Kabardino-Balkarian State University

named after H. M. Berbekov

Medical faculty
Department of propedeutics of internal diseases

Lecture “Nutrition tools - standards and guidelines.

DRI lists and targets. Determination of individual
requirements. Proteins, fats,
carbohydrates,reference intake rates. ”

Fiapsheva Asiyat Zurabovna

2020
Lecture plan:
1. DRI lists and targets.
2. The Carbohydrates.
3. Lipids.
4. Proteins.
1. Dietary Reference
Intakes (DRI).
DRI lists and targets.
Dietary Reference Intakes (DRI) a set of five lists of
values for measuring the nutrient intakes of healthy
people in the United States and Canada.
The lists are:
1. Recommended Dietary Allowances (RDA)—
adequacy
2. Adequate Intakes (AI)—adequacy
3. Tolerable Upper Intake Levels (UL)—safety
4. Estimated Average Requirements (EAR)—research
and policy
5. Acceptable Macronutrient Distribution Ranges
(AMDR)—healthful ranges for energy-yielding
nutrients.
• For each nutrient, the DRI establish a number of
values, each serving a different purpose.
Recommended Dietary Allowances (RDA)
and Adequate Intakes (AI).
1. The RDA reflect the average daily amount of
a nutrient considered adequate to meet the
needs of most healthy people in a particular life
stage and gender group.
2. AI - nutrient intake goals for individuals set
when scientific data are insufficient to allow
establishment of an RDA value and assumed to
be adequate for healthy people.
3. Tolerable Upper Intake Levels (UL) – the
highest average daily nutrient intake levels that
are likely to pose no risk of toxicity to almost all
healthy individuals of a particular life stage and
gender group.

4. Estimated Average Requirements (EAR) -

nutrient values used in nutrition research and
policy making and the basis upon which RDA
values are set.
5. Acceptable Macronutrient Distribution
Ranges (AMDR) - values for carbohydrate, fat,
and protein expressed as percentages of total
daily caloric intake.

• The Estimated Energy Requirement (EER)

represents the average dietary energy intake
considered adequate to maintain energy
balance in healthy people.
2. The Carbohydrates: Sugar,
Starch, Glycogen, and
Fiber
• Сarbohydrates compounds composed of
single or multiple sugars. The name means
“carbon and water,” and a chemical
shorthand for carbohydrate is CHO,
signifying carbon (C), hydrogen (H), and
oxygen (O).

• In the next few sections we'll talk about the

forms assumed by carbohydrates: sugars,
starch, glycogen, and fibers.
• All carbohydrates are made up of separate "units"
which are saccharides.
• Carbohydrates containing
- one unit are called monosaccharides,
- two units are disaccharides,
- two to ten units are oligosaccharides,
- and more than ten are polysaccharides.
• According to their ability to hydrolyze into
monomers, carbohydrates are divided into two
groups: simple (monosaccharides) and complex
(polysaccharides).
Sugars
• Six sugar molecules are important in
nutrition:
1. Glucose
2. Fructose
3. Galactose
4. Lactose
5. Maltose
6. Sucrose.
3 monosaccharides (glucose, fructose, and
galactose), 3 disaccharides (lactose, maltose,
and sucrose).
aGalactose does not occur in foods singly but only as
part of lactose.
bThe chemical bond that joins the monosaccharides of
lactose differs from those of other sugars and makes
lactose hard for some people to digest—lactose
intolerance (see later section, p. 124). Appendix A
presents more detailed structures.
• When you eat a food containing
monosaccharides, you can absorb them
directly into your blood.
• When you eat disaccharides, though, you
must digest them first.
• Enzymes in your intestinal cells split the
disaccharides into separate
monosaccharides so that they can enter
the bloodstream.
• Many foods are sources of glucose: sugar - 99.9%;
sweets - 95%; honey and grapes - 80%; white bread,
boiled potatoes and corn - 70%.

