4P/Desktop/e-Class%202020%20batch/Biolemistry/Chapter-22.pdf ‘Steven V}_Muteition —- + Q & |! B® Pageview (1) kwashiorkor, aind (2) marasmus (rae 2, Kwashiorkor Kwashiorkor represents protein malnutrition in children, characterised by edema. (The term kwushiorkor means, in one of the dialects of Africa, the sickness of the older child when the next child is born). It was typically seen in children around the age of two who were deprived of breast milk after the birth of. younger sibling. In lower socio-economic populations, the supplemented diet mainky consists of starchy food, which is very low in protein. A diet love in the protein-to-energy ratio results in bilateral edema, making the child miserable and apathetic, ‘The child may have moon face and a pot belly, with skin changes on the buttocks, inner thighs and perineum. Hair loses its black colour and turns reddish or grey, It becomes sparse and loose and can be easily plucked, tinenemical mechanism underying te csease ‘Low protein-to-energy ratio causes high insulin and low cortisol levels in the plasma leading to increased uptake of amino acids by the muscles, diverting them from the liver. As a result, the synthesis of albumin is diminished Table 2225 Comparison between kwashiortor and marasmus ‘Bilateral pitting edema with a protruding abdomen, ‘+ Muscle wasting isnot marked, stunted ina Seaton a mete os, Shun oli drone maine oe e ee6 ize AY Read aloud ‘J Draw »~ ‘pf Highlight there is no edema), The absence of edema in the presence df severe muscle wasting is characteristic of marasmas. Marasmic Kwashiorkor ‘When a child has both protein and calorie deficiency. sign, ‘of muscle wasting and edema are seen, reflecting a more severe form of PEM called marasmic kwashiorkor. anagement of FEM Supplementing with diets that provide 150-200 Caliig body weight and 3-4 g of protein/kg body weight wil provide relief. The treatment includes stabilisation and rehabilitation, Malnourished children are vuinerabe to multiple infections and hence, broad spectrum antibitss should be given as the situation demands, Pulse protes mixed with milk proteins along with flout, sugar and oll make a suitable dietary regimen for PEM patients. Nutritional Anemias ‘The term ‘anemia’ refers to a lowered concentration of haemoglobin or RBC in blood. As a result, in anemia. the coxygen-carrying capacity of blood is reduced. A decreaseLc: ee «pec dynamic action (SOA) is the increased heat production following the ingestion of food, reflecting the expenditure of additional nergy for the utilisation of foods by the body. SDA for carbohydrates, lipids and proteins are 5, 15 and 30 per cent respectively. « caotyeates are the chief sources of energy, providing 50-80 of the total calorie requirements of the body. Dietary fibre promotes nomal bowel motility, prevents constipation, improves glucose tolerance and reduces chotesteral levels. Glycemic index of various tatbohydrate foods are used in formulating therapeutic iets for diabetic patients, + igds ae the storage form af energy. The body obtains lipids in two forms: (1) vsibke lipids, and (2) invisible lipids. They. suey ‘cuenta fatty acids to the body. The body requires SFA, MUFA and PUFA in a ratio of 1:1:1. Vegetable oils ave rich sources of different types of fatty acids. Elevated cholesterol levels (+250 mg/AL) are associated with cardiovascular risk. + Proteins are needed for the growth and maintenance of body tissues. 