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Nutrition1: Outline

Nutrient any substance obtained from food that contributes to mental or physical health or growth.All energy is provided by 3 classes of nutrients: fats,carbohydrates and proteins. Nutrition utilization of foods by living organism Malnutrition over- or under- consumption of any essential nutrient. Underconsumption, the more common problem results in deficiency diseases. Deficiency diseases may be primary or secondary. Estimated Average Requirement (EAR) The average daily nutrient intake level estimated to meet the requirement of one half of the individuals in a particular life stage and gender group. Useful in estimating the actual requirements in groups and individuals Average daily dietary intake level that is sufficient to meet the nutrient requirements of nearly all individuals in a life stage and gender group. Not the minimal requirement for healthy individuals; rather, Set to provide a margin of safety for most individuals Set at 2 SDs above the EAR RDA = EAR + 2SDEAR

THE AMERICAN STANDARD Dietary Reference Intakes (DRI ) Estimates the amounts of nutrients required to prevent deficiencies and maintain optimal health and growth. Replace and expand on the RDA Establish upper limits on the consumption of some nutrients, and incorporate the role of nutrients in lifelong health.

Adequate Intake ( AI ) Based on estimates of nutrient intake by a group of apparently healthy people that are assumed to be adequate.

Example: AI for young infants human milk recommendation based on the est daily mean nutrient supplied by human milk for healthy full-term infants who are exclusively breast-fed

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Nutrition1: Outline
Tolerable Upper Intake Level ( UL ) The highest average daily nutrient intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population. Useful because of the increased availability of fortified foods and the increased use of dietary supplements. Applies to chronic daily use (AR), corrected for incomplete utilization or dietary nutrient bioavailability AR + 2 SD or 2CV to cover the needs of almost all Filipinos For energy, the recommended intake is set at the estimated average requirement of individuals in a group (no SD), to prevent obesity

Age Categories and Reference Weights

ENERGY The capacity to do work Energy Requirement Level of energy intake from food that will balance energy expenditure when the individual has a body size and composition and level of physical activity consistent with long-term good health and that will allow for the maintenance of economically necessary and socially desirable physical activity. - 1985 FAO/WHO/UNU Expert Consultative Group Energy Requirement In children and pregnant or lactating women, the energy requirement includes the energy needs associated with the deposition of tissues or the secretion of milk at rates consistent with good health. Average of the individual requirements , without specific provision for the known individual variation in requirement. - 1985 FAO/WHO/UNU Expert Consultative Group Julie & Zyrhc 2

THE PHILIPPINE STANDARD Recommended Energy and Nutrient Intakes (RENI) One of the features of the 2002 nutrient-based standard terminology in the Phil Replaces the RDA of USA and Euro dietary standards to emphasize that the standards are in terms of nutrients, and not foods or diets. Defined as levels of intakes of energy and nutrients which are adequate for the maintenance of health and wellbeing of nearly all healthy Filipinos Recommended Energy and Nutrient Intakes (RENI) For most nutrients, these are equal to the average physiologic requirement

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Nutrition1: Outline
Energy Requirement Expressed as the number of kilojoules that must be consumed per day to support growth and maintenance. Units of Energy: Joule (J) ; Calorie One calorie = 4.128J Energy Available From Major Foodstuffs Factors Affecting Resting Energy Expenditure (BMR) Gender or Sex males have higher BMR than females Weight the heavier the person,the higher the BMI Age BMR generally decreases with age Body composition individuals with a higher % body fat have lower BMR; those with higher % lean body mass have higher BMR ( muscles are more metabolically active than fat tissues Sleep BMR is lower by 10% when a person is sleeping Components of Energy Expenditure 1. Basal metabolic rate or Resting expenditure energy Environment temperature - BMR is increased in a cold environment because the body has to produce more heat to maintain normal body temperature Physical Activity Provides the greatest variation energy expenditure In general: a. Sedentary adults kcal/kg/day b. Moderately active kcal/kg/day c. Very active adults kcal/kg/day in

2. Physical activity 3. Metabolic response to food (formerly specific dynamic action) Resting Energy Expenditure Energy expended by an individual in a resting, post absorptive state Formerly termed basal metabolic rate Represents the energy required to carry out the normal body functions, such asRespiration, blood flow,ion transport and maintenance of cellular activity 50-70% of the daily energy expenditure In practice, BMR/BEE and RMR/REE are often used interchangebly

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Metabolic Response to Food Specific dynamic action of food or thermic effect of food Diet-induced thermogenesis The production of heat by the body increases as much as 30% above the resting level during the digestion and absorption of food. Julie & Zyrhc 3