• Maltose known as malt sugar. It is

obtained from cereal grains, mainly
from germinated grains of rye and
barley. Maltose appears wherever starch
is being broken down. It arises during
the digestion of starch in the human
body.
• Galactose and Lactose known as
milk sugar. Dairy products are
the main sources of them.

• Fructose (fruit sugar). The

main sources of fructose
are fruits.

• Sucrose. Natural sources of

"pure" sucrose are sugarcane
stalks, sugar beet roots, juices
of coconut palm, Canadian
maple, and birch.
• Added sugars - sugars and syrups added to a food for any
purpose, such as to add sweetness or bulk or to aid in
browning (baked goods). Also called carbohydrate
sweeteners, they include concentrated fruit juice, glucose,
fructose, high fructose corn syrup, sucrose, and other
sweet carbohydrates.
 Starch
• In addition to occurring in sugars, the glucose in
food occurs in long strands of thousands of glucose
units. These are the polysaccharides
(see Figure 4–3).
• Starch is a plant’s storage form of glucose.
 Glycogen

• Just as plant tissues store glucose in long chains of

starch, animal liver and muscle tissues store glucose
in long chains that clump together to form glycogen
(depicted in Figure 4–3).
 Fibers
Most fibers are polysaccharides—chains of sugars—
but they differ from starch in that the sugar units are
held together by bonds that human digestive
enzymes cannot break.
 Characteristics, Sources, and Health
effects of Fibers (1)
Food Sources:
Barley, oats, oat bran, rye, fruit (apples, citrus),
legumes (especially young green peas and black-eyed
peas), seaweeds, seeds, many vegetables, fibers used
as food additives, Brown rice, fruit, legumes, seeds,
Vegetables (cabbage, carrots, brussels sprouts), wheat
bran, whole grains, extracted fibers used as food
additives.
 With these actions in the body:
• Reduce blood cholesterol • Yield small fat
by binding bile molecules after
• Slow glucose absorption fermentation that the
• Slow transit of food colon can use for
through upper GI tract; energy
delay nutrient absorption • Increase satiety
• Hold moisture in stools, • Stimulate colon lining,
softening them (less increase fecal weight,
fermentable soluble fibers) and speed fecal
• Nourish beneficial passage through colon
bacterial colonies in • Provide bulk and
the colon feelings of fullness
 And receive these
probable health benefits:
• Alleviate constipation (less fermentable soluble fibers)
• Lower risk of heart disease
• Lower risk of diabetes
• Lower risk of colon and rectal cancer
• Increase satiety (improve weight management)
• Alleviate constipation
• Lower risk of hemorrhoids and appendicitis
• Reduce complications from diverticulosis
• Lower risk of colon and rectal cancer
 Carbohydrates in the Body:

▪ Energy source. Sugars and starch from the diet

provide energy for many body functions; they provide
glucose, the preferred fuel for the brain and nerves.
▪ Glucose storage. Muscle and liver glycogen store
glucose.
▪ Raw material. Sugars can be partly broken down to
fragments that are used in making other compounds,
such as certain amino acids (the building blocks of
proteins), as needed.
▪ Structures and functions. Sugars interact with
protein molecules, affecting their structures and
functions.
▪ Digestive tract health. Fibers help maintain healthy
bowel function (reduce risk of bowel diseases).
▪ Blood cholesterol. Fibers promote normal blood
cholesterol concentrations (reduce risk of heart
disease).
▪ Blood glucose. Fibers modulate blood glucose
concentrations (help control diabetes).
▪ Satiety. Fibers and sugars contribute to feelings of
fullness.
▪ Body weight. A fiber-rich diet is conducive to a
healthy body weight.
Recommendations for Carbohydrate intakes
1. Total carbohydrate
Dietary Reference Intakes (DRI)
▪ At a minimum, adults and children need
130 g/day to provide glucose to the brain.
▪ For optimal health, most people should consume
between 45 and 65% of total calories from
carbohydrate.
Dietary Guidelines for Americans
▪ Choose nutrient-dense grains, fruit, starchy
vegetables, legumes, and milk to meet the day’s total
carbohydrate intake.
2. Added sugars
Dietary Guidelines for Americans
▪ Limit intakes of added sugars to a maximum
of 10% of total calories.