10%-15% of the total energy requirements can be met through proteins. Various indices are employed to assess the nutritive value of proteins, They include biological value, net protein utilisation, protein efficiency ratio and amino acid score. Animal, proteins are better sources of essential amino. acids compared to vegetable Fatrns, However, vegetable proteins supply all the essential amino acids by mutual supplementation, « Yeaning and minerals, though non-calorgenic, are excential for the varfous metabolic reactions in the body. They are required fn small ‘gantities and are hence called micronutrients. « Liblanced diet should be composed of all the esvential nutrients in the right proportions matching the needs of the human Bory Consuming a normal mixed diet provides all the essential nutrients, « topmacibe balanced diets for diferent individuals, a knowledge ofthe nutritional compastion of various common Fods i nacestay There incade cereals, pulses. vegetables, Fruits, meat. poultry, e9g, milk and deity products, © Doesity i ‘excess calorie intake cou with lack of adequate physical activity, Persons endowed with more of brown adipose Tey a et of es ty ahs naar at feel eve © Pratein energy malnutrition (PEM) ic maatly seen In young chien in developing countries de ta malnutrition the cisical pcre of POA is manifested in two oe Tkwashlorkor (protein deficiency-characterised by ‘edema), and (2) marasmus (calorie deficiency- characterised by muscle wasting) @oeeeeee¢eNutrition- Overview a Nutrients are the constituents of food necessary t sustain the normal functions of the body. a All energy is provided by three classes of nutrients: fats, carbohydrates, proteins (macronutrients) © Those nutrients needed in lesser amounts, vitamins and minerals, are called the micronutrientsCALORIFIC VALUE ee a Energy content of food materials is measured in calories & usually expressed in kilocalories. = 1 calorie is the heat required to raise the temperature of 1 g of water through 1°C 4 1 kel = 1000 cals = 4.2 kilojoules + Calorific value = energy density (energy yield/unit Wt of food)CALORIFIC VALUE OF NUTRIENTS NUTRIENTS ENERGY YIELD (keal/g) Carbohydrates 4.0 Fats 9.0 Proteins 4.0 Alcohol 7.0Acceptable Macronutrient Distribution Ranges es MACRONUTRIENT — RANGE (% of energy) Ft Ee EeEnergy Requirements of a normal person | © To maintain basal metabolic rate (BMR) — 60% © For specific dynamic action (SDA) or thermogenic effect of food- 10% «1 Extra energy expenditure for physical activities- 30%Respiratory Quotient(RQ) ee o It is the ratio of CO2 output to O2 consumption during the oxidation of food. a Fer carbohydrates 1 | For fats 0.7 4) Forproteins 0.8 1 RQ of a mixeddiet is about 0.85(it changes to near 1 if carb content is increased) 4 Insulin administration increases RQ to near 1by increasing glucose oxidation.RQ lO ———————————————— 3 lt has been established that on a mixed diet with RQ of 0.85,each litre of O2 consumed by an individual represents an energy expenditure of 4.825Kcal. © This can be used tocalculate total energy expenditure by a person over a given period of timeBasal Metabolic Rate a Amount of energy required by the body to maintain normal function during the rest. 2 60-70% of total calories used up by the body. © regulated by thyroxin.Cont...... SSS SSS SSS SSS © If BMR is increased- weight loss. © health benefits- risk of developing heart disease, stroke andl diabetes. © An average BMR for aclults between 1200 and 1800 kcal.COnt..o4+ mm © If BMR Is increased- weight loss. © health benefits- risk of developing heart disease, stroke and diabetes. | An average BMR for adults between 1200 and 1800 kcal.COM ciases eww co If BMR is increased- weight loss. > health benefits- risk of developing heart disease, stroke and diabetes. > An average BMR for adults between 1200 and 1800 kcal.COfhicssues Mm Determination of BMR « Genetics: » Age: decreases with age. After 20 years, it reduces about 2% every decade. « Gender: Mena higher BMR due to greater muscle meiss. + Body Surface Area: higher is the BMR. Thin, tall people have a higher BMR.COMP ess Mm > Body Fat Percentage: If the body fat % is lower, then BMR will be higher. = Body Temperature: With an f of 0.5° C in the internal body temperature, BMRT by about 7%. © Diet: Because of starvation or serious abrupt calorie reduction, BMR can drop by about 30%,Cont..... —_ © External Temperature: Exposure to low temperature leads to increase in BMR & is reverse for high temperature. © Thyroxine- accelerates the metabolic