NUTRITION

Diet & nutrition

nutrients =Nutrients are the
constituents of food
necessary to sustain the
normal functions of the
body.
Energy balance.
Over nutrition.
 Body mass index

Wt in kg/Ht in meter 2
squared
A way of expressing relative

obesity to height
Desirable range is b/w 20 &
05/26/10 2
 Energy metabolism
Metabolism of food stuff
 exergonic reaction & endergonic reaction
 energy expenditure by the body for two
resions
 1, utilization for physical work
 2, utilization for involuntary work
 this part of expenditure is constant and at a
basal rate.

05/26/10 3
CALORIC VALUE OF FOOD
On burning different foodstuffs different
amount of energy
 How much heat will be obtained by burning
a particular food stuff is expressed by “caloric
value”
Definition
The amount of heat energy obtained by burning

1.0 gm of the food stuff completely in the

presence of O2
 Bomb calorimeter

05/26/10 4
 CALORIE
Unit of energy (c)
Def-
 the amount of heat required to raise the
temp- of 1.0 gm of water by 1˚c
 (from 15 – 16˚c).this is ordinary calorie and is
too small.
KILOCALORIE

A unit thousand time of the ordinary calorie is

called ‘’Kilocalorie’’ or simply Calorie ‘C’.

 Calorie in biological science always means a
‘’Kilocalorie’’
05/26/10 5
 Calories obtained / gm

05/26/10 6
 Basal metabolism
Energy required = varies
 but
 the rate of energy production in
individual by its overall cellular
metabolism is more or less constant under
some standard /basal conditions
 basal conditions are
1.Person should be awake but
2.At complete rest both physically and mentally
3.Post absorptive state(12-18 hrs after meal)
4.Should be in reclining position
5.Environmental temp-2o˚c - 25˚c
6.Comfortable humidity and pressure
05/26/10 7
 BMR
Rate of energy production under basal
conditions per unit of time and per sq meter
of body surface
Normal in adult male =40C/sqm/hr
 in adult female= 37C/sqm/hr


05/26/10 8
 Factors influencing BMR
1.age
2.sex
3.surface area
4.climate
5.state of nutrition
6.body tem-
7.barometric pressure
8.habits
9.drugs
10.hormones
11.pregnency

05/26/10 9
 Variations in BMR
PATHOLOGICAL
Fever
Diseases having increased cellular activity
Endocrine disease
 hyperthyroid
 hypothyroid
 Cushing's disease
 addision,s disease
IMPORTANCE OF BMR


05/26/10 10
QUOTIENT(RQ)
or respiratory coefficient


Definition Is the ratio of volume of CO2

produced by the volume of O2 consumed
(CO2/O2) during a given time.
 an indicator of which fuel is being metabolized to supply the
body with energy.
forms of indirect calorimetry
is a unit less number
used in calculations of basal metabolic
rate(BMR)when estimated from carbon
dioxide production.
Reflects cellular processes
Proportional increase or decrease of CO2
produced and O2 utilized, will keep the ratio
unchanged. But any disproportionate
variation will be reflected by a corresponding
change in the ratio.
RQ indicates type of the food burning inside
05/26/10
the body or conversion of one food stuff into11
Differ from RQ
RESPIRATORY EXHANGE RATIO (R)
It is the ratio of CO2 & O2 at any given time
whether or not equilibrium has been reached.
It is affected by factors other than metabolism
R rises during hyperventilation
 falls after exercise
 rises in metabolic acidosis
 falls in metabolic alkalosis


05/26/10 12
 RQ
Normal RQ = 0.85 in healthy adult, on mixed
diet.
• Carbohydrates ~ 1.0
Protein ~ 0.81. ( due to the complexity of the
various ways in which different amino acids
can be metabolized, no single RQ can be
assigned to the oxidation of protein in the diet.
• Lipids ~ 0.7
• Excess glucose leads to a RQ > 1.0. The excess
glucose, converted to CO2, increases minute
ventilation in order to prevent respiratory
acidosis.
• An RQ > 1 indicates net lipogenesis


05/26/10 13
 Factors affecting RQ
 1, DIET
 carbohydrates (C6 H12 O6) = RQ = 1.
(the volume of CO2 produced is the
same as the volume of O2 consumed)
 the amount of O2 present is just
sufficient to oxidize the H present in the
same molecule. 6o2 6CO2
 C6H12O6 + =
+ 6H2O
 CO2 produced/O2 consumed=6/6=1


05/26/10 14
RQ of Fat
 It is lowest
As fat is a O2 poor compound.