American Heart Association

▪ A prudent daily upper limit is not more than
100 cal (about 6 teaspoons) of added sugars for
most women and children or 150 cal for most
men.
World Health Organization (WHO)
▪ Strong recommendation a
Both adults and children should reduce the intake
of added sugars to less than 10% of total energy
intake.

▪ Conditional recommendation b
Both children and adults should further reduce the
intake of added sugars to below 5% of total energy
intake.
3. Whole grains
Dietary Guidelines for Americans
▪ A healthy eating pattern includes grains, at least half of
which are whole grains.

4. Fiber
Dietary Reference Intakes (DRI)
▪ 38 g of total fiber per day for men through age 50; 30 g
for men 51 and older.
▪ 25 g of total fiber per day for women through age 50;
21 g for
aStrong women 51
recommendations andthat
indicate older.
desirable effects of adherence to the
recommendation outweigh undesirable consequences. The recommendation can be
applied in most situations.

bConditional recommendations are made with less certainty, but with some scientific
support.
 Deficit
• We need carbohydrate, there is no good substitute
for carbohydrate.
• When the body faces a severe carbohydrate deficit,
it has two problems.
• Having no glucose, it must turn to protein to make
some (the body has this ability), diverting protein
from its own critical functions, such as maintaining
immune defenses.
• When body protein is used, it is taken from blood,
organ, or muscle proteins; no surplus of protein is
stored specifically for such emergencies.
• Protein is indispensable to body functions, and
carbohydrate should be kept available precisely to
prevent the use of protein for energy. This is called
the protein-sparing action of carbohydrate.
• As for fat, it regenerates a small amount of glucose
—but not enough to feed the brain and nerve
tissues.
• As for fat, although glucose can be converted into
body fat, fat regenerates a small amount of glucose
— not enough to feed the brain and nerve tissues.
3. The Lipids
• Lipid - a family of organic (carbon
containing) compounds soluble in
organic solvents but not in water.

Lipids include:
1. Triglycerides (fats and oils)
2. Sterols
3. Phospholipids.
1. Triglycerides - one of the three main
classes of dietary lipids and the chief form
of fat in foods and in the human body. A
triglyceride is made up of three units of
fatty acids and one unit of glycerol.
2. Sterols - one of the three main classes
of dietary lipids. Sterols have a
structure similar to that of cholesterol.
3. Phospholipids - one of the three main
classes of dietary lipids. These lipids are
similar to triglycerides, but each has a
phosphorus-containing structure in place of
one of the fatty acids. Phospholipids are
present in all cell membranes.
Triglycerides usually include mixtures of
various fatty acids.
• Fatty acids - organic acids composed of carbon
chains of various lengths. Each fatty acid has an
acid end and hydrogens attached to all of the
carbon atoms of the chain.
• Sometimes in the fatty acids the chain has a
place where hydrogens are missing: an “empty
spot,” or point of unsaturation.
• Saturated fatty acid - a fatty acid carrying the
maximum possible number of hydrogen atoms
(having no points of unsaturation).
• A saturated fat is a triglyceride with three
saturated fatty acids.
• Unsaturated fatty acid - a fatty acid that lacks
some hydrogen atoms and has one or more points of
unsaturation.
• An Unsaturated fat is a triglyceride that contains
one or more unsaturated fatty acids.
• Monounsaturated fatty acid - a fatty acid
containing one point of unsaturation.

• Monounsaturated fats - triglycerides in which most

of the fatty acids have one point of unsaturation (are
monounsaturated).

• Polyunsaturated fatty acid (PUFA) - a fatty acid

with two or more points of unsaturation.

