen-containing
compounds.
2. Sulfite oxidase: mitochondrial enzyme
catalyzes terminal step in metabolism of
sulfur –containing amino acids.
3. Aldehyde oxidase: participates in
metabolism of purines
C. Absorption and metabolism
a. Absorption sites: stomach and small
intestines where 25-80% of dietary Mo is
absorb
b. Urinary excretion: major route of
elimination but is also excreted via bile to
lesser extent
D. Recommended intake
Recommended intake is based on
USRDA of 45 per day
E. Interrelationship with other nutrients
a. Mo or sulfate has antagonistic effect on
copper
b. In animal studies, Mo has been found to
isolate reactive sulphide groups, which
bind copper iron. A high sulfate intake:
increases urinary excretion of mineral
c. Mn, Zn, Fe, Pb, Vitamin C, methionine,
cysteine and protein might affect Mo
availability
F. Food sources
Milk and milk products, whole grains,
legumes (peas and beans) and meat
G. Deficiency
Rare unless diet is particularly rich in
antagonistic substances such as sulfate,
copper and tungstate
H. Toxicity
Rare; toxicity symptoms: diarrhea, slow
growth and anemia characterized by
failure of RBCs to mature
8. Cobalt
A. Description
Highly concentrated in spleen, kidneys,
and pancreas as component of vitamin
B12 (4%)
B. Function
a. Essential component of Vitamin B12 that
is essential for maturation of RBCs
b. Cofactor for energy metabolism
c. Activates arginase that converts arginine
to urea
C. Absorption
a. Absorbed mainly in jejunum
 Nutrition and Diet Therapy
b. About 85% of absorbed Co is excreted in
urine, but small amount is excreted in
feces and perspiration
D. Food sources
Liver, kidney, oysters and clam
E. Deficiency
There are no documented cases of Co
deficiency, except for its association with
vitamin B12
F. Toxicity
a. Co can have toxic effects when taken in
large doses and may result to goiter,
hypothyroidism, hypotension and heart
failure
b. Polycythemia: increase in number of
RBCs; typical in Co toxicity related with
excessive beer drinking
9. Chromium
A. Description
a. Chromium differs from iron, zinc, copper
and molybdenum since it does not
function in enzymes system and is not
part of metalloprotein complexes. It can,
however, form complex with nicotinic
acid and glutathione to form organic
compound, Glucose Tolerance Factor
(GTF)
b. Chromium in food exists in trivalent form
(Cr3)
c. Also occur in more readily absorbable
biologically active organic complex
B. Functions
a. As part of GTF, chromium potentates
action of insulin allowing entry of glucose
into cells and facilitating binding of insulin
to surface of cell
b. Plays role in RNA synthesis
c. Involved in amino acid transport and in
breakdown of glycogen and lipids
d. Essential in lowering blood cholesterol
levels
C. Absorption and metabolism
a. Absorption of inorganic Cr3+: poorer
than biologically active organic
complex
b. Only small percentage of dietary Cr is
absorb in small intestine (from less than
1%-3%)
c. Its absorption is influenced by following
factors:
1. Amino acid
2. Phytates
3. Oxalate
4. Nicotinic acid and vitamin C
d. In blood, Cr is bound to proteins albumin,
transferrin & globulin. It is excreted via
kidneys
e. Consumption of diet high in simple sugars
has been found to raise urinary
chromium
D. Recommended intake
There is no recommended intake for
Filipinos. The 2001 US adequate intake
recommended 25 (females) to 35
(males) mg/day
E. Food sources
Brewers yeast, meats, liver and whole
grains
F. Deficiency
a. Impaired glucose utilization, but normal
concentrations of insulin in blood
b. Disturbed amino acid metabolism
c. Elevated blood cholesterol levels leading
to damage to wall of aorta
d. Impaired growth
e. Increased mortality rates
G. Toxicity
a. Chromium toxicity due to excessive
intake has not been documented
b. Chromium poisoning: allergic and
eczematous dermatitis and systemic
effects in liver and kidneys
10. Fluoride
A. Description
Normally present in small amounts; in
greatest concentration 99% in bones
and teeth
 Nutrition and Diet Therapy
B. Function
a. Involved in mineralization of teeth and
bones; formation of hydroxyapatite
b. Helps prevent dental carries

C. Absorption
a. Almost completely absorbed from GI
tract
b. Carried in blood in an organic form, non-
ionic and as ionic fluoride
c. Excreted via urine, which accounts for
about 90% of total excretion
d. Remaining fluoride is eliminated in feces
with minor losses occurring in sweat