The O2 present in it can not fully oxidizes the H

O2 consumed from outside

Oxidation of

 2C15H110O2 + 163 O2→ 114 CO2 + 110H2O

RQ = 114/163 =0.70

05/26/10 15
RQ for protein
RQ =0.8
2C3H7O2N + 6O2 → (NH2)2CO + 5CO2 + 5H2O

RQ = 5/6 = 0.8

05/26/10 16
2, effect of interconversion in
the body
When CHO are converted into Fat
RQ will rise
O2 rich compound is converted into O2

O2 liberated from CHO, consequently less O2 is

required from outside

CO2 is produced more than O2 consumed so RQ

rises
A reversal when Fat is converted into CHO

05/26/10 17
 Clinical conditions are
In acidosis = RQ , CO2 out put > then O2
consumption.
In alkalosis = RQ ↓
In febrile conditions =RQ ↑ due to> breathing
> CO2 production >CO2 wash.
In diabetes mellitus, RQ fall
In starvation = fall

05/26/10 18
SIGNIFICANCE OF RQ

1, DETERMINE METABOLIC RATE

2,TYPE OF FOOD BURNING

3,DIAGNOSIS OF VARIOUS DISEASES

05/26/10 19
Caloric or energy
requirements
the average dietary energy intake
predicted to maintain an energy balance
in a healthy adult of a defined age, gender,
and height whose weight and level of
physical activity are consistent with good
health.
Or


enough food to replace the calories expended

per day
sedentary adults = 30 kcal/kg/day to maintain
body weight;
moderately active adults = 35 kcal/kg/day and
very active adults require 40 kcal/kg/day.
( 2,000 or 2,500 kcal/day.)
05/26/10 20
How energy is used in the
body

1. BMR (RMR)

wt= 70 kg (male)

SA = 1.7 sq metre

70/1.7 = 41 C/sq

metre/hr
1.7ᵡ 41ᵡ 24 =1672 c/ day

05/26/10 21
2, Thermic effect of food or
SDA
The production of heat by the body
increases as much as 30% above
the resting level during the
digestion and absorption of food.
This effect is called the thermic
effect of food or diet-induced
thermogenesis. Over a 24–hour
period, the thermic response to
food intake may amount to 5–10%
of the total energy expenditure

05/26/10 22
3, physical activity
Influence of muscular work on total
metabolism
Influence of mental work on total metabolism
Influence of sleep on total metabolism



05/26/10 23
 Obesity

05/26/10 24
INTRODUCTION

All components of diet are necessary

Qualitative & Quantitative requirement
Quantitative requirement varies with age, sex & life
style of individual.
Overt nutritional def- is rare (in deprived persons)
Some degree of nutritional def- is present in
Poor, elderly , growing children, pregnant women

 lactating mother, ill, convalescing pt’s,

alcoholics, strict vegetarians, malabsorption and
more deprived population



05/26/10 25
Definition
Obesity is an abnormal accumulation of body
fat, usually 20 percent or more over an
individual's ideal body weight.

Definition of Overweight &
Obesity
Using BMI

ITEMS BMI GRADE

UNDER WEIGHT ≤ 18.5

NORMAL 18.5 – 24.9

OVER WEIGHT 25.0 – 29.9
OBESITY 30.0 – 34.9 I
OBESITY 35.0 – 39.9 II
EXTREME OBESITY ≥ 40 III
body mass index (BMI),
or Quetelet index,
a statistical measure which compares a
person's weight and height.
Though it does not actually measure
the percentage of body fat,
it is used to estimate a healthy body
weight based on a person's height.
Body mass index is defined as the
individual's body weight divided by the
square of his or her height.(kg/m2).
a BMI chart,