• Polyunsaturated fats - triglycerides in which most

of the fatty acids have two or more points of
unsaturation (are polyunsaturated).
• Trans fats (a hydrogenated fat ) - fats that
contain any number of unusual fatty acids—trans-
fatty acids—formed during processing. It is a
previously unsaturated fat to which hydrogens have
been added.
• High intakes of saturated and trans fats are
associated with cardiovascular disease (CVD),
the number-one cause of death among adults in
the United States and Russia. (2)
• People who center their diets on foods rich in
saturated fatty acids and trans-fatty acids often
have blood lipid profiles that indicate higher
risks of developing CVD.
Сholesterol - a member of the group of lipids known
as sterols.
Food Cholesterol and Blood Cholesterol
- High blood LDL cholesterol is a major indicator of
CVD risk.
- Food cholesterol has little effect on blood
cholesterol values in most people. (5)
Even eating an egg each day, a notoriously rich source
of cholesterol, does not appear to raise the risk of
heart disease. (6)
- The two main food lipids associated with raising
LDL cholesterol are saturated fat and trans fat when
intakes exceed recommendations.
 Essential fatty acids
• Essential fatty acids - fatty acids that the body
needs but cannot make and so must be
obtained from the diet.
• Linoleic acid and Linolenic acid is an essential
fatty acids.
• Linoleic acid - an essential polyunsaturated
fatty acid of the omega-6 family.
• Linolenic acid - an essential polyunsaturated
fatty acid of the omega-3 family.
 Omega-6 and Omega-3 Fatty Acid Families
• Omega-6 fatty acid - a polyunsaturated fatty acid with
its endmost double bond six carbons from the end of
the carbon chain.
• Given dietary linoleic acid, the body can produce other
needed members of the omega-6 family. For example,
arachidonic acid, from which the body makes
biologically active compounds.
• Omega-3 fatty acid - a polyunsaturated fatty acid with
its endmost double bond three carbons from the end of
the carbon chain.
• Given dietary linolenic acid, the body can make other
members of the omega-3 series. Two family members
of great interest to researchers are EPA and DHA.
• EPA - eicosapentaenoic acid
• DHA - docosahexaenoic acid
• Omega-3 fatty acids made from linolenic acid
in the tissues of fish.
• The body makes only limited amounts of EPA
and even less DHA, but they are found
abundantly in the oils of certain fish.
• EPA (omega-3) forms its own eicosanoids
that often oppose those from arachidonic
acid (omega-6).
omega-3 eicosanoid omega-6 eicosanoid
relaxes blood vessels constricts the vessels
and lowers the blood and increases pressure
pressure

• A balance between the two therefore

promotes normal blood pressure. (3)
Functions of the essential Fatty Acids:
▪ Provide raw material from which eicosanoids
(biologically active lipids) are made.
▪ Serve as structural and functional parts of cell
membranes.
▪ Contribute lipids to the brain and nerves.
▪ Promote normal growth and vision.
▪ Maintain health of the skin, thus protecting
against water loss.
▪ Help regulate genetic activities affecting
metabolism.
▪ Participate in immune cell functions.
 Food sources of Omega-6 and Omega-3 Fatty Acids

Omega-6
• Nuts and seeds (cashews, walnuts, sunflower
Linoleic seeds, others)
acid • Poultry fat
• Vegetable oils (corn, cottonseed, safflower,
sesame, soybean, sunflower); margarines
made from these oils
Omega-3 • Nuts and seeds (chia seeds, flaxseeds,
walnuts, soybeans)
Linolenic • Vegetable oils (canola, flaxseed,
acid soybean, walnut, wheat germ; liquid
or soft margarine made from canola or
soybean oil)
• Vegetables (soybeans)
 Egg, enriched:
EPA 75–100 mg DHA/egg (flaxseed-enriched)
and 100–130 mg DHA/egg (fish oil-enriched)
DHA Human milk
Fish and seafood:
Top contributors: (500–1,800 mg/3.5 oz) Barramundi,
Mediterranean seabass (bronzini), herring (Atlantic and
Pacific), mackerel, oyster (Pacific wild), salmon (wild and
farmed), sardines, shark,swordfish, tilefish, toothfish (includes
Chilean seabass), lake trout (freshwater, wild, and farmed)
Good contributors: (150–500 mg/3.5 oz) Black bass, catfish
(wild and farmed), clam, crab (Alaskan king), croakers, flounder,
haddock, hake, halibut, oyster (eastern and farmed), perch,
scallop, shrimp (mixed varieties), sole
Other contributors: (25–150 mg/3.5 oz) Cod (Atlantic and
Pacific), grouper, lobster, mahi-mahi, monkfish, orange roughy,
red snapper, skate, tilapia, triggerfish, tuna, wahoo
Figure Z
 The Usefulness of Fats