activity of the body > Exercise: decreases body weight by burning calories as well as increases BMR by building extra lean tissue.SSeS = Normal Value for BMR - usually expressed in kel /hr/m? + For adult men BMR is 34-37 kel/hr/m? & for women 30-35 kel/hr/m?Thermic effect of food It refers to 7 heat production or 7 metabolic rate following intake of food. Part of this is due to the expenditure of energy for digestion, absorption & active transport of products of the digestion. So actual energy from food is lesser than that of theoretical calculation,ONT. .8. Value of SDA are protein- 30% lipid- 15% carbohydrate- 5% So for mixed diet extra 10% calories should be provided.Energy requirements depend on the occupation, physical activity & life style of the individual Activity level may be divided into — sedentary, moderate & heavy. For jlentary k, + 30% of BMR, m ate work, + 40% of BMR, and for he work, + 50% of BMR should be added. Energy requirements during pregnancy is +300 kel/day, and during lactation is +500 kel/day in addition to the basic requirements,quantitatively the most important class of dietary fats Saturated fatty acids with carbon chain lengths « 14 (myristic) and 16 (palmitic) are most potent in increasing the serum cholesterol. Consumption of saturated fats is stro associated with high levels of total cholesterol and LDL & increased risk of CHD Source- coconut and palm oils, dairy and meat productsAonounsaturated fats: MUFA Fatty acids with ene double bond Palmitoleic (w) acid, elaidic acid (wo) and oleic acid (wo) Derived from vegetables and fish Lower both total plasma cholesterol and LDL Mediterranean cultures, with diets rich in olive oil (high in oleic acid), show a low incidence of CHDPOLYUNSATURATED FATS more than one double bond w-6 Fatty acicls First double bond beginning at the sixth carbon atom Linoleic acid (18:2, ,%'4), Arachidonic acid (20:4, 214) Obtcined from vegetable oils Plasma LDL are lowered, but HDL, which protect against CHD, are also lower~3 Fatty acids First double bone at the third carbon ctom - Linolenic acid (18:3), EPA (Eicosaapentaenoic ccicl) (20:5 and DHA (Docoscihexanoic acid) (22:6) Found in plants (mainly a-linolenic acid), and in fish oil containing EPA and DHA Suppress cardiac arrhythmias, thrombosis, & blood pressure. w3 fattyacids reduces insulin resistance, inflammation, death rate from heart attacks, Alzheimers disease A deficiency of essential fatty acids is characterized by sealy dermatitis, hair loss, ancl poor wound healingDHA is present in high concentration in retina, cerebral cortex, tesitis & sperm. lt is needed for the development of brain and retina and is supplied via placenta and milk. Pt. with retinitis pigmentosa have low blood level of DHA The optimal w, to w, PUFA is b/w 4-6:1Trans fatty a Formed during the hydrogenation of liquid vegetable oils Elevate serum LDL (but not HDL), and they increas the risk of CHD Do not occur naturally in plants, but occur in small amounts in animals.rydrat Monosaccharides Disaccharides Polysaccharides FiberRequirements for carbohydrate RDA for carbohydrate is set at 130 g/day for adults and children Not essential nutrients, because the carbon skeletons of amino acids can be converted into glucose Adults should consume 45-65 percent of their total calories.ydrate and blood glucose Glycemic index : Area under the blood glucose curves seen after ingestion of a carbohydrate rich meal (50 g) compared with the area under the blood glucose e after a ref, meal (50 g of glucose). je carbohydrate has o high Gl mplex carbohydrate has a low GlGlycemic Index High GI (glucese) Low GI (be E E Ss" § é a 50 100 Minutes after intakeFOOD ITEMS Potato chips Bread White rice (polished) Parboiled rice Legumes & peanuts lee cream GLYCEMIC INDEX 80-90 70-79 70-79 60-69 35-40 35-40INoncligestible carbohydretes and lignin present in plants. Soluble fiber refers to fibers that form a viscous gel when mixed with a liquid. Insoluble fiber passes through the digestive