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Fundamentals of Nutrition
MAR-ANN B. BRINGAS, MD
Assistant Professor
Department of Biochemistry and Nutrition
FEU-NRMF Ins...
Nutrition Principles
Wellness
Manage changing
nutrition needs over
the life cycle
Fist Year:
Structure/ function
courses
P...
What is Clinical Nutrition
Clinical nutrition is the study of the relationship
between food and a healthy body.
It is the ...
Nutrition Definition
NUTRITION is the composition and
quantity of food intake and the
utilization of the food by
the livin...
The Meaning of…
Nutrition Health
Food Nutrients
Essential
nutrient
NUTRITION THREE AREAS
ESSENTIAL NUTRIENTS
Proteins Isoleucine
Leucine
Lysine
Phenylalanine
Threonine
Tryptophan
Methionine
Valine
Fat-soluble
vi...
NUTRITIONAL STATUS / NUTRITURE
• The condition of the body as a result of
ingestion and utilization of food.
• Nutritional...
NUTRITIONAL STATUS ASSESSMENT
•AnthropometryA
•Biochemical DataB
•Clinical HistoryC
•Dietary Intake surveyD
ANTHROPOMETRY
Physical measurement of weight, height, and body
compartments of fat and lean tissue
Growth Body
composition...
ANTHROPOMETRY
http://www.slideshare.net/soharashed/assessment-of-nutritional-status
ANTHROPOMETRY Adults
Height measurement
 Stand erect and barefooted
on a STADIOMETER with a
movable headpiece.
 The head...
ANTHROPOMETRY Infants
http://www.slideshare.net/soharashed/assessment-of-nutritional-status
INDICES OF GROWTH
Weight for age
Weight for
height
Height for age
Weight/height ratios
Quetelet’s index
weight in kg
heigh...
ANTHROPOMETRY
Height - chronic nutrition
Weight - measure of growth
Gomez classification
Waterlow classification
Body Mass...
Gomez Classification
The child's weight is compared to that of a normal child
(50th percentile) of the same age. It is use...
Waterlow Classification
Chronic malnutrition results in stunting. Malnutrition
also affects the child's body proportions e...
BODY MASS INDEX FOR FILIPINOS
Body Mass Index = Weight [kilograms]/Height [meters]2 OR
= Weight [pounds]x703/ height [inch...
BODY MASS INDEX
International standard for assessing body size in
adults is the BMI = weight (kg)/ Height (m2)
BMI-ASSOCIATED RISKS
Waist circumference
• Predicts mortality better than any other
anthropometric measurement
No risk of illness due
to overwe...
BIOCHEMICAL DATA
• Assessment or measurement of the level of
nutrient in the body
PROTEIN
plasma amino acid
level
serum al...
CLINICAL HISTORY AND
PHYSICAL EXAMINATION
• Complete medical history
• Complete physical examination
• Signs/symptoms of n...
CLINICAL NUTRITIONAL ASSESSMENT
Detailed nutritional
history that includes:
Clinical
Dietary
Socioeconomic
Family issues
A...
DIETARY ASSESSMENT
National
• Food balance
sheets
• Market
databases
Household
• Food account
method
• List-recall method
...
DIETARY INTAKE SURVEY
http://www.slideshare.net/soharashed/assessment-of-nutritional-status
DIETARY INTAKE SURVEY
http://www.slideshare.net/soharashed/assessment-of-nutritional-status
DIETARY INTAKE SURVEY
http://www.slideshare.net/soharashed/assessment-of-nutritional-status
DIETARY INTAKE SURVEY
http://www.slideshare.net/soharashed/assessment-of-nutritional-status
Recommended Energy and Nutrient Intake (RENI)
• Formerly termed RDA
• Amount of energy and essential nutrients needed to
m...
Recommended Energy and Nutrient Intake (RENI)
Philippines, 2002 Edition
COMPONENTS OF ENERGY EXPENDITURE
Basal Metabolic Rate
BMR
Physical Activity PA
Specific Dynamic
Action of Food
SDA
Growth
BASIC METABOLIC RATE
• Largest component of energy expenditure
• Energy used at rest
• Calories spent with NO activity
• I...
Factors That Affect BMR
Factors That Affect BMR
FACTOR EFFECT ON BMR
Environmental
temperature
Both heat and cold raises BMR
Fasting/ starvation L...
PHYSICAL ACTIVITY
• Second largest component
• More vigorous physical
work would require
greater energy
SPECIFIC DYNAMIC ACTION OF FOOD
• Production of heat by the body above basal level
during digestion and absorption of food...
GROWTH
Additional energy to cover for the
cost of increasing body weight and height
ENERGY REQUIREMENT
• Most basic nutritional requirement
taking precedence over all other
nutritional needs
• Energy – the ...
Calorie (C)
• Standard unit for
measuring energy
• Amount of heat energy
needed to raise the
temperature of 1 ml of
water ...
ENERGY YIELD OF FOOD SOURCES
NUTRIENT In vitro
Bomb
Calorimeter
Cal/g
In vivo
Oxidation
Cal/g
Standard
Conversion
factor
C...
ESTIMATING DAILY ENERGY
EXPENDITURES
• Total Energy Expenditure
TEE
• Total Energy Requirement
TER
• Total Caloric Require...
CALCULATION OF TER: Factorial Method
IBW • Determination of ideal body weight
BMR • Calculation of BMR for 24 hrs.
cBMR • ...
PHYSICAL ATIVITY
Bed rest 10% of corrected BMR
Sedentary 30% of corrected BMR
Light 50% of corrected BMR
Moderate 75% of c...
TER CALCULATION
Case
◦ Height: 5’4’’ or 160 cm
5 fett 4 inches tall = 64 inches
64 in. x 2.54 = 162.56 or 160 cm
Actual Bo...
TER CALCULATION
A. DETERMINATION OF IBW
• Use the standard weight and height tables
Tannhauser method
• [height in cm. – 1...
TER CALCULATION
B. DETERMINE BMR FOR 24 HRS
Male = 1 kcal/ kg IBW/hr x 24
Female = 0.95 kcal/kg IBW/hr x 24
Example: Male ...
TER CALCULATION
C. CORRECT THE BMR
Subtract 10% of kcal/kg/IBW/hr of sleep
from BMR
Example: Slept for 8 hrs.
0.1 x 54 kg ...
TER CALCULATION
D. COMPUTE FOR PHYSICAL ACTIVITY
Example: Moderate Physical Activity
75% of corrected BMR
0.75 x 1252.8 = ...
TER CALCULATION
E. COMPUTE FOR SDA
10% of the sum of cBMR and PA
Example: 10% (cBMR + PA)
0.1 (1252.8 + 939.6) = 219.24 kc...