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Nutrition1: Outline
Amounts to 5-10% of the total energy expenditure During adolescence,body composition changes radically,and by adulthood, males have greater proportion of lean body mass,hence, higher energy requirements. REE differs by as much as 10% between men and women (Lutz and Przytulski,1994) Body Size A small person needs less energy than a large person while a person with a large body requires proportionately more energy A tall individual uses more energy than a shorter one to perform a task because the latter one has less muscular tissue or lean body mass than the former (Lutz and Przytulski,1994) Level of Physical Activity Effect is primarily related to growth and changing body size, particularly from infancy to adolescence Infants, children, and adolescents need more energy per unit body weight than adults Older persons have lower energy needs because of their decline in activity and lower BMR (Latham, 1997) Gender Differences in body composition of men and women largely account for differences in energy requirements per unit body weight Differences in physical activity represent the largest source of variability in energy requirements. Chronic changes in physical activity can produce chronic changes in energy requirements that can lead to changes in the level at which body weight and body composition are maintained over time (Hill and Silver,1995) Measuring Energy Requirement End products of tissue metabolism are heat production, carbon dioxide and water Heat production is a direct indicator of calorie requirement Julie & Zyrhc 4

Factor Affecting Energy Requirements Age Age Gender Body Size Level of Physical Activity

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Nutrition1: Outline
Body functions as a bomb calorimeter utilizing protein, fat and carbohydrate for controlled oxidation RQ Average Situation Approximately 4.83 kcal/L O2 consumed at an average RQ of 0.82 RQ < 0.70 fat converted to carbohydrate RQ > 1.0 fat synthesized from carbohydrate An RQ of greater than 1.0 indicates net synthesis of fatty acids and triglycerides. Triglycerides are mobilized from adipose tissues and FAs are oxidized in various tissues. FA synthesis from carbohydrates is greater than the rate of FA oxidation accumulation of fat in the bod Fatty Liver

Measuring Energy Requirement Direct calorimetry Measurement heat production Not easy account for all methods of heat loss

Indirect calorimetry Calculate heat production based on respiratory gasses measured over a unit of time Oxygen consumption Co2 production

Acceptable Macronutrient Distribution Ranges Range of intakes for a particular macronutrient that is associated with reduced risk of chronic disease while providing adequate amounts of essential nutrients.

DIETARY FATS biochemistry Strongly influence the incidence of coronary heart disease (CHD) Type of fat is more important than the total amount of fat consumed. Julie & Zyrhc 5

Nutrition1: Outline
Elevated levels of LDL-C and triacylglycerol result in increased risk for cardiovascular disease. High levels of HDL-C have been associated with decreased risk for heart disease. Strongly associated with high levels of total plasma cholesterol and LDL-C Associated with increased risk of CHD Main sources: dairy and meat products, coconut and palm oils Those with C-14 (myristic) and C-16 (palmitic) are the most potent in increasing serum cholesterol

Dietary fats and plasma lipids Triacylglycerols are the most important class of dietary fats. The most important structural features: - presence or absence of double bonds - number and location of double bonds (n-6 vs n-3) - cis vs trans configuration of the unsaturated FAs

Monounsaturated Fats (MUFAs) TAGs containing FAs with one double bond. Generally derived from vegetables and fish When substituted for sat. FAs in the diet,they can lower both the total plasma cholesterol and LDL-C and maintain or increased HDL-C Mediterranean diets rich in olive oil (high in monounsat oleic acid) show low incidence of CHD.

Polyunsaturated Fats (PUFAs) Saturated Fat Triacylglycerols (TAG) composed primarily of FAs whose side chains do not contain any double bonds. TAGs containing FAs with more than one double bonds. The effects of PUFAs on cardiovascular disease is influenced by the location of the double bonds within the molecule. n-6 FAs: long-chain, with the first double bond beginning at C-6 (when counting from the methyl end of the FA) Julie & Zyrhc 6

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Nutrition1: Outline
n-3 FAs: the first double bond begins at the third carbon atom They elevate serum LDL-C (but not HDLC), and they increase the risk of CHD Do not naturally occur in plants but occur in small amounts in animals. Formed during the hydrogenation of liquid vegetable oils ( ex; manufacture of margarine) Major component of commercial baked cookies and cakes, and most deep-fried foods Words in the label: partially hydrogenated

Essential FAs Linoleic acid (18:2, 9,12) and linolenic acid (18:3, 9,12,15) They are required for the fluidity of membrane structure and synthesis of eicosanoids. Linoleic acid is obtained from vegetable oils;linolenic acid from plants and fish oils

Functions of Fats in the body: - precursors prostaglandins, for synthesis of Dietary Cholesterol Found only in animal products. Its effect on plasma cholesterol is less important than the amount and types of FAs consumed.

prostacyclins, leukotrienes,thromboxanes - carriers of fat-soluble vitamins - slow gastric emptying - give foods a desirable texture and taste SCALY DERMATITIS - a very characteristic symptom assoc. with inadequate fat intake Trans fatty acids Chemically classified as unsaturated FAs but behave more like saturated FAs.