D. Interrelationship with other nutrients

a. Aluminum, calcium, magnesium and
chloride reduced uptake and utilization
of fluoride
b. Phosphate and sulfate increased uptake
of fluoride

E. Recommended intake
For recommended intake, please refer to
PDRI (2015)

F. Food sources
Drinking water (if fluoridated or fluoride
containing H2O), tea, seafoods and
marine fish

G. Deficiency
Susceptibility to tooth decay

H. Toxicity
a. Fluorosis: mottled enamel due to high
doses of fluoride
b. Other toxicity symptoms include nausea,
diarrhea, chest pains, itching and
vomiting
 Nutrition and Diet Therapy
D. Interrelationship with other nutrients
Molybdenum, lowers plasma
concentration and cellular uptake of
silicon

E. Food Sources
Whole grain cereals and root crops

F. Deficiency
Silicon deficiency: associated with
growth retardation, disturbance on
development of bone structure, and
structural abnormalities with ground
matrix and connective tissues, skin and
ligaments

2. Vanadium
Animal studies show that it plays an
important role in growth; in metabolism
of glucose, iron, and lipids; in
reproduction; and in bone development

3. Nickel
Functions as cofactor/structural
component of some metalloenzymes

4. Arsenic
Possible roles in phospholipid metabolism
and methyl group (CH3) chemistry

5. Boron
Parathormone action: metabolism of Ca,
OTHER MINERALS P and Mg, and formation of active form
1. Silicon of Cholecalciferol
A. Function
Essential for normal growth and
6. Tin
development of bone cartilage and
Growth-enhancing effect seen in
connective tissue
animals. Symptoms of tin deficiency:
poor growth, dermatitis and hair loss
B. Absorption
a. Dietary forms are diverse, occurring as
WATER AND ELECTROLYTES
silica, monosilicic and silicon
b. Silicic acid: freely diffusible throughout A, WATER
tissue fluids and is easily excreted in urine 1. General Description
Water accounts for about 60% of total
C. Recommended intake body weight of an adult, making it most
Amount needed by humans is still abundant constituent of body
unknown
2. Functions
 Nutrition and Diet Therapy
a. Transports nutrients and waste products a. Kidneys
throughout body b. Lungs
b. Helps to form structure of c. Skin
macromolecules d. Feces
c. Participates in chemical reactions
d. Serves as solvent in which most of 6. Maintenance of water balance
chemical reactions take place a. Water balance or fluid balance is
e. Acts as lubricants around joints achieved through:
f. Serves as shock absorber inside eyes and  control of fluid intake
spinal cord.  control of rate of fluid loss through
g. Aids in regulation of body temperature kidneys
b. Maintained through actions of following
3. Distribution hormones:
Body water: found in two major angiotensin, antidiuretic hormone (ADH)
compartments: and aldosterone
a. Intracellular compartment with its c. Water balance is disturbed in:
intracellular fluid (ICF) approximately  Dehydration: condition resulting
30L, potassium is major cation, and from excessive water loss,
phosphate is major anion accompanied by losses of
b. Extracellular compartment with its electrolytes
extracellular fluid (ECF) approximately  Overhydration (water
15-17L, sodium is major cation, and intoxication): condition that results
chloride is major anion from excessive intake of fluids
without equivalent amount of salt
This is subdivided into:
a. Intravascular fluid compartment: all fluids 7. Regulators of water balance
within blood vessel-3L. a. Thirst: conscious desire to drink
b. Intercellular, interstitial or extravascular b. Hormonal control: Renin-Angiotensin-
fluid compartment: fluids around and Aldosterone Mechanism
between cells  Renin: enzyme from kidneys that is
c. Transcellular fluid compartment: fluid in secreted in response to low renal
eyeball (vitreous humor), around joints blood flow; converts plasma
(synovial fluid) and within digestive proteins angiotensin I to
secretions angiotensin II
d. Homeostasis: maintenance of normal  Aldosterone: hormone from
ECF or external environment of cells adrenal cortex that stimulates
sodium retention
Fluids in body:  Vasopressin or ADH: secreted by
 Intracellular: inside cells pituitary gland; retains water
 Extracellular: outside cells
 Interstitial: between cells 8. Water requirements
 Intravascular: inside blood vessels To compensate for water losses, body
must take in daily at least 2.5L of water
4. Sources of body water based on recommended intake of 1ml
a. Fluids (water and beverages) per kcal of energy expenditure. Table
b. Foods 11.1 presents minimum daily
c. Metabolic water (water released in body requirements for water according to
as an end product of metabolism) population group