TER CALCULATION
F. COMPUTE FOR TOTAL ENERGY
REQUIREMENT
TER = cBMR + PA + SDA
TER = 1252.8 + 939.6 + 219.24
TER = 2411.64 ...
CALCULATION OF NUTRIENT
DISTRIBUTION BASED ON TER:
Nutrient Percentage
Carbohydrate 55-70%
Protein 10-15%
Fat 20-30%
Given TER 2400kcal/day
NUTRIENT % COMPUTATION GRAMS
equivalent
CHO 60% 2400 kcal/d x .6 = 1447 kcal 1447/4 = 360
Protein 1...
TEE/TER/TCR
TCR = BMR x Activity Factor x Injury Factor (1.0)
Resting or Basal
Metabolic Rate
(BMR)
Harris-Benedict
Equati...
ENERGY FOR BMR
• Men = 66+ ( 13.7 x weight kg ) + ( 5 x height Cm ) -
( 6.8 x age in years )
• Women = 655.1 + ( 9.6 x wei...
ACTIVITY FACTOR
LEVEL OF
INTENSITY
TYPE OF ACTIVITY ACTIVITY FACTOR TEE(Kcal/Kg/Day
)
Very light Seated and standing activ...
STRESS FACTOR/INJURY FACTOR
Starvation 0.8-1.0
Normal/ Non-Stressed 1.0-1.3
S/P surgery without complications 1.25-1.35
Mo...
STEPS IN CALCULATING DIETS USING
The HARRIS -BENEDICT Equation
A Filipino laborer, 36 years of age, 5 feet 4 inch
tall, en...
BMR
• Men’s BMR = 66+ (13.7 x weight kg) + (5 x ht cm) -
(6.8 x age in years)
• BMR = 66+ (13.7 x 54 kg) + (5 x 162 cm) – ...
TOTAL CALORIC REQUIREMENT
TCR = BMR x Activity Factor x Injury Factor (1.0)
TCR = 1400 x 1.7 x 1 = 2380 kcal or 2400 kcal
...
ACTIVITY FACTOR
LEVEL OF
INTENSITY
TYPE OF ACTIVITY ACTIVITY FACTOR TEE(Kcal/Kg/Day
)
Very light Seated and standing activ...
TCR
Factorial
Method
2412 kcal
Harris
Benedict
Method
2400 kcal
Short
Method
2200 kcal
Use 2400 kcal
CALCULATION OF TER
Use corrected body weight in Obese patients
• Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet.
Fe...
Example: Corrected Body Weight
• Height: 5’4”
• Actual Body Weight 65kg
Given
• IBW = 50 + (2.3x4) = 59.2 59 kgs
IBW = 50 ...
Example: Corrected Body Weight
• Height: 5’4”
• Actual Body Weight 80 kg
Given
• IBW = 50 + (2.3x4) = 59.2 59 kgs
IBW = 50...
Example: Corrected Body Weight
• CBW= IBW + [(ABW– IBW) x 25%]
CORRECTED BODY WEIGHT
• = 59kg + (21 x 25%)
• = 59kg + 5.25...
CALCULATION OF NUTRIENT
DISTRIBUTION BASED ON TER:
Nutrient Percentage
Carbohydrate 55-70%
Protein 10-15%
Fat 20-30%
Given TER 2400kcal/day
NUTRIENT % COMPUTATION GRAMS
equivalent
CHO 60% 2400 kcal/d x .6 = 1440 kcal 1440/4 = 360
Protein 1...
DIET PRESCRIPTION
Rx Kcal 2400 kcal
CHO 360 g , CHON 80 g, Fats 60 g
Grams of each day may be rounded off
60% 15% 30%
FOOD EXCHANGE LIST
List I. Vegetable Exchange
List II. Fruit Exchange
List III. Milk Exchange
List IV. Rice Exchange
List ...
FOOD EXCHANGE LIST
• Green leafy and non-leafy vegetables.
• Two exchanges of vegetable A is equal to One
exchange of vege...
FOOD EXCHANGE LIST
• Varieties of milk appear in the milk exchanges.
• Milk is classified into whole and non-fat types spe...
FOOD EXCHANGE LIST
• 3 categories based on the amounts of fat:
• Low fat meat exchange = 8 g protein , 2 g fat
• Medium fa...
COMPOSITION OF FOOD EXCHANGES
LIST FOOD MEASURE CHO
gram
CHON
gram
FAT
gram
ENERGY
kcal kj
I-A Vegetable A 1 cup, raw
½ co...
TRANSLATING A DAY’S EXCHANGES INTO A DAY’S MEAL
BREAK
FAST
EXCH FOOD
Fruit 1 1 slice papaya
Milk 1 1 glass fresh cow’s mil...
TRANSLATING A DAY’S EXCHANGES INTO A DAY’S MEAL
LUNCH EXCH. FOOD
Veg A 1 ½ cup talong
Veg B 2 1cup kalabasa
Fruit 1 1 medi...
FOR WEIGHT LOSS
Using the Harris-Benedict Equation, individuals can take
a mathematical approach to weight loss.
There are...
FOOD LABELS
DAILY VALUES OF FOOD LABELS
Food labels must present the “% daily Value” for these nutrients
Note: Daily Values were estab...
HOW TO CALCULATE DAILY VALUES
The Daily values on food labels are designed for a
2000- kcalorie intake
Macronutrients have...
HOW TO CALCULATE THE ENERGY
AVAILABLE IN FOODS:
1 slice of bread with 1 tablespoon of
peanut butter on it contains
16 gram...
1 slice of bread with 1 tablespoon of peanut butter on it contains :
16 grams carbohydrate, 7 grams proteins, and 9 grams ...
LET’S CHECK!
Fat:
(6.5/65) 100 = 10%
Carbohydrate
(15/300) 100 = 5%
Sodium
(240/2400)100= 10%
Protein
(3/50)100 = 10%
Chol...
Calorie balance is like a scale. To remain in balance and maintain your body
weight, the calories consumed (from foods) mu...
CARBOHYDRATES
• Major source of energy
• Cheapest source of energy
• Provide quick and sustained body fuel
CARBOHYDRATES
DIETARY FIBER
CARBOHYDRATES Functions:
• Fuel for energy
• Protein sparer
• Allows for normal fat metabolism
• Maintains functional inte...
CARBOHYDRATES Sources:
• Starches
• Root crops
• Fruits
• Sugar and candies
• Vegetables
• Liver glycogen
RENI FOR CHO: 55...
FATS Types
• Lipids
• Provides high caloric value
• Classification:
– Simple
– Compound lipids
– Derived lipids
FATS Types
FATS Types
• Visible fat
• Hidden fat
• Cholesterol - vital substance in human cell metabolism
Functions:
 Vital substanc...