Fats in the Body

▪ Energy fuel. Fats provide 80 to 90 percent of
the resting body’s energy and much of the
energy used to fuel muscular work.
▪ Energy stores. Fats are the body’s chief form
of stored energy.
▪ Emergency reserve. Fats serve as an
emergency fuel supply in times of severe
illness and starvation.
▪ Padding. Fats protect the internal organs from
shock, cushioning them with fat pads inside the
body cavity.
▪ Insulation. The layer of fat under the skin
insulates the internal tissues against cold
temperatures.
▪ Cell membranes. Fats form the major material of
cell membranes.
▪ Raw materials. Lipids are converted to other
compounds, such as hormones, bile, and vitamin D,
as needed.
Fats in Food
▪ Nutrients. Food fats provide essential fatty acids, fat-
soluble vitamins, and other needed compounds.
▪ Transport. Fats carry fat-soluble vitamins A, D, E, and
K along with some phytochemicals and assist in their
absorption.
▪ Energy. Food fats provide a concentrated energy
source.
▪ Sensory appeal. Fats contribute to the taste and smell
of foods.
▪ Appetite. Fats stimulate the appetite.
▪ Texture. Fats make fried foods crisp and other foods
tender.
▪ Satiety. Fats in foods contribute to feelings of fullness.
 Lipid intake Recommendations for Healthy People

1. Total fat a

Dietary Reference Intakes

▪ An acceptable range of fat intake is estimated at 20 to
35% of total calories.

a Includes monounsaturated fatty acids.

2. Saturated fat
American Heart Association
▪ For adults who would benefit from lowering blood LDL
cholesterol:
▪ Reduce percentage of calories from saturated fat to
between 5 and 6%.
Dietary Reference Intakes
▪ Keep saturated fat intake low, less than 10% of calories,
within the context of an adequate diet.
Dietary Guidelines for Americans b
▪ Consume less than 10% of calories per day from saturated
fats.
b The Dietary Guidelines for Americans 2015 use the term solid fats to describe sources of
saturated and trans-fatty acids. Solid fats include milk fat, fats of high-fat meats and cheeses,
hard margarines, butter, lard, and shortening.
3. Trans fat
American Heart Association
▪ For adults who would benefit from lowering
blood LDL cholesterol:
▪ Reduce percentage of calories from trans
fat.

Dietary Guidelines for Americans b

▪ A healthy eating pattern limits trans fats.
4. Polyunsaturated fatty acids
Dietary Reference Intakes
▪ Linoleic acid (5 to 10% of total calories):
17 g/day for young men.
12 g/day for young women.
▪ Linolenic acid (0.6 to 1.2% of total calories):
1.6 g/day for men.
1.1 g/day for women.
Dietary Guidelines for Americans
▪ A healthy eating pattern includes oils.
5. Cholesterol
Dietary Reference Intakes
▪ Minimize cholesterol intake within the context of a
healthy diet.
4. The Proteins and Amino
Acids
• Proteins compounds- composed of carbon,
hydrogen, oxygen, and nitrogen and arranged
as strands of amino acids. (Some amino acids
also contain the element sulfur.)
• Amino acids - the building blocks of protein.
Each has an amine group at one end, an acid
group at the other, and a distinctive side
chain.
• Amine group - the nitrogencontaining portion
of an amino acid.
Side chain - the unique chemical structure attached
to the backbone of each amino acid that distiguishes
one amino acid from another.
The side chains make the amino acids differ in size,
shape, and electrical charge.
• Essential amino acids - amino acids that
either cannot be synthesized at all by the
body or cannot be synthesized in amounts
sufficient to meet physiological need.