5. Loss of body water

 Nutrition and Diet Therapy
Minimum Daily Requirements for Water  When water loss excess
electrolyte loss, ECF becomes
hypertonic in relation to ICF, water
moves from cells to ECF to restore
equilibrium
 When water enters ECF with
insufficient electrolytes to
maintain density of solution, EC
becomes hypotonic and moves
into cell

b. Other mechanisms involve balance

B. ELECTROLYTES between
1. Description oncotic pressure: exerted by proteins in
Electrolytes: products of ionization of salt, plasma; keeps fluids inside body
acid or base dissolved in water, hydrostatic pressure: exerted by
electrically charged particles; and pumping action of heart on fluid in blood
anions and cations distributed vessels, keeps fluid outside blood vessels
throughout fluid compartments of body
a. Anions: negatively charged particles, 3. Electrolyte requirement
e.g. chlorides, bicarbonates, Minimum daily requirements for sodium,
phosphates,sulfates, potassium and chloride in your PDRI
b. Cations: positively charged particles, (2015)
e.g. sodium, potassium, calcium, a. Maintenance of Acid-base Balance
magnesium 1. Acid-base balance or hydrogen ion
concentration must be controlled
2. Mechanism of electrolyte balance 2. Plasma pH is 7.4
3. Optimal pH at which the body can
a. Sodium and chloride (both ECF
operate ranges from 7.35 to 7.45
electrolytes) and potassium and
4. Body mechanisms that help maintain
phospates (both ICF electrolytes) are
this normal pH range are:
major electrolytes regulating water
a. Buffer systems prevent drastic
movement
change of pH of blood
 Nutrition and Diet Therapy
 Bicarbonate-carbonic
system
 Phosphate system
 Hemoglobin-
oxyhemoglobin system
 Proteins
b. Lungs excrete CO2
c. Kidneys excrete excess acids in urine
Glossary of Water Terms
Artesian Water: drawn form well that taps
confined aquifer in which water is under
pressure
Bottled Water: drinking water sold in bottles
Carbonated Water: contains carbon dioxide
gas, either naturally occurring/added, causes
bubbles to form in it; aka “bubbling/sparkling
water”. Seltzer, soda, and tonic waters are
legally soft drinks and are not regulated as
water
Distilled Water: has been vaporized and
recondensed, leaving it free or dissolved
minerals
Filtered Water: treated by filtration, usually
through activated carbon filters that reduce
lead in tap water, or by reverse osmosis units
that force pressurized water across membrane
removing lead, arsenic, and some
microorganisms from tap water
Hard Water: high calcium and magnesium
content
Mineral Water: spring/well that typically
contains 250-500 parts per million (ppm) of
minerals. Minerals give water distinctive flovor.
Many minerals water high in sodium
Natural Water: obtain from spring/well that is
certified to be safe and sanitary. Mineral
content may not be changed, but water may
be treated in other ways such as with ozone or
by filtration
Public Water: municipal/county water system
that has been treated and disinfected
Purified Water: treated by distillation/other
physical/chemical processes that remove
dissolved solids. Contains no
minerals/contaminants, it is useful for medical
and research purposes
Soft Water: high sodium or potassium content
Spring Water: originating from underground
spring/well; may be bubbly (carbonated), flat,
or still (not carbonated); brand names: “Spring
Pure”, do not necessarily mean water comes
from spring
Well Water: from ground water by tapping into
aquifer
Hard Water vs. Soft Water
(figure 12.2-12.5)
Hard Water
 Contains calcium and magnesium
 Leaves ring on tub, crust of rocklike
crystals in teakettle, and gray residue in
laundry
Soft Water
 Contains sodium and potassium
 Makes more bubbles with less soap
 Easily dissolves certain contaminant
minerals (Cd & Pb) from old pumping
pipes
OSMOTIC PRESSURE
 Osmosis: movement of water across
membrane toward more concentrated
solutes
 OSMOTIC PRESSURE: amount of pressure
needed to prevent movement of water
across membrane
DEHYDRATION
Health care workers use oral rehydration
therapy (ORT): simple solution of sugar, salt, and
water, taken by mouth – to treat dehydration
 Nutrition and Diet Therapy
caused by diarrhea. A simple ORT recipe (cool May support bones, arteries; may protect
before giving): against heart disease & cancer
 ½ L boiling water Green Benefits: lutein, zeaxanthin, egcg,
 Small handful of sugar (4tsp) isoflavones, indoles, glucosinolates,
 3 pinches of salt (1/2 tsp) isothiocynates, sulforaphane
(figure 12.7: pH Scale) May support eyes, arteries, lungs, liver, & blood
cells; may promotes wound healing & healthy
BICARBONATE gums
Alkaline compound with formula HCO3; Yellow Benefits
produced in all cell fluids from dissociation of
carbonic acid to help maintain body’s acid- Phytochemicals
base balance. Also secreted from pancreas Plant compounds with biologic activity with
during digestion as part of pancreatic juice health benefits
(figure 12.8: Bicarbonate-Carbonic Acid Buffer
System)