FATS ESSENTIAL FATTY ACIDS
• Linoleic Acid
• Alpha - Linolenic Acid
• Arachidonic Acid
FATS Types
Radical chain reaction mechanism of lipid peroxidation
From Wikipedia, the free encyclopedia
FATS Types
SFA PUFA MUFA
Most animal
products
Milk and dairy
prod.
Cocoa butter
Coconut Oil
Palm Kernel oil
Vegetable seed...
COMPOSITION OF COMMONLY ENCOUNTERED
DIETARY LIPIDS
FROM ANIMALS
• Rich in
saturated fatty
acids
• Butter and
Lard
FROM PLA...
GROWTH
FATS ESSENTIAL FATTY ACIDS
FATS ESSENTIAL FATTY ACIDS
• Insoluble in water
• Cannot be made by the body
• Soluble in solvents with low polarity
• Low...
FATS ESSENTIAL FATTY ACIDS
• Humans evolved on a diet with equal amounts of
omega-6 and omega-3 FA
• Present diet : omega ...
FATS ESSENTIAL FATTY ACIDS
Greenland Inuit gutting a seal in the early 1900s.
Their diet consisted largely of fish, whale,...
FATS ESSENTIAL FATTY ACIDS
Cold water fishes:
tuna ,cod, sardines, mackerel,
salmon, herring
FATS ESSENTIAL FATTY ACIDS
FATS
MECHANISM OF ACTION OF EFA
PG 2 series PG3 series
Vasoconstriction Vasodilatation
Potent platelet aggregator Inhibit ...
FATS Functions
• Source of energy
• Protein sparer
• Serve as shock absorber
• Strengthens biological membrane
structure
•...
FATS Source
• STORAGE OF FATS
– White fats
– Brown Fats
• SOURCES OF FATS
– animals (butter, lard, meat, eggs, milk)
– pla...
PROTEIN
• First substance recognized as a vital part of
living tissue
• Nitrogen-containing compounds which yield
amino ac...
PROTEIN
PROTEIN
• Repair of worn-out body tissue proteins
• Muscle building
• Maintenance of growth
• Source of heat and energy
• ...
PROTEIN Sources
Animal Plant
PROTEIN Quality
• Determined by the
extent of indispensable
amino acids needed by
the body to maintain
equilibrium
Complet...
PROTEIN Quality
AMINO ACID SCORE
• Analyze protein
as to its essential
amino acid
content in
relation to a
reference
prote...
PROTEIN Quality
NITROGEN BALANCE
CONDITION MEASUREMENT SIGNIFICANCE
Positive N intake > N excretion Growth
Equilibrium N intake = N excret...
FOOD PROTEIN SUPPLEMENTATION
• Combination of complete and
incomplete protein in sufficient
quantity and quality
• Example...
WHAT FOODS SHOULD WE EAT?
HI- 5 DIET: Fruits and vegetables
Whole Grain Cereals
More on Fish
Beans, Nuts and Legumes
Full ...
Traffic Light of Nutrition
FOOD
 Pork & pork products
 Crabs, shell, shrimps
 Beef
 Chicken
 Fish
 Full cream powder...
MALNUTRITION
Pathologic state resulting from a relative or absolute deficiency or
excess of one or more essential nutrient...
MALNUTRITION
Pathologic state resulting from a relative or absolute deficiency or
excess of one or more essential nutrient...
MANUTRITION Etiology
Pregnancy or lactation Lack of Family Planning
Improper Weaning practices Lack of Immunization
Povert...
PROTEIN ENERGY MANUTRITION
 the most common, most disastrous form of
malnutrition in the world.
 It is characterized not...
PROTEIN ENERGY MANUTRITION
Marasmus Kwashiorkor
MARASMUS PATHOPHYSIOLOGY
Insufficient
energy intake
Body draws on its
own stores
Liver glycogen is
exhausted within
a few ...
KWASHIORKOR
• Protein Malnutrition
• Nutritional Edema Syndrome
• Etiology:
Insufficient intake of good
quality protein
KWASHIORKOR
DIAGNOSTIC SIGN
Edema
COMMON SIGNS
Hair changes
Skin depigmentation
Moon face
Anemia
OCCASIONAL SIGNS
Flaky pa...
KWASHIORKOR
CHO intake
CHON intake
HypoalbuminemiaDecreased visceral
protein synthesis
Fat mobilization
and amino acid
rel...
Protein-Energy (calorie)
malnutrition
Kwashiorkor
(edema with maintenance of
some subcutaneous fat tissue)
Marasmus
(skin ...
KWASHIORKOR vs. MARASMUS
KWASHIORKOR MARASMUS
Primary
Deficiency:
PROTEIN deficiency, due to no protein in
diet or inadequ...
OVERNUTRITION
• Obesity
• Weight is 20% above IBW
• Etiology:
– Excessive intake of food compared with its
utilization
– O...
OVERNUTRITION
• Male % body fat >/= 25%
• Female % body fat >/= 30-35%
• BMI = 30 or above
• Scale weight is 20% above Hea...
OVERNUTRITION
OVERNUTRITION
Central, apple, android Lower, pear, gynecoid
OVERNUTRITION
OBESITY IS RELATED TO MANY DISEASE ENTITIES
• Osteoarthritis
O
• Breathlessness
B
• Endocrine disorders
E
• Stroke
S
• Inc...
OVERNUTRITION
THE WEIGHT LOSS TRIAD
Control Energy
Intake
Control
Problem
behaviors
Perform
regular physical
activity
BREAST FEEDING
Optimal method
of feeding infants
Gold standard
Most appropriate
form of nutrition
for infants
Better than ...
BREAST FEEDING
MILK LET-DOWN REFLEX
Prolactin – produces milk
Oxytocin – release milk
BREAST FEEDING
• Factors affecting
composition of breast milk:
– Time of day
– Diet of mother
– Mother’s emotional state
–...
BREAST MILK Colostrum
• Secretion of breast during the first 2-4 days post-partum
• Deep yellow in color
Colostrum
Nutriti...
BREAST MILK
FOREMILK HINDMILK
First milk obtained during a
nursing period
Last milk obtained during a
nursing period
Clear...
BREAST MILK Storage
BREAST MILK
Typical contents of 100 ml breast milk produced on days 1-5 (colostrum) and
more than 15 days (mature milk) po...
BREAST MILK Composition
NUTRIENT COMPOSITION
Carbohydrates Lactose
Fats More than 98% TAG
- Oleic and palmitic acid
- Lino...
BREAST MILK Composition
ANTIMICROBIAL FACTORS
secretory IgA, IgM, IgG
lactoferrin
lysozyme
complement C3
leucocytes
bifidu...