track largely intact. Dietary fiber provides little energy but has several beneficial effects The recommended daily fiber intake is 25 g/day for women and 38 g/day for menBeneficial effects Adds bulk to the diet and increasing bowel motility. Soluble fiber delays gastric emptying and can result in a sensation of fullness & reduced peaks of blood glucase following a meal, Soluble fiber lowers LDL cholesterol levels by increasing fecal bile acid excretion and interfering with bile acid reabsorption. Fiber-rich diets decrease the risk for constipation, hemorrhoids, and diverticulosis,Dietary Prot Provide essential amino acids RDA - 1g/kg/day for adults Idren should consume 2 g/kg/day Source- animal provides high quality - plantprovide the essential amino acids required for tissue maintenance. Protein Digestibility-Corrected Amino Acid Scoring Highest possible score under these guidelines is 1.00. BV = Retained Nitrogen x 100 Absorbed NitrogenSOURCE Egg & Milk Fish, Poultry Gelatin Soybean Wheat bread PDCAAS VALUE 1.0 0.82-0.92 0,08 1.0 0.40Nitrogen balance 1. Positive nitrogen balance- nitrogen intake exceeds nitrogen excretion childhood, pregnancy, or during recovery from an emaciating illness. 2. Negative nitrogen balance: nitrogen loss is greater than nitrogen intake. associated with inadequate dietary protein, lack of an essential amino acid, or during physiologic strNitrogen balance 1. Positive nitrogen balance- nitrogen intake exceecls nitrogen excretion childhood, pregnancy, or during recovery from an emaciating illness, 2. Negative nitrogen balance: nitrogen loss is greater than nitrogen intake. associated with inadequate dietary protein, lack of an essential amino acid, or during physiologic stressConsumption of excess protein - eliminated from the body as urinary nitrogen it is often accompanied by increased urinary calcium, increasing the risk of nephrolithiasissInutrition Kwashiorkor Protein deprivation is relatively greater thein the reduction in total calories Frequently seen in children after weaning at about one year of age symptoms Stunted growth, edema dehydration (diarrhoea & vomiting Skin lesions, depigmented hair Anorexia, enlarged fatty liver, and decreased plasma albumin concentration.Marasmus: Calorie deprivation is relatively greater than the reduction in protein children younger than one year symptoms : arrested growth extreme muscle wasting (emaciation) weakness, and anemiaWt. for age (% expected) Wr. for Hi, MI Edema Mood when picked up Alert, irritable Appetite GoodoO Balanced diet is the one which contains a variety of foods in such quantities and proportions that the need for energy, proteins, vitamins, minerals and fats is adequately met for maintaining health, vitality and general well being and also makes a small provision for extra nutrients to withstand short duration of leanness. Objective is to safeguard the population from nutritional deficiencies.Q it should meet the energy intake from O Protein— 10-15% of energy intake Fats- 15-30% of energy intake Carbohydrate — remaining Pattern of balanced diet vary in different parts of the world o Each country have their own standardsDetermining factors Region Economic status Religion Customs Culture Taboos Taste Habits of the peopleenergy F intake in relation to expenditur result in obesity, heart disease or proton: It is Individualised because 2 Basal metab: Teal per kg body weight per hour 0 Daily activities — walking, dressing, sitting, etc. 0 Occupational work- Light, moderate or heavyReference standards ars weighs free from diseases and physically fit for active work, 8 hours work, 8 hours sleep, 4-6 hours sitting or other routine works cind 2 hot 50kg, free from diseases and physically fit for active work, 8 hours k, 8 hours sleep, 4-6 hours sitting or other routine works and 2 hours in walking , recreation or in household activities.Factors affecting energy requirement Age Sex Body composition Physical activity Working conditions Physiological