Other dietary factors affecting CHD Soy protein: Consumption of 25-50 g/day causes about 10% decrease in LDL-C in patients with elevated plasma cholesterol Julie & Zyrhc 7

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Nutrition1: Outline
Alcohol consumption: moderate consumption ( 2 drinks a day) decreases the risk of CHD because of elevation of HDL-C. Red wine also contains phenolic compounds that inhibit lipoprotein oxidation.These antioxidants are also present in raisins and grape juice Polysaccharides are complex carbohydrates most often polymers of glucose, which do not have a sweet taste. Starch is abundant in plants common sources of which are wheat grains, potatoes, dried peas and vegetables Dietary fiber: nondigestible carbohydrates and lignin ( complex polymer of phenylpropanoid subunits) present in plants; provides little energy but has benefecial effects Total fiber sum of dietary fiber and functional fiber Soluble fiber forms a viscous gel when mixed with liquid. Insoluble fiber passes through the GIT largely intact. The recommended daily fiber intake is 25g/day for women and 38 g/day for men.

DIETARY CARBOHYDRATES Primary role is to provide ENERGY. Consumption has increased over the years hence others link it with obesity Classification: mono-,di,polysaccharides and fiber Glucose and fructose are the principal monosacch found in food; abundant in fruits,corn syrup,sweet corn,honey The most abundant disaccharides are sucrose,lactose and maltose. Sucrose is table sugar and is abundant in molasses and maple syrup. Lactose is the principal sugar in milk. Maltose is a product of enzymic digestion of polysaccharides; found in large amounts in beer and malt liquors

Glycemic Index The area under the blood glucose curves seen after ingestion of a meal with carbo-rich food, compared with the area under the blood glucose curve Julie & Zyrhc 8

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Nutrition1: Outline
observed after a meal consisting of the same amount of carbo in the form of glucose or white bread. 45-65% of the total daily caloric requirement with added sugar no more than 25% of the total energy

Simple sugars and disease There is no direct evidence that the consumption of simple sugars is harmful. Diets high in sucrose DO NOT lead to diabetes or hypoglycemia. Carbohydrates are NOT inherently fattening. Fat synthesis occurs only when carbohydrates are consumed in excess of the bodys energy needs. There is an association between sucrose consumption and dental caries,particularly in the absence of flouride treatment.

Importance of Glycemic Index Foods that raise the plasma glucose levels tend to promote glycosylations which are chemical reactions and nonenzyme catalyzed. Important in the dietary management of diabetes mellitus and other hyperglycemic disorders. Foods with low GI are: fruits, vegetables, nuts, protein-rich foods, oatmeal, whole grain cereals. Foods with high GI are: pastries, cookies, sweets, potatoes, soda pop, white bread, rice, refined carbohydrates.

DIETARY PROTEIN The quality of a dietary protein is a measure of its ability to provide the essential amino acids required for tissue maintenance. Protein Digestibility-Corrected Amino Acid Scoring (PDCAAS) is the standard by which to evaluate protein quality. PDCAAS is based on the profile of essential amino acids and the digestibility of protein. The amino acid score provides the method to balance intakes of poorerquality proteins by vegetarians and others who consume limited quantities of high quality dietary proteins.

Requirements for Carbohydrates NOT essential in the diet Cheap, readily available Antiketogenic Dietary fiber has desirable health effect Lactose promotes calcium absorption Preferred energy source by CNS, RBC Spares protein requirements

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Nutrition1: Outline
Most healthy adults are normally in nitrogen balance.

Proteins from animal sources Have a high quality because they contain all the essential amino acids in proportions similar to those required for synthesis of human tissue proteins. Sources: meat,poultry, milk and fish

Requirements for protein in humans The greater the proportion of animal protein included in the diet, the less protein is required. RDA: 0.8 g/kg body weight for adults As high as 1 g/kg for athletes. Pregnant and lactating women: 30 g/day in addition to their basal requirement. Growing children: 2 g/kg/day

Proteins from plant sources Lower quality; from wheat,corn, rice, and beans. Maybe combined in such a way that the result is equivalent in nutritional value to animal protein.

Protein Catabolic Rate Urea is a major product of protein catabolism The amount of urea nitrogen excreted each day can be used to estimate the rate of protein catabolism And determine whether protein intake is adequate to offset it Total protein loss and protein balance can be calculated from urinary urea nitrogen (UUN) as follows: o Protein catabolic rate (g/d) = [24-hr UUN(g) + 4] x 6.25 (g protein/ g nitrogen) Julie & Zyrhc 10

Nitrogen Balance Occurs when the amount of nitrogen consumed equals that of the nitrogen excreted in the urine, sweat, and feces.

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Nutrition1: Outline
The value of 4 is the est of unmeasured N loss Protein balance (g/d)= protein intake protein catabolic rate

Protein-Energy Malnutrition (PCM) Protein deficiency is called kwashiorkor, while calorie deficiency is called marasmus. Kwashiorkor is a Gambian word which means disease of the deposed child. PEM or PCM is clinically is a spectrum of varying degrees of a mixture of calorie and protein deficiency. Major malnutrition problem of the third world.

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