28
A graph of body mass index . World Health Organization .

29
TYPES OF OBESITY
A immediate
1, EXOGENOUS
2, ENDOGENOUS
B pathological
1, HYPERPLASTIC
2,HYPERTROPHIC

05/26/10 30
Factors predispose to
obesity
Genetic – familial tendency.
Sex – women more susceptible .
Activity – lack of physical activity.
Psychogenic – emotional deprivation,
depression .
Social class – poorer classes.
Alcohol – problem drinking.
Smoking – cessation smoking.
Prescribed drugs – tricyclic derivatives.
Metabolic changes in
obesity
Not permanent can be changed by wt
reduction
usually hyperinsulinaemia
in fat metabolism
 TG level will rise
 Serum cholesterol will be high
 FFA normal
2. in CHO metabolism
 More conversion to fat
3. acid base changes (obesity hypoventilation
syndrome)

05/26/10
 LEPTIN 32
Leptin
Protein hormone secreted by adipocytes
Levels correlate with lipid content of cells
Leptin acts on the hypothalamus to reduce
hunger and to stimulate energy expenditure




Ghrelin
Hormone secreted in the stomach
Acts on the hypothalamus to stimulate appetite
Levels peak just before meals and drop
afterward
Health Consequences of Obesity
Increase in risk of:
Major cause of  Hypertension
preventable death  Dyslipidemia
Increase in mortality  Diabetes type 2
from all causes  Coronary artery
Increase in risk for disease
these cancers  Stroke
 Endometrium  Gallbladder disease
 Breast  Osteoarthritis
 Prostate  Sleep apnea &
 Colon respiratory
problems


 BALANCED DIET
A DIET when it include
 proportionate quantities of food items form
different food groups
 to supply
 the essential nutrients in complete fulfillment of
the requirement of the body
BASED ON

1.easily available,
2.within economic means.
3.easily digestible
4.should fit with local food habits
5.Should contain enough roughage material


05/26/10 2nd lecture 36

 Basic food groups
Group 1 = dairy products & milk
Group 2 = Meat
Group 3 = Green leafy vegetables
Group 4 = Fruits
Group 5 = cereals


 A balanced diet can planed by keeping

1.Age
2.Sex
3.Caloric requirement
4.From basic food groups
5.Within purchasing capacity

05/26/10 37
 BASIC FUNCTION OF
NUTRIENTS
Carbohydrate energy production
Fats
Protein protection against
infections
 growth &
 repair
Vitamins
Minerals
water regulation of tissue
functions
05/26/10 38
Plan of balanced diet
Age
Sex
physical activity
special nutritional needs
Economic status
Need for minimum cost
Varieties from basic food groups

05/26/10 39
protein in nutrition

05/26/10 40
protein(essential AA)

Biological value
AA composition
Balance of AA
Availability of amino acid from foods
Relation ship of AA

05/26/10 41
A, BIOLOGICAL VALUE
The % age of absorbed Nitrogen which is retained
in the body.
Several methods of calculation
By measurement
 1.wt gain in gms / gms of protein consumed
 2. on retention of absorbed N2
First animal is kept protein free diet for two days,

fecal & urinary N2 estimated. Then animal is fed

with measured
 amount of test protein and fecal & urinary N2
determined again
05/26/10 42
B, amino acid
composition
Essential AA+ available together +
simultaneously, so they can be utilized for
protein synthesis

05/26/10 43
Quantity of protein
Optimum requirement = 1gm/kg of body wt
Critical intake level = 0.25 – 0.33 gms/kg body
wt
+ve & - ve nitrogen balance
 chemical score
It is the ratio b/w the contents of the most

limiting AA in the test protein to the contents

of the same AA in egg protein is expressed in
%.
Egg = reference protein

05/26/10 44
Protein deficiency
Causes
Consequences
 Growth retardation
 Weigh loss
 Anemia
 Delayed wound healing
 Fatty liver
 due to impaired apoprotein synthesis
 Decreased plasma proteins
 Infections
 Hormone def-.