BREAST MILK Composition
HORMONES
feedback inhibitor of lactation (FIL)
insulin
prolactin
thyroid hormones
corticosteroids,...
BREAST MILK Composition
HUMAN MILK COW’S MILK
Water Same Same
Kcal/ 100 ml 71 66
Proteins (g/100 ml)
Casein
Whey
1-1.5 %
3...
BREAST MILK Composition
BREAST MILK Attributes
INFANT
• Bacteriologically safe
• Always fresh and ready to go
• Contributes to maturation of GIT
•...
BREAST MILK Attributes
• Proper quality and quantity of nutrients
• Anti-infective properties are universally
effective
• ...
• Lack of motivation and preparation
• Aesthetic reasons
• Working mothers
• Fear of pain
• Anxiety
• Chronic diseases
• I...
Thanks you for listening.
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
Fundamentals of Nutrition 2017
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Fundamentals of Nutrition 2017

  1. 1. Fundamentals of Nutrition MAR-ANN B. BRINGAS, MD Assistant Professor Department of Biochemistry and Nutrition FEU-NRMF Institute of Medicine
  2. 2. Nutrition Principles Wellness Manage changing nutrition needs over the life cycle Fist Year: Structure/ function courses Prevention/ Primary Care Risk factor management with dietary modifications Second year: Scientific Basis of Medicine Therapeutics Primary or adjunct therapy with specific goals Clinical clerkships
  3. 3. What is Clinical Nutrition Clinical nutrition is the study of the relationship between food and a healthy body. It is the science of nutrients and how they are digested, absorbed, transported, metabolized, stored, and eliminated by the body. It is interested in how the environment affects the quality and safety of foods, and what influence these factors have on health and disease.
  4. 4. Nutrition Definition NUTRITION is the composition and quantity of food intake and the utilization of the food by the living organism. Essential nutrient Inessential Nutrient
  5. 5. The Meaning of… Nutrition Health Food Nutrients Essential nutrient
  6. 6. NUTRITION THREE AREAS
  7. 7. ESSENTIAL NUTRIENTS Proteins Isoleucine Leucine Lysine Phenylalanine Threonine Tryptophan Methionine Valine Fat-soluble vitamins A/D/E/K Water- soluble vitamins Thiamine Niacin Ascorbic acid Riboflavin Pyridoxine Cobalamin Folic acid Fats Linoleic acid Arachidonic acid Linolenic acid Minerals Calcium Iron Potassium Magnesium Chlorine Phosphorus Sodium Iodine Sulfur Manganese Copper Cobalt Zinc molybdenum
  8. 8. NUTRITIONAL STATUS / NUTRITURE • The condition of the body as a result of ingestion and utilization of food. • Nutritional status is dependent on the: intake of dietary nutrients relative need for nutrients body’s ability to utilize them
  9. 9. NUTRITIONAL STATUS ASSESSMENT •AnthropometryA •Biochemical DataB •Clinical HistoryC •Dietary Intake surveyD
  10. 10. ANTHROPOMETRY Physical measurement of weight, height, and body compartments of fat and lean tissue Growth Body composition Energy expenditure
  11. 11. ANTHROPOMETRY http://www.slideshare.net/soharashed/assessment-of-nutritional-status
  12. 12. ANTHROPOMETRY Adults Height measurement  Stand erect and barefooted on a STADIOMETER with a movable headpiece.  The head piece is leveled with skull vault & the height is recorded to the nearest 0.5 cm. http://www.slideshare.net/soharashed/assessment-of-nutritional-status
  13. 13. ANTHROPOMETRY Infants http://www.slideshare.net/soharashed/assessment-of-nutritional-status
  14. 14. INDICES OF GROWTH Weight for age Weight for height Height for age Weight/height ratios Quetelet’s index weight in kg height in m2
  15. 15. ANTHROPOMETRY Height - chronic nutrition Weight - measure of growth Gomez classification Waterlow classification Body Mass Index (BMI)
  16. 16. Gomez Classification The child's weight is compared to that of a normal child (50th percentile) of the same age. It is useful for population screening and public health evaluations. • Formula: Actual body weight X 100 Ideal body weight • Interpretation: Status Weight for age Normal 90 – 100% Malnutrition First degree 75-89% Second degree 60-74% Third degree <60% Overweight 101-120% Obese >120%
  17. 17. Waterlow Classification Chronic malnutrition results in stunting. Malnutrition also affects the child's body proportions eventually resulting in body wastage. • Formula: Actual body weight X 100 = Wasting Weight for height Actual height X 100 = Stunting Height for age Standard Stunting Wasting Normal >95% >90 % Mild 87.5-95% 80 – 90% Moderate 80-87.4% 70-79% Severe <80% <70%
  18. 18. BODY MASS INDEX FOR FILIPINOS Body Mass Index = Weight [kilograms]/Height [meters]2 OR = Weight [pounds]x703/ height [inches]2
  19. 19. BODY MASS INDEX International standard for assessing body size in adults is the BMI = weight (kg)/ Height (m2)
  20. 20. BMI-ASSOCIATED RISKS
  21. 21. Waist circumference • Predicts mortality better than any other anthropometric measurement No risk of illness due to overweight Avoid weight gain or drop on weight Should drop weight Seek for help from health care professionals Men < 94 cm 94-101 > 102 Women < 80 cm 80-87 > 88 Waist circumference (cm)
  22. 22. BIOCHEMICAL DATA • Assessment or measurement of the level of nutrient in the body PROTEIN plasma amino acid level serum albumin level hair root morphology NUTRIENTS Serum retinol Serum iodine Calcium Vit D levels LIPIDS serum cholesterol serum triglycerides lipoprotein
  23. 23. CLINICAL HISTORY AND PHYSICAL EXAMINATION • Complete medical history • Complete physical examination • Signs/symptoms of nutritional deficiency
  24. 24. CLINICAL NUTRITIONAL ASSESSMENT Detailed nutritional history that includes: Clinical Dietary Socioeconomic Family issues Areas of interest include: • present and past illnesses • family illness history • food allergies or intolerance • medications • nutritional supplements • over-the-counter meds • alcohol use • work environment • education level.