stateEnergy requirement- adults 45 cal / kg weight /per day Reference Woman: 40 cal Reference Man-_per day Light work — 2425 cal Moderate work — 2875 cal Heavy work — 3800 cal kg weight/per day Reference Woman- per day Light work — 1875 cal Moderate work — 2225 cal Heavy work — 2925 calgy- vulnerable group Pregnant woman - daily reqt + 300 cal per day Lactating mother(0-6 months) - daily reqt + 550 cal per day Lactating mother(7-12months) - daily reqt + 400 cal per day Children — rapid growth period needs 100-120 cal per day and later on 80-90 cal per day Puberty — requriement is same as adults a Adults = generally 2% decline of resting metabolism for0 Protein quality ( Protein energy ratio) =Eneray from protein X 100 Total energy intake O Ratio of protein calorie to the total energy calories 0 Reference Man- 8.3 % Reference Woman- 9.1% Pregnant women- 10% Lactating mother-11% If PE is less than 4 % unable to satisfy the protein requirement 0 Recommended- 15-20% of total calorie intake1 Intake is expressed in terms of Grams per Kg body weight O ICMR recommends 1 gram per Kg body weight for adults Infants — 2 Gms per kg body weight ( first 6months) 1.5- 1.8 Gms per kg body weight till 10 years u Adolescents- 1.2 to 1.4 gms per kg body weight | During pregnancy- additional 14 gms per day © During lactation — 25 gms per day (0-6 months )Protein no extra recommendations for elderly o higher intake of protein does not confers great benefit Surplus quantity intake in more harmful than beneficialAmino acids Requirement of amino acids decreases sharply and age advances 5 EAA requirement expressed in Mgms per kg body weight Infants — 742 mg Pre chilelren- 352 mg School children — 260 mg 0 Adults — 84 mg= re Fats = a During infancy — fats constitutes 50% of total energy intake Adults — fat constitutes 20% of total energy intake 50% should be EFA from Vegetable oils Requirement of EFA ranges from 3-6% of energy intake in young children Recommended as equal proportion of Visible and invisible fats in the diet for all age groups.Fat intake Group Intake perday Percentage Percentage in Grams of total of EFA per energy day Reference man 20 9 3 & woman Pregnant | 30 i 45 woman Lactating 45 mother ChildrenEnergy balance When you participate in sport and other activities, you burn extra nergy. The amount of energy you use will depend on what type of exercise you do how long you exercise for » how hard you exercise. Here are some guidelines for the energy used in different activities: Activity Keals per hour 140 300 wimming 400 Tennis 490 Jogging 600mins Your body needs to help it work normally. Vitamins are needed for many functions including: releasing energy from food repair and growth of tissues resisting infection and disease regulating chemical reactions in the body. Fruit and vegetables contain o lot of vitamins.T Vitamins Do not need to remember this s table gives information about some important vitamins: Vitamin A Vitamin C Vitamin B1 Vitamin D Found in Why is it needed Fish, milk, vegetables, eggsEyesight, healthy and cheese skin Fruit (especially citrus Healthy teeth and gums, fruits) and vegetables avoiding scurvy Whole-grain foods, Breaking down nuts and meat carbohydrates Animal products. Also Absorbing calcium and made in the body when the phosphorous, avoiding sun shines on the skin titketsFibre is actually a substance called cellulose. It is found in the cell walls of plants. Fruit, vegetables and » grain cereals are good sources of dietary fibre ho eat too little fibre often suf y run a higher risk of bowel carWater The body is mainly composed of wate fi Approximately 6¢ of an adult’s weight and approximately 80% of achild’s weight is made up of water. It is vitally important that you drink enough water. Dehydration can seriously damage performance.Exercise Metabolism Energy Requirements at Rest Almost 100% of ATP produced by aerobic metabolism Blood lactate levels are low (<1.0 mmol/L) * Resting O2 consumption: — 0.25 L/min - 3.5 mi/kg/min