Pengantar Ilmu Gizi

Chapter Outline
 Definisi Ilmu Gizi
 Klasifikasi Zat Gizi
 Riset di bidang Ilmu Gizi
 Gizi dan Kesehatan
 Evaluasi status Gizi
 Level StatusGizi
 Deficiensi
 Factor yg mempengaruhi pilihan pangan
 Goal Of Nutritional Status

Quality: Intake that allows you to function at your best and promotes
health.
 Intake that provides adequate levels of each nutrient
Quantity of intake that promotes a healthy body weight.
 Nutrition Defined
 Nutrition – the science of foods and
the nutrients they contain
 Also consider the action of these foods and
the nutrients in the body
 Nutrition Defined
 Actions in the body include:
 Ingestion
 Digestion
 Absorption
 Transport
 Metabolism
 Excretion
 Diet and Health
 Diet- the foods one consumes
•The quality of your daily diet
affects the risk of chronic
diseases
 Meaning…..The food choices you
make daily have a cumulative
impact on your health
 What’s Considered Food?
 Foods contain nutrients and are
derived from plant or animal sources

 Nutrients are used by the body to

provide energy and to support
growth, maintenance and repair of
body tissues
 ~ 40 nutrients identified at this time
 Functional Foods
 Functional foods contain substances that
provide health benefits beyond those of
their nutrients
 May be a natural functional food or as a
result of additives
 Tomatoes – contain lycopene
 Orange juice with calcium
 Classifying Nutrients
There are 6 Classes of Nutrients
1. Carbohydrates
2. Lipids (fats)
3. Proteins
4. Vitamins
5. Minerals
6. Water
Body Composition
 Describing the Nutrients
 There are several ways to classify the
classes of nutrients.
 Organic or inorganic
 Essential or nonessential
 Macronutrient or micronutrient
 Energy yielding or not
 Classifying Nutrients
 Essential nutrients – nutrients the body
either cannot make or cannot make
enough of to meet its needs.
 These nutrients must be obtained from foods
(ingested in some manner)
 Examples:
• Vitamins
• Calcium, iron, and other minerals
• Some of the amino acids
 Classifying Nutrients
 Nonessential nutrients – body can make
from other nutrients ingested
 Examples:
• Cholesterol
• Some amino acids
 Classifying Nutrients by
Composition
 Organic nutrients - contain carbon
• Carbohydrates
• Lipids
• Proteins
• Vitamins
 Inorganic nutrients - do not contain
carbon
• Minerals
• Water
 Quantity Needed
 Macronutrients: need in relatively large
amounts
 Carbohydrates, lipids, proteins

 Micronutrients: need in relatively small

amounts
 All other nutrients
 Classifying Nutrients
 Energy-yielding nutrients (3):
 Carbohydrates
 Fats (lipids)

 Proteins

 Where does the energy come from?

 A little more on energy
 Measure energy in kilocalories in U.S.
 What most think of as a “calorie” is really a
kilocalorie
 Kcal = amount of energy needed to raise the
temperature of 1 kg of water by 10C
 Measure energy in kilojoules (kJ) in most
other countries
 Energy in the Body
 The body uses the energy yielding
nutrients to fuel all activities
 All energy yielding nutrients are “caloric”.
 If more energy is ingested than is needed
to fuel body activities the extra energy is
stored as _________ and ________
occurs.
Energy-Yielding
Nutrients
 Energy-Yielding Nutrients
 Carbohydrates: C, H, O
 4 kcal/gram
 Body’s primary source of energy
• Use as glucose
 Brain’s only source of energy
 Stores are limited ~12-24 hours (in liver and
muscle)
 Carbohydrate rich foods……..
 Energy-Yielding Nutrients
 Fats: C, H, O
 9 kcal/gram
 Body’s alternate source of energy
• Use fat along with glucose as an energy source
most of the time

 Stores are unlimited

 Energy-Yielding Nutrients
 Proteins: C, H, O, N, S
 4 kcal/gram (same as _______)
 Body’s least desirable source of energy
• WHY? …….
 Protein is used for energy only when there
isn’t any carbohydrate available as an energy
source.
 Energy-Yielding Non-nutrient
 Alcohol – 7 kcal/gram

 Non-nutrient because it interferes with

growth, maintenance and repair of the
body
 Alcohol’s metabolites are harmful
 Energy Density
 Measure of the kcal per gram of food
 _______ has the highest energy density of
the 3 energy-yielding nutrients.