  25. 25. DIETARY ASSESSMENT National • Food balance sheets • Market databases Household • Food account method • List-recall method • Inventory method • Household record method • Telephone survey • Use of household food-consumption data for National Food- Consumption Individuals • 24-hour recall • Food records • Weighed-food records • Dietary history • Food frequency questionnaire • Observed food consumption Video and photographic methods
  26. 26. DIETARY INTAKE SURVEY http://www.slideshare.net/soharashed/assessment-of-nutritional-status
  27. 27. DIETARY INTAKE SURVEY http://www.slideshare.net/soharashed/assessment-of-nutritional-status
  28. 28. DIETARY INTAKE SURVEY http://www.slideshare.net/soharashed/assessment-of-nutritional-status
  29. 29. DIETARY INTAKE SURVEY http://www.slideshare.net/soharashed/assessment-of-nutritional-status
  30. 30. Recommended Energy and Nutrient Intake (RENI) • Formerly termed RDA • Amount of energy and essential nutrients needed to meet the minimum requirement to: * maintain health * provide reserves * added amount for incomplete digestion • Factors that influence RDA: * Age * Sex * physiologic stresses
  31. 31. Recommended Energy and Nutrient Intake (RENI) Philippines, 2002 Edition
  32. 32. COMPONENTS OF ENERGY EXPENDITURE Basal Metabolic Rate BMR Physical Activity PA Specific Dynamic Action of Food SDA Growth
  33. 33. BASIC METABOLIC RATE • Largest component of energy expenditure • Energy used at rest • Calories spent with NO activity • Indicates amount of energy used to sustain life’s processes
  34. 34. Factors That Affect BMR
  35. 35. Factors That Affect BMR FACTOR EFFECT ON BMR Environmental temperature Both heat and cold raises BMR Fasting/ starvation Lowers BMR Malnutrition Lowers BMR Hormones (gender) Thyroid, male hormones, premenstrual hormones raise BMR Smoking/Caffeine Increases energy expenditure Sleep BMR lowest when sleeping
  36. 36. PHYSICAL ACTIVITY • Second largest component • More vigorous physical work would require greater energy
  37. 37. SPECIFIC DYNAMIC ACTION OF FOOD • Production of heat by the body above basal level during digestion and absorption of food • Highest for proteins (12%) • Low for carbohydrates (6%) and fats (4%) • SDA contribute ̴ 10% of the consumed calories
  38. 38. GROWTH Additional energy to cover for the cost of increasing body weight and height
  39. 39. ENERGY REQUIREMENT • Most basic nutritional requirement taking precedence over all other nutritional needs • Energy – the capacity to do work • Measured in terms of calories
  40. 40. Calorie (C) • Standard unit for measuring energy • Amount of heat energy needed to raise the temperature of 1 ml of water by 1 degree centigrade. • Kilocalorie (C)= 1000 cal
  41. 41. ENERGY YIELD OF FOOD SOURCES NUTRIENT In vitro Bomb Calorimeter Cal/g In vivo Oxidation Cal/g Standard Conversion factor Cal/g CHO 4.10 4.00 4 CHON 5.65 5.20 4 FATS 9.45 9.00 9 ALCOHOL 7.10 7.10 7
  42. 42. ESTIMATING DAILY ENERGY EXPENDITURES • Total Energy Expenditure TEE • Total Energy Requirement TER • Total Caloric Requirement TCR Amount of Calories needed per day
  43. 43. CALCULATION OF TER: Factorial Method IBW • Determination of ideal body weight BMR • Calculation of BMR for 24 hrs. cBMR • Correct the BMR for sleep PA • Compute for physical activity SDA • Compute for SDA TCR • Compute for TCR = cBMR + PA + SDA
  44. 44. PHYSICAL ATIVITY Bed rest 10% of corrected BMR Sedentary 30% of corrected BMR Light 50% of corrected BMR Moderate 75% of corrected BMR Heavy 100% of corrected BMR
  45. 45. TER CALCULATION Case ◦ Height: 5’4’’ or 160 cm 5 fett 4 inches tall = 64 inches 64 in. x 2.54 = 162.56 or 160 cm Actual Body Weight : 65kg
  46. 46. TER CALCULATION A. DETERMINATION OF IBW • Use the standard weight and height tables Tannhauser method • [height in cm. – 100] – [(height cm - 100)10%] • If height is 160 cm. • [160 – 100] – [(160 – 100) 10%] = 54 kg. Fernando/ NDAP • Males IBW = 50 kg + 2.3 kg every inch over 5 ft. • Females IBW = 45.5 kg + 2.3 kg every inch over 5 ft. • Ex: 5 feet 2 inch male • = 50 + (2x2.3 kg) • = 54.6 kgs or 120 lbs
  47. 47. TER CALCULATION B. DETERMINE BMR FOR 24 HRS Male = 1 kcal/ kg IBW/hr x 24 Female = 0.95 kcal/kg IBW/hr x 24 Example: Male IBW = 54 kg. 1 kcal/kg x 54 kg x 24 = 1296 kcal/day
  48. 48. TER CALCULATION C. CORRECT THE BMR Subtract 10% of kcal/kg/IBW/hr of sleep from BMR Example: Slept for 8 hrs. 0.1 x 54 kg x 8 hrs = 43.2 kcal 1296 kcal – 43.2 kcal = 1252.8 kcal
  49. 49. TER CALCULATION D. COMPUTE FOR PHYSICAL ACTIVITY Example: Moderate Physical Activity 75% of corrected BMR 0.75 x 1252.8 = 939.6 kcal Bed rest 10% of corrected BMR Sedentary 30% of corrected BMR Light 50% of corrected BMR Moderate 75% of corrected BMR Heavy 100% of corrected BMR
  50. 50. TER CALCULATION E. COMPUTE FOR SDA 10% of the sum of cBMR and PA Example: 10% (cBMR + PA) 0.1 (1252.8 + 939.6) = 219.24 kcal/day
  51. 51. TER CALCULATION F. COMPUTE FOR TOTAL ENERGY REQUIREMENT TER = cBMR + PA + SDA TER = 1252.8 + 939.6 + 219.24 TER = 2411.64 kcal/day
  52. 52. CALCULATION OF NUTRIENT DISTRIBUTION BASED ON TER: Nutrient Percentage Carbohydrate 55-70% Protein 10-15% Fat 20-30%
  53. 53. Given TER 2400kcal/day NUTRIENT % COMPUTATION GRAMS equivalent CHO 60% 2400 kcal/d x .6 = 1447 kcal 1447/4 = 360 Protein 10% 2400 kcal/d x .10 = 241 kcal 241/4 = 60 Fat 30% 2400 kcal/d x .30 = 724 kcal 724/9 = 80 Diet Rx: TER 2400 kcal, 362g CHO, 60g Protein, 80g Fats CALCULATION OF NUTRIENT DISTRIBUTION BASED ON TER:
  54. 54. TEE/TER/TCR TCR = BMR x Activity Factor x Injury Factor (1.0) Resting or Basal Metabolic Rate (BMR) Harris-Benedict Equation
  55. 55. ENERGY FOR BMR • Men = 66+ ( 13.7 x weight kg ) + ( 5 x height Cm ) - ( 6.8 x age in years ) • Women = 655.1 + ( 9.6 x weight kg ) + ( 1.8 x ht cm) - ( 4.7 x age in years) HARRIS –BENEDICT EQUATION • Men: 1 kcal/kg/hour x 24 hours • Women: 0.9 kcal/kg/hour x 24 hours SHORT METHOD
  56. 56. ACTIVITY FACTOR LEVEL OF INTENSITY TYPE OF ACTIVITY ACTIVITY FACTOR TEE(Kcal/Kg/Day ) Very light Seated and standing activities. Painting trades, driving, laboratory work, typing, sewing, ironing, cooking, playing cards, musical instrument 1.3 (men) 1.3(women) 31 30 Light Intensive exercise for at least 20 minutes 1 to 3 times/ week. Bicycling, jogging, basketball, swimming, skating, etc. If you do not exercise regularly, but you maintain a busy life style that requires you to walk frequently for long periods, you meet the requirements of this level 1.6 (men) 1.5 (women) 38 35 Moderate Walking 3.5-4mph. Intensive exercise for at least 30 to 60 minutes 3 to 4 times per week. Any of the activities listed above will qualify Intensive exercise for at least 3- 4x/week 1.7 (men) 1.6 (women) 41 37 Heavy Intensive exercise for 60 minutes or greater 5 to 7 days per week Labor-intensive occupations include construction work (brick laying, carpentry, general labor, etc.). Farming, landscape worker or similar occupations. 2.1 (men) 1.9 (women) 50 44 Exceptional Training in professional or world-class athletic events 2.4 (men) 2.2 (women) 58 51
  57. 57. STRESS FACTOR/INJURY FACTOR Starvation 0.8-1.0 Normal/ Non-Stressed 1.0-1.3 S/P surgery without complications 1.25-1.35 Moderate Stress from chronic illness 1.35-1.5 Severe stress (acute illness, severe infection, trauma etc) 1.5
  58. 58. STEPS IN CALCULATING DIETS USING The HARRIS -BENEDICT Equation A Filipino laborer, 36 years of age, 5 feet 4 inch tall, engaged in moderate physical activity. Height: 162cm Ideal Body weight: 54 kgs Nutrient distribution of TER: • Carbohydrates = 60% • Protein = 10 % • Fats = 30 %
  59. 59. BMR • Men’s BMR = 66+ (13.7 x weight kg) + (5 x ht cm) - (6.8 x age in years) • BMR = 66+ (13.7 x 54 kg) + (5 x 162 cm) – (6.8 x 36 yo) • BMR = 66+ 740 + 810– 244.8 • BMR = 1371 kcal = 1400 kcal Harris-Benedict Equation • Men: 1 kcal/kg/hour x 24 hours • BMR = 54 x 24 = 1296 kcal = 1300 kcal Short Method
  60. 60. TOTAL CALORIC REQUIREMENT TCR = BMR x Activity Factor x Injury Factor (1.0) TCR = 1400 x 1.7 x 1 = 2380 kcal or 2400 kcal (round to nearest 50) TCR = 30-58 kcal/kg/day (refer to table) = 41 x 54 = 2200 kcal
  61. 61. ACTIVITY FACTOR LEVEL OF INTENSITY TYPE OF ACTIVITY ACTIVITY FACTOR TEE(Kcal/Kg/Day ) Very light Seated and standing activities. Painting trades, driving, laboratory work, typing, sewing, ironing, cooking, playing cards, musical instrument 1.3 (men) 1.3(women) 31 30 Light Intensive exercise for at least 20 minutes 1 to 3 times/ week. Bicycling, jogging, basketball, swimming, skating, etc. If you do not exercise regularly, but you maintain a busy life style that requires you to walk frequently for long periods, you meet the requirements of this level 1.6 (men) 1.5 (women) 38 35 Moderate Walking 3.5-4mph. Intensive exercise for at least 30 to 60 minutes 3 to 4 times per week. Any of the activities listed above will qualify Intensive exercise for at least 3- 4x/week 1.7 (men) 1.6 (women) 41 37 Heavy Intensive exercise for 60 minutes or greater 5 to 7 days per week Labor-intensive occupations include construction work (brick laying, carpentry, general labor, etc.). Farming, landscape worker or similar occupations. 2.1 (men) 1.9 (women) 50 44 Exceptional Training in professional or world-class athletic events 2.4 (men) 2.2 (women) 58 51
  62. 62. TCR Factorial Method 2412 kcal Harris Benedict Method 2400 kcal Short Method 2200 kcal Use 2400 kcal
  63. 63. CALCULATION OF TER Use corrected body weight in Obese patients • Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet. Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet. Ideal Body Weight •CBW= IBW + [(ABW– IBW) x 25%] CORRECTED BODY WEIGHT (if % IBW is => 125%)
  64. 64. Example: Corrected Body Weight • Height: 5’4” • Actual Body Weight 65kg Given • IBW = 50 + (2.3x4) = 59.2 59 kgs IBW = 50 kg + 2.3 kg for each inch over 5 feet. • = 65 kg/59kg x 100% • = 110% • NO NEED TO USE CORRECTED BODY WEIGHT %IBW= ABW/IBW x 100%
  65. 65. Example: Corrected Body Weight • Height: 5’4” • Actual Body Weight 80 kg Given • IBW = 50 + (2.3x4) = 59.2 59 kgs IBW = 50 kg + 2.3 kg for each inch over 5 feet. • = 65 kg/59kg x 100% • = 135% • USE CORRECTED BODY WEIGHT %IBW= ABW/IBW x 100%
  66. 66. Example: Corrected Body Weight • CBW= IBW + [(ABW– IBW) x 25%] CORRECTED BODY WEIGHT • = 59kg + (21 x 25%) • = 59kg + 5.25kg • = 64.25 kg CBW= 59kg + (80kg-59kg) x 25% USE 64 kg in computing TER instead of 59 kg
  67. 67. CALCULATION OF NUTRIENT DISTRIBUTION BASED ON TER: Nutrient Percentage Carbohydrate 55-70% Protein 10-15% Fat 20-30%
  68. 68. Given TER 2400kcal/day NUTRIENT % COMPUTATION GRAMS equivalent CHO 60% 2400 kcal/d x .6 = 1440 kcal 1440/4 = 360 Protein 10% 2400 kcal/d x .10 = 240kcal 240/4 = 60 Fat 30% 2400 kcal/d x .30 = 720kcal 720/9 = 80 Diet Rx: TER 2400 kcal, 360g CHO, 60g Protein, 80g Fats CALCULATION OF NUTRIENT DISTRIBUTION BASED ON TER:
  69. 69. DIET PRESCRIPTION Rx Kcal 2400 kcal CHO 360 g , CHON 80 g, Fats 60 g Grams of each day may be rounded off 60% 15% 30%
  70. 70. FOOD EXCHANGE LIST List I. Vegetable Exchange List II. Fruit Exchange List III. Milk Exchange List IV. Rice Exchange List V. Meat Exchange List VI. Fat Exchange List VII. Sugar Exchange
  71. 71. FOOD EXCHANGE LIST • Green leafy and non-leafy vegetables. • Two exchanges of vegetable A is equal to One exchange of vegetable B LIST I. Vegetable • This includes fresh fruits, canned, dried, and fruit juices specified as concentrated or diluted and sweetened or unsweetened LIST II. Fruit Exchanges
  72. 72. FOOD EXCHANGE LIST • Varieties of milk appear in the milk exchanges. • Milk is classified into whole and non-fat types specified as concentrated or diluted. • The nutrient value of ½ glass evaporated milk as whole milk is given as well as the equivalent of other types of milk. LIST III. Milk Exchanges • Varieties of bread, bakery products, rice and corn products • Considering patients who are on low fat diet, bakery products with high fat content are to be restricted or should be considered in the fat exchange. LIST IV. Rice Exchanges
  73. 73. FOOD EXCHANGE LIST • 3 categories based on the amounts of fat: • Low fat meat exchange = 8 g protein , 2 g fat • Medium fat meat exchange = 8 g protein , 7 g fat. • High fat meat exchange = 8 g protein , 10 g fat. • Each category differs by almost 35 kcal. LIST V. Meat Exchanges • Saturated or polyunsaturated fatty acids. LIST VI. Fat Exchanges • Soft drinks, fruit concentrates and alcohols are included to provide additional information and to aid in the dietary computation. LIST VII. Sugar Exchanges
  74. 74. COMPOSITION OF FOOD EXCHANGES LIST FOOD MEASURE CHO gram CHON gram FAT gram ENERGY kcal kj I-A Vegetable A 1 cup, raw ½ cooked - - - - I-B Vegetable B ½ cup cooked/raw 3 1 16 67 II Fruit varies 10 40 167 III Milk Evap Whole Powdered Skim Very Low ½ cup 1 cup 4 tbsp 4 tbsp 12 12 12 12 12 8 8 8 8 8 10 10 10 5 trace 170 711 80 335 IV Rice varies 23 2 100 418 IV Meat Low fat Med fat High fat Varies Varies Varies 8 8 8 2 7 10 50 209 95 398 122 510 VI Fat 1 tsp 5 45 188 VII Sugar 1 tsp 5 20 84
  75. 75. TRANSLATING A DAY’S EXCHANGES INTO A DAY’S MEAL BREAK FAST EXCH FOOD Fruit 1 1 slice papaya Milk 1 1 glass fresh cow’s milk Sugar 1 2 teaspoons jelly preserves/spread Rice 3 6 pcs. Pan de sal Meat 2 2 slices cheese/ 3 tbsp corned beef
  76. 76. TRANSLATING A DAY’S EXCHANGES INTO A DAY’S MEAL LUNCH EXCH. FOOD Veg A 1 ½ cup talong Veg B 2 1cup kalabasa Fruit 1 1 medium slice mango ripe Sugar 2 4 pcs. Chocolate candy with milk Rice 3 1 ½ cup rice Meat 2 2 medium size chicken wings Fat 1 1 cup coconut milk (ginataang gulay)
  77. 77. FOR WEIGHT LOSS Using the Harris-Benedict Equation, individuals can take a mathematical approach to weight loss. There are 3500 kilocalories in 1 lb (0.45 kg) of body fat. Using the Harris-Benedict Principle, if someone has a daily allowance of 2500 kilocalories, but he reduces his intake to 2000, then the calculations show a one pound loss every 7 days. 3500 kcal/ 7 days = 500 kcal/day
  78. 78. FOOD LABELS
  79. 79. DAILY VALUES OF FOOD LABELS Food labels must present the “% daily Value” for these nutrients Note: Daily Values were established for adults and children over 4 years old. The values for energy-building nutrients are based on 2000 kcalories a day. For fiber, the daily values was rounded up from 23. Food Component Daily value Calculation factor Fat 65 g 30% of kcal Saturated fat 20 g 10% of kcal Cholesterol 300 mg - Carbohydrate (total) 300 g 60% of kcal Fiber 25 g 11.5 g per 1000 kcal Protein 50 g 10% of kcal Sodium 2400 mg Potassium 3500 mg Vitamin C 60 mg Vitamin A 1500 ug Calcium 1000 mg Iron 18 mg Note: Daily Values were established for adults and children over 4 years old. The values for energy-building nutrients are based on 2000 kcalories a day. For fiber, the daily values was rounded up from 23.
  80. 80. HOW TO CALCULATE DAILY VALUES The Daily values on food labels are designed for a 2000- kcalorie intake Macronutrients have daily requirements of: Carbohydrates 60%, Fats 30%, Protein 10% of TCR. 2000 kcal x 0.60 kcal from CHO = 1200 kcal from CHO 2000 kcal x 0.30 kcal from fat = 600 kcal from fats 2000 kcal x 0.10 kcal from protein = 200 kcal from protein A person who prefer to count in grams should convert using the 4- 4-9 rule 1200 kcal/ 4 kcal per gram = 300 grams CHO 600 kcal/ 9 kcal per gram = 66 or 65 grams fats 200 kcal/ 4 kcal per gram = 50 grams protein
  81. 81. HOW TO CALCULATE THE ENERGY AVAILABLE IN FOODS: 1 slice of bread with 1 tablespoon of peanut butter on it contains 16 grams carbohydrate, 7 grams proteins, and 9 grams fat: TOTAL 173 16 g carbo x 4 kcal/g 64 7 g protein x 4 kcal/g 28 9 g fat x 9 kcal/g 81 To determine the percentage of kcal from fat: 81 fat kcal / 173 = 0.468 ( rounded to 0.47) Then multiply by 100 to get the percentage: 0.47 x 100 = 47% 47% of this serving is from FAT
  82. 82. 1 slice of bread with 1 tablespoon of peanut butter on it contains : 16 grams carbohydrate, 7 grams proteins, and 9 grams fat: Calories 173 % Daily Value Total Fat 9 g 14% Total CHO 16 g 5% Total CHON 7 g 14% Calories 173 % Value Total Fat 9 g 81 47% Total CHO 16 g 64 37% Total CHON 7 g 28 16% 100% Nutrition Facts 9 g fat x 9 kcal/g = 81 kcal 16 g carbohydrate x 4 kcal/g = 64 kcal 7 g proteins x 4 kcal/g = 28 kcal Total = 173 kcal Based on a 2000 kcal diet: (9g/65 g) x 100 = 13.8 14% (16 g/300 g) x 100 5 % (7/50 g) x 100 14%
  83. 83. LET’S CHECK! Fat: (6.5/65) 100 = 10% Carbohydrate (15/300) 100 = 5% Sodium (240/2400)100= 10% Protein (3/50)100 = 10% Cholesterol (30/300) 100 = 10%
  84. 84. Calorie balance is like a scale. To remain in balance and maintain your body weight, the calories consumed (from foods) must be balanced by the calories used (in normal body functions, daily activities, and physical activity).
  85. 85. CARBOHYDRATES • Major source of energy • Cheapest source of energy • Provide quick and sustained body fuel
  86. 86. CARBOHYDRATES
  87. 87. DIETARY FIBER
  88. 88. CARBOHYDRATES Functions: • Fuel for energy • Protein sparer • Allows for normal fat metabolism • Maintains functional integrity of the CNS • Facilitates excretion of toxins • Precursor of nucleic acid, connective tissue matrix, galactoside to nerve tissue • Aids in normal elimination of waste materials • Promote growth of coliform bacteria
  89. 89. CARBOHYDRATES Sources: • Starches • Root crops • Fruits • Sugar and candies • Vegetables • Liver glycogen RENI FOR CHO: 55-70% of TCR
  90. 90. FATS Types • Lipids • Provides high caloric value • Classification: – Simple – Compound lipids – Derived lipids
  91. 91. FATS Types
  92. 92. FATS Types • Visible fat • Hidden fat • Cholesterol - vital substance in human cell metabolism Functions:  Vital substance in human metabolism  Precursor of steroid hormones  Precursor of vitamin D  Essential in forming bile acids  Brain and nervous tissue component  Cell membrane component
  93. 93. FATS ESSENTIAL FATTY ACIDS • Linoleic Acid • Alpha - Linolenic Acid • Arachidonic Acid
  94. 94. FATS Types
  95. 95. Radical chain reaction mechanism of lipid peroxidation From Wikipedia, the free encyclopedia
  96. 96. FATS Types SFA PUFA MUFA Most animal products Milk and dairy prod. Cocoa butter Coconut Oil Palm Kernel oil Vegetable seed oils (sunflower oil, safflower oil, corn oil and soybean oil) Nut oil Cold water ocean fish Olive Oil Canola Oil Peanut Oil
  97. 97. COMPOSITION OF COMMONLY ENCOUNTERED DIETARY LIPIDS FROM ANIMALS • Rich in saturated fatty acids • Butter and Lard FROM PLANTS • Rich in saturated fatty acids • Coconut and Palm oil FROM PLANTS • Rich in monounsaturated fatty acids • Olive oil and Canola oil • Rich in polyunsaturated fatty acids • Soybean oil and Corn oil
  98. 98. GROWTH
  99. 99. FATS ESSENTIAL FATTY ACIDS
  100. 100. FATS ESSENTIAL FATTY ACIDS • Insoluble in water • Cannot be made by the body • Soluble in solvents with low polarity • Low melting point • Liquid at room temperature • Double bonds are oxidizable (DANGER)
  101. 101. FATS ESSENTIAL FATTY ACIDS • Humans evolved on a diet with equal amounts of omega-6 and omega-3 FA • Present diet : omega 6:omega 3 is 20-25:1 • Desirable ratio : 5-10:1
  102. 102. FATS ESSENTIAL FATTY ACIDS Greenland Inuit gutting a seal in the early 1900s. Their diet consisted largely of fish, whale, seal, and walrus, resulting in a high intake of omega 3 fatty acids. Copyright Arctic Institute
  103. 103. FATS ESSENTIAL FATTY ACIDS Cold water fishes: tuna ,cod, sardines, mackerel, salmon, herring
  104. 104. FATS ESSENTIAL FATTY ACIDS
  105. 105. FATS MECHANISM OF ACTION OF EFA PG 2 series PG3 series Vasoconstriction Vasodilatation Potent platelet aggregator Inhibit platelet aggregator Increases LDL Decreases LDL Decreases HDL Increases HDL Antiarrhythmic Antithrombotic Anti-atherosclerotic Anti-inflammatory Lowers blood pressure Improves endothelial function Lowers triglyceride concentrations
  106. 106. FATS Functions • Source of energy • Protein sparer • Serve as shock absorber • Strengthens biological membrane structure • Body insulator • Dietary vehicle • Supplies taste and flavor to food
  107. 107. FATS Source • STORAGE OF FATS – White fats – Brown Fats • SOURCES OF FATS – animals (butter, lard, meat, eggs, milk) – plants (vegetable oils) RENI FOR FATS: 20-30% of TCR
  108. 108. PROTEIN • First substance recognized as a vital part of living tissue • Nitrogen-containing compounds which yield amino acids upon hydrolysis • Classification: – Indispendible AA – Dispensible AA – Conditionally dispensible
  109. 109. PROTEIN
  110. 110. PROTEIN • Repair of worn-out body tissue proteins • Muscle building • Maintenance of growth • Source of heat and energy • Maintains normal osmotic relations among body fluids • As enzymes and hormones • As acid-base regulators • As transporters
  111. 111. PROTEIN Sources Animal Plant
  112. 112. PROTEIN Quality • Determined by the extent of indispensable amino acids needed by the body to maintain equilibrium Complete Incomplete
  113. 113. PROTEIN Quality AMINO ACID SCORE • Analyze protein as to its essential amino acid content in relation to a reference protein PROTEIN EFFICACY RATIO • Analyze proteins in terms of promoting growth and weight gain for every gram of protein BIOLOGIC VALUE (BV) • Proteins with complete essential amino acids will maintain nitrogen balance but those with incomplete essential amino acids will promote negative nitrogen balance NET PROTEINUTILIZATION (NPU) • Product of BV and Degree of food protein digestibility AA score = mg IDAA/g test protein --------------------------- x 100 mg IDAA/g reference protein PER = growth in grams ------------------------- Protein intake in grams BV amount of protein retained -------------------------------- x 100 amount of protein ingested NPU N intake – N output --------------------------- N intake
  114. 114. PROTEIN Quality
  115. 115. NITROGEN BALANCE CONDITION MEASUREMENT SIGNIFICANCE Positive N intake > N excretion Growth Equilibrium N intake = N excretion Maintenance and repair Maintenance N intake < N excretion Wasting
  116. 116. FOOD PROTEIN SUPPLEMENTATION • Combination of complete and incomplete protein in sufficient quantity and quality • Examples: – Cereal and milk – Macaroni and cheese – Rice, beans, and fish sauce – Wheat and beans
  117. 117. WHAT FOODS SHOULD WE EAT? HI- 5 DIET: Fruits and vegetables Whole Grain Cereals More on Fish Beans, Nuts and Legumes