• Conditionally essential amino acid - an amino

acid that is normally nonessential but must be
supplied by the diet in special circumstances
when the need for it exceeds the body’s
ability to produce it.
Essential Amino Acids Nonessential Amino Acids
1. Histidine 10. Alanine
2. Isoleucine 11. Arginine
3. Leucine 12. Asparagine
4. Lysine 13. Aspartic acid
5. Methionine 14. Cysteine
6. Phenylalanine 15. Glutamic acid
7. Threonine 16. Glutamine
8. Tryptophan 17. Glycine
9. Valine 18. Proline
19. Serine
20. Tyrosine
• There is a wide variety of proteins in the
world because an almost infinite
number of amino acid sequences can be
formed. The special forms of proteins
allow them to perform various tasks in
the body (hemoglobin, hormones,
enzymes, immune cells are proteins).
1. Acid-base balance. Proteins help maintain
the acid-base balance of various body fluids
by acting as buffers.
2. Antibodies. Proteins form the immune
system molecules that fight diseases.
3. Blood clotting. Proteins provide the netting
on which blood clots are built.
4. Energy and glucose. Proteins provide some
fuel for the body’s energy needs.
5. Enzymes. Proteins facilitate needed chemical
reactions.
6. Fluid and electrolyte balance. Proteins help
to maintain the water and mineral
composition of various body fluids.
7. Gene expression. Proteins associate and
interact with DNA, regulating gene
expression.
8. Hormones. Some hormones are proteins or
are made from amino acids.
9. Structure and movement. Proteins form
integral parts of most body tissues and
confer shape and strength on bones, skin,
tendons, and other tissues. Structural
proteins of muscles execute body
movement.
10. Transport. Proteins help transport needed
substances, such as lipids, minerals, and
oxygen, around the body.
 How Much Protein Do People Need?
• The DRI value for protein intake is designed to
cover the need to replace protein containing
tissue that healthy adults break down every
day.
• Protein intake Recommendations
for Healthy Adults
• 0.8 g protein/kg body weight/day.
▪ Women: 46 g/day
Men: 56 g/day.
▪ Acceptable intake range: 10 to 35% of calories
• But elderly people, may need more
than this minimum for optimal health.
(4)
• Athletes, too, may need slightly more
protein— 1.2 to 1.7 grams per
kilogram per day.
Protein Deficiency and
Excess
 Deficiency
• In protein deficiency, when the diet supplies
too little protein or lacks a specific essential
amino acid relative to the others (a limiting
amino acid), the body slows its synthesis of
proteins while increasing its breakdown of
body tissue protein to liberate the amino
acids it needs to build other proteins of more
critical importance. Without its most critical
proteins, many of the body’s life-sustaining
activities would come to a halt.
• The consequences of protein
deficiency include slow growth in
children, impaired brain and kidney
functions, weakened immune
defenses, and impaired nutrient
absorption from the digestive tract.
 Excess
• Health effects of protein excess are less well
established.
• Kidney Disease
Animals fed experimentally on high-protein
diets often develop enlarged kidneys or livers.
In human beings, a high-protein diet increases
the kidneys’ workload, but research is
insufficient to say whether this alone can
damage healthy kidneys or cause kidney
disease. (9)
• In people with kidney stones or other
kidney diseases, however, a high-protein
diet may speed the kidneys’ decline. (10)
For people with established kidney
problems, a somewhat lower protein intake
often improves the symptoms of their
disease. (11) The challenge is to provide
enough protein to support the body’s
health, but not more than the damaged
kidneys can handle.
• Cancer
• The risk of cancer does not appear to
increase with greater protein intakes.
However, eating a diet high in red
meats and processed meats
correlates with certain cancers,
particularly colon cancer. (12)
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877.
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