 Foods with a high energy density provide

more kcal per gram than low density
foods.
Energy Density
 6 Classes of Nutrients

 Carbohydrates
 Lipids (fats)
 Proteins
• Vitamins
• Minerals
• Water
 Vitamins
 Essential
 Organic, micronutrient
 Not energy-yielding
 Fairly easily destroyed/damaged
 Can be water-soluble or fat-soluble
Examples:
 Minerals
 Essential
 Inorganic, micronutrient
 Not energy-yielding
 Indestructible
Examples:
 Water
 Water (H2O)
 Essential
 Organic or inorganic?
 Noncaloric
 The Science of Nutrition
 One of the newest sciences
 New branch is nutritional genomics
• Study of the interaction of nutrients with
DNA/genes and how those genes impact health
 Like all sciences, nutrition is based on
scientific research
 Scientific Method
1. Observations  Questions
2. Hypotheses  Predictions
3. Test hypotheses/predictions
4. Analyze data and draw conclusions
5. Share results
 Observations and Questions
 Make observations about diet and health.
These observations lead to questions
For example:
 The incidence of breast cancer is much lower
in Japan than in the U.S.
 Diet in Japan is rich in…..while in U.S. diet is
rich in ……
 Question?:
Develop Hypotheses and Make
Predictions
 Hypothesis – tentative explanation of the
observations or answer to the question

 Make prediction – If the hypothesis is

true what else is true?
 Experiments
 Conduct experiments to test the
predictions
 Easier said than done when people are
involved!
 We’ll consider research designs later/soon.
 One Experimental Design
 When possible, randomly assign subjects
to either a control of experimental group
 Goal is for two groups to be as similar to each
other as possible
 Control Group – either no change to diet or
given a placebo
 Experimental group – diet changed or given
a supplement
 Experimental Design
 Compare the health/lab values of the two
groups before and after the diet change.
 Example – DASH diet study
 Analyze results…
 Analyze results
 Draw conclusions about the validity of the
hypothesis
 Test alternate hypotheses
 Share findings
 Publish in nutritional journals
 Present findings at conferences
 Common Research Designs
1. Epidemiological study (observe)
 Cross-sectional (snap shot)
 Case-controlled
 Cohort (longitudinal)
2. Experimental (intervene)
 Animal studies
 Human clinical trials
 Lab studies
page 13
 The Science of Nutrition
1. Epidemiological studies
• Study of populations
• Look for correlations between dietary
practices and health
Epidemiological Studies
Cross-sectional
• Study of a population at a given point in time
and look for correlations between diet and health
Case-controlled study
• Compare diet of similar individuals with and
without a disease/condition
• Look for differences in diet that might account
for the differences in health
 Epidemiological Studies
Cohort or Longitudinal Studies
• Follow a group of people (a cohort) over a
period of time
• Look for differences in diet that might
account for the differences in health
 Experimental Studies
Clinical or Human Intervention study
• Randomly assign like people to either the
experimental or control group
• Alter the diet of experimental group as
compared to a control group
• Compare incidence of disease/lab values/
performance …. of two groups
 Clinical Trials
 Terms:
 Blind experiments
• Subjects do not know which group they are in
 Double blind experiments
• Neither subjects nor the researchers know which
group the subjects are in until after the experiment
is over

• Goal is to avoid bias in the reporting/recording of

the data.
 Experimental Studies
Animal Studies
• Controlled studies in lab setting using
animals
• Alter diet of experimental group
• Compare health/lab values of control and
experimental groups
• Benefits? ….
• Drawbacks? ……
 Experimental Studies
Lab-Based Studies
• Also called in vitro studies
• Examine impact of a substance on living tissue in
a “test tube”

-------------------------------------------------------------
• See page 14 for strengths and weaknesses of
the research designs
 The Science of Nutrition
Size matters in research!
 Good studies have relatively large sample
sizes
 Preliminary studies have smaller sample
sizes
 Science Of Nutrition
 From scientific studies come nutritional
recommendations.
 Dietary Recommendations
Dietary Reference Intakes (DRI)
1. EAR - Estimated Average Requirements
2. RDA – Recommended Dietary Allowances
3. AI – Adequate Intake
4. UL – Tolerable Upper Intake Levels

All based on nutritional research.