05/26/10 45
Protein calorie
malnutrition
A pathological state resulting from absolute or
relative deficiency of one or more essential
nutrients
Primary malnutrition
Secondary malnutrition
 CLASSIFICATION

a. General classification

Mid arm circumference= < 75 % of the

expected
Skin fold thickness by herpenden caliper
 Quac strip
05/26/10 46
Cont-
Welcome classification
Edema present Edema absent
Weight for age, kwashiorkor Ponderal
80
Wt–for
60%ageof std Marasmic retardation
marasmas
< 60% of std kwashiorkor

Gomez classification
1st degree
Wt is 75 – 95 % of the expected wt
2nd degree
Wt is 60 – 75 % of the expected wt
3rd degree
Below 60 % of expected wt

05/26/10 47
Assessment of Nutr
status
Direct
Clinical
Anthropometric
Dietary
Laboratory
Indirect
Health statistics
Ecological variables
Clinical Assessment
Useful in severe forms of PEM
Based on thorough physical examination
for features of PEM & vitamin
deficiencies.
Focuses on skin, eye, hair, mouth &
bones.
Chronic illnesses & goiter to be excluded
ANTHROPOMETRY
Objective with high specificity &
sensitivity
Measuring Ht, Wt, MAC, HC, skin fold
thickness, waist & hip ratio & BMI
Reading are numerical & gradable on
standard growth charts
Non-expensive & need minimal training
KWASHIORKOR
Cecilly Williams, a British nurse, had
introduced the word Kwashiorkor to the
medical literature in 1933. The word is
taken from the Ga language in Ghana &
used to describe the sickness of
weaning.
ETIOLOGY
Kwashiorkor can occur in infancy but its
maximal incidence is in the 2nd yr of life
following abrupt weaning.
Kwashiorkor is not only dietary in origin.
Infective, psycho-socical, and cultural
factors are also operative.
ETIOLOGY (2)
Kwashiorkor is an example of lack
of physiological adaptation to
unbalanced deficiency where the
body utilized proteins and
conserve S/C fat.
One theory says Kwash is a result
of liver insult with
hypoproteinemia and oedema.
Food toxins like aflatoxins have
been suggested as precipitating
CONSTANT FEATURES OF KWASH

OEDEMA

PSYCHOMOTOR CHANGES

GROWTH RETARDATION

MUSCLE WASTING
USUALLY PRESENT SIGNS
MOON FACE

HAIR CHANGES

SKIN DEPIGMENTATION

ANAEMIA
OCCASIONALLY PRESENT SIGNS

HEPATOMEGALY

FLAKY PAINT DERMATITIS

CARDIOMYOPATHY & FAILURE

DEHYDRATION (Diarrh. &

Vomiting)
SIGNS OF VITAMIN DEFICIENCIES

SIGNS OF INFECTIONS
DD of Kwash Dermatitis
Acrodermatitis Entropathica
Scurvy
Pellagra
Dermatitis Herpitiformis
MARASMUS
The term marasmus is derived from the
Greek marasmos, which means wasting.
Marasmus involves inadequate intake of
protein and calories and is characterized
by emaciation.
Marasmus represents the end result of
starvation where both proteins and
calories are deficient.
MARASMUS/2
Marasmus represents an adaptive
response to starvation, whereas
kwashiorkor represents a maladaptive
response to starvation
In Marasmus the body utilizes all fat
stores before using muscles.

EPIDEMIOLOGY & ETIOLOGY
Seen most commonly in the first year of
life due to lack of breast feeding and
the use of dilute animal milk.
Poverty or famine and diarrhoea are the
usual precipitating factors
Ignorance & poor maternal nutrition are
also contributory
Clinical Features of Marasmus

Severe wasting of muscle & s/c fats

Severe growth retardation
Child looks older than his age
No edema or hair changes
Alert but miserable
Hungry
Diarrhoea & Dehydration

 CHO ROLE IN DIET
NORMALLY 55 – 65 % OF THE TOTAL FOOD
CALORIES
Protein sparing action
Role of cellulose
Excessive intake
 Intestinal disturbances(bacterial fermentation)
 Galactose------ cataract.


05/26/10 64
 Daily FAT requirements
20 – 35 % of energy should be provided by
fat/day
Ω -6- PUFA ------- 5 – 10 %
Ω-3- PUFA --------- 0.5 – 1.2 %
PLASMA CHOLISTEROL & C H D


 plasma cholesterol arises from

1, diet

2, endogenous

Transported as lipoprotein.


05/26/10 65
Thank You!