REGULATION IN THE LUNGS

 Lungs control concentration of carbonic
acid by raising/slowing respiration rate
 If too much carbonic acid, RR speeds up
= increases amount of CO2 exhaled, thus
lowering carbonic acid
 If too much bicarbonate, RR slows = CO2
is retained and forms more carbonic
acid

REGULATION IN THE KIDNEYS

 Kidneys control concentration of
bicarbonate by either reabsorbing or
excreting it, depending on whether pH
needs to be decreased/increased
 Body’s total acid burden remains nearly
constant
 Acidity of urine fluctuates to
accommodate that balance

PHTOCHEMICALS AND FUNCTIONAL FOODS Health effects

Phytonutrients
Red Benefits: lycopene, ellagic acid, quercetin,
hesperidin, anthocyanins
May support prostate, urinary tract; may
protect against cancer/heart disease
Purple Benefits: resveratrol, anthocynanins,
flavonoids
May support bones, heart, arteries, brain,
cognition, & healthy aging; may protect
against cancer
White Benefits: illicin, quercetin, glucosinolates
Ability to prevent and treat diseases like cancer,
diabetes and heart diseases is attributed to:
a. Metabolic detoxification of toxic
substances
b. Prevention of oxidation
c. Enhancement of immune function
d. Inhibition of proteases
e. Shielding of protective structures of cells
and membrane stabilizing effect
f. Stimulation of DNA repair
 Nutrition and Diet Therapy
Functional Foods c. Reduction of energy may cause textural
 Modified food/food ingredient (may be changes that may have bitter after taste
natural/formulated food) that may d. Removal of substances like caffeine,
provide health benefit requires use of expensive technology
 Other terms: e. Fortification of food alters flavour and
 Pharmafoods stability of product, and may be
 Foodaceuticals expensive
 Nutraceuticals f. Addition of low molecular weights may
alter weight of product
Quality attributes of functional foods
a. High fiber Factors to consider for health claims of
b. Reduced fat functional food
c. Reduced energy a. Identity of active constituents food and
d. Low cholesterol food ingredients
e. Reduced caffeine b. Digestibility
f. Low sodium/low salt c. Bioavailabilty
g. Vitamin/mineral fortified d. Nutrient/food interaction
e. Physiologic effects
Examples of functional foods f. Pharmacologic effects
a. Foods with benefits to gastro intestinal g. Improvement in biologic function and/or
system protection against disease
b. Foods that afford protection to h. Safety
cardiovascular system i. Consistency of findings among many
c. Foods that protect against degenerative studies
diseases j. Specificity of outcome to nutrient (food)
d. Foods with sugar or fat alternatives k. Presence/absence of dose-response
e. Foods with optimal fat ratios for elderly, relationship
people with diabetes, those at risk of l. Biologic plausibility of association
heart disease and those with m. Significance of association
inflammatory disease
f. Foods designed for athletes Examples of Functional Foods
g. Foods that enhance immune function  Cranberries: protect against urinary tract
infections
Factors to be altered in the production of  Garlic: lower blood cholesterol
functional foods  Tomatoes: protect against some cancers
a. Sensory quality  Yogurt: source of probiotics, good for
b. Functional properties digestion, increase immune system
c. Handling costs/increased processing
d. Packaging requirements

Technological considerations in production

of functional foods
a. Textural changes (high fiber) may affect
heat changes, stability, unpleasant taste
and aroma
b. Reduction of lipids (cholesterol, fat)
affects foamality, emulsifying ability,
freezing and melting point, and taste
 Nutrition and Diet Therapy
 Micronutrient Deficiencies: more on
macronutrient
 Overeating and lack of exercise
 Food insecurity

Current Nutrition-related Issues

 Fad Diets: Keto diet, Intermittent fasting,
Low carbs diet
 Nutritional Supplements: can cause
toxicity