Nutritional factors and

disease

Dr.P.RAMARAO ,M.D;
Associate Professor of General
Medicine
Nutrition by definition is the process
of nourishment while nutrient is the
substance that provides
nourishment
Nutrients are classified as
macronutrient or micronutrient
based on daily requirement
Vitamins and minerals that are
required in amount less than 100 mg
per day constitute micronutrients
Nutrients that cannot be synthesised
in body are called essential
Carbohydrates, fats and proteins
mainly provide energy and help in
tissue building and maintenance
Vitamins and minerals mainly support
metabolism
A requirement is defined as the lowest
continuing intake of a nutrient that will
maintain a defined level of nutrition in
an individual
Obtaining adequate nutrition is a
fundamental requirement for the
survival of every individual and
species
In recent decades, economic
success has been rewarded by
plentiful nutrition unknown to
previous generations, which has led
to a pandemic of obesity and its
consequences for health
 Energy balance
Energy balance is achieved when energy
intake = energy expenditure
Energy expenditure has several
components
The basal metabolic rate
It is most closely predicted by fat-free
mass (i.e. total body mass minus fat
mass), which is lower in females and
older people
Extra metabolic energy is consumed
during growth, pregnancy and lactation,
and when febrile
Metabolic energy is also required for
thermal regulation
The energy required for digestion of food
(diet-induced thermogenesis)
Energy expenditure also occur during
muscular activity
Energy intake is determined by the
‘macronutrient’ content of food
Carbohydrates, fat, protein and alcohol
provide fuel for oxidation in the
mitochondria to generate energy (as
adenosine triphosphate (ATP))
The energy provided by each of
these elements differs:
• carbohydrates (16 kJ/g)
• fat (37 kJ/g)
• protein (17 kJ/g)
• alcohol (29 kJ/g).
Macronutrients (energy-
yielding nutrients)
 Carbohydrates
Carbohydrates account for the major part
of energy requirement
They are basically made of either simple
sugars or complex sugars
It is recommended that simple sugars
should not account for more than 10% of
total energy
A wide range of carbohydrate (55% to
75%) intake should be from whole grains
and legumes, vegetables and fruits
If the available carbohydrate intake is less
than 100 g per day, however, increased
lipolysis leads to ketosis
 Proteins
The dietary proteins are essential to
provide amino acids for the synthesis of
body proteins, both structural proteins
and biologically active enzymes
Adequate dietary protein is essential
during growth in children
In the adult, it is essential for the
synthesis of new proteins to replace
those, which are being broken down
Additional proteins are also required
during pregnancy and lactation for the
growing foetus and infant
Essential amino acids
• Tryptophan
• Histidine
• Methionine
• Threonine
• Isoleucine
• Valine
• Phenylalanine
• Lysine
• Leucine
The safe level of intakein terms of dietary
protein is 1.0 g/kg body weight per day
Additional protein requirements of 15 g per day
during pregnancy and 25 g per day during 0-6
months of lactation have been recommended.
 Fats
Fat has the highest energy density and
excessive consumption may be an
insidious cause of obesity
Like amino acids, there are fatty acids
that are essential for body and are called
essential fatty acids (EFAs)
The fat intake should not exceed 30% of
total energy
Cholesterol is also absorbed directly from
food in chylomicrons and is an important
substrate for steroid and sterol synthesis,
but not an important source of energy
 Dietary fibre
Dietary fibre which forms an
indigestible and important
component of plant foods were
never considered as source of
energy
Some dietary fibres undergo
fermentation in the colon and yield
short chain fatty acids
These are used as source of energy
by the colonic cells and by the liver
and contributes to bowel health
Assessment of Nutritional
Status
PARAMETERS FOR ASSESSMENT OF
NUTRITIONAL STATUS
Dietary intake
– Food frequency method
– 24-hour recall
 Physical activity pattern
Clinical assessment of nutritional
deficiency signs
Anthropometric assessment of
nutritional status
Body mass index (BMI)
BMI = wt kg/ht (m)2
BMI is a useful way of identifying
under- or over-nutrition but
cannot discriminate between lean
body or muscle mass and fat
mass
Triceps skinfold thickness. Lean
patients 6–12 mm; obese
patients 40–50 mm.