 EAR and RDA
1. Estimated Average Requirements
 Intake amount that appears to meet the
needs of 50% of the population
• Age, gender, “condition” based
• Set after review of many research studies
2. Recommended Dietary Allowances
 RDA is set to meet the needs of 98% of the
population (without reaching toxic levels)
DRI
 AI
3. Adequate Intake (AI)
• AI = average amount of the nutrient that a
group of healthy people consume

• AI is set when there isn’t enough research to

set an estimated average requirement
(EAR) or RDA
• Examples: Vitamin D, water, fiber
 UL
4. Tolerable Upper Intake Level (UL)
• Maximum daily amount of nutrient that
appears safe for most healthy people
• Intake above the UL is associated with
toxicity symptoms
• Most often see with overuse of supplements or
intake of many fortified foods
DRI
 Other Recommendations
 Estimated Energy Requirements (EER)
 Caloric intake that will maintain energy
balance in a healthy person
• Values given are for “reference” male and female
who is fairly active
 Values are not very useful for individuals!
Energy – Why not set
an RDA?
 Other Recommendations
 Acceptable Macronutrient Distribution
Range
 or, recommended intake of energy yielding
nutrients
• 45-65% of caloric intake from carbohydrate
• 20-35% of caloric intake from fat
• 10-35% of caloric intake from protein
 Other Recommendations
 Other countries and international
organizations set their own nutritional
recommendations
e.g. World Health Organization (WHO)
 Nutrition and Health
 Nutrition and health are closely related
 Chronic health issues associated with diet:
 Heart disease
 Type II Diabetes
 Osteoporosis

 See page 24
 Improving your Health
 Goal is to reduce the number of risk
factors that are in your control
 Risk factor = something that statistically
increases the incidence of a disease
• Risk factors may not be the cause of the
disease………
 Improving Health
 Risk factors in your control:
 Smoking
 Alcohol intake
 Over-consumption of calories
 Physical inactivity
 Poor quality diet
 Improving Health
 Risk factors you cannot control:
 Age
 Gender
 Genetics (family history)
 Ethnicity
 Maine Data
 27% report NO physical activity
 Only 1in 5 engage in moderate physical activity ~5
days/week
 74% do NOT eat 5 servings of fruits and
vegetables daily
 25% of Maine adults are obese (2007)
 Levels of Nutritional Status
 Ideal nutrition
 Intake is sufficient to meet daily needs and to
keep nutritional stores full while maintaining a
healthy body weight
 Levels of Nutritional Status
 Borderline nutrition
 intake is sufficient to meet daily needs, but not
enough to keep reserves full
• Body is not prepared to handle times of stress
 Illness, pregnancy…
• Slows growth and development of fetus and
growing child
 Levels of Nutritional Status
 Malnourished* - under-noursished
 intake insufficient to meet daily caloric and
nutrient needs and nutrient reserves are empty
• Life threatening, medical intervention required
• Chronically malnourished children may not be able
to "catch-up" for poor nutrition, therefore they may
not reach their full potential

*text – malnutrition = “bad” nutrition, whether it is due to

an excess or deficiency of nutrients
 Mal/under-nourished
 Populations at increased risk:
 anyone living in poverty
• especially infants, children, pregnant women,
elderly
 elderly in general, including those living in nursing
homes
 pregnant teens
 drug and alcohol addicts
 individuals with eating disorders
 anyone with prolonged illness, including hospital
patients
 Levels of Nutritional Status
 Over-nutrition – 2 aspects
 excessive caloric intake that leads to obesity
• Increase risk of obesity related diseases
 heart disease, diabetes….
 overuse of vitamin supplements that leads to
toxicity
Evaluating Nutritional Status
1. Personal History
• SES, living situation, personal health, family
health history, diet history, drug history
2. Anthropometric data
– Height, weight, blood pressure, pulse rate
3. Physical exam
– Hair, skin, eyes, tongue…
4. Laboratory tests
– Cholesterol levels, iron levels…
 Nutritional Deficiencies
 Overt vs. covert deficiency
 Overt – outward signs of the deficiency

 Covert or sub-clinical– deficiency may be

detected by lab tests, but not outward signs of
the deficiency
 Nutritional Deficiencies
 Primary vs. secondary deficiency
 Primary – inadequate intake of the nutrient

 Secondary – body doesn’t absorb adequate

amounts, excretes too much….
• Body “mishandles” the nutrient

 Diet history helps distinguish between these

 Food Choices
 Small group exercise
 What influences your food choices each day?
 Why do you eat what you eat?
 Food Choices – Text Answers
1. Personal 8. Economy $
preferences 9. Positive or negative
2. Habit associations
3. Ethnic heritage 10. Emotional Comfort
4. Tradition 11. Values -Religious,
political, environmental
5. Social interactions or
pressure 12. Health concerns
6. Availability 13. Nutritional value
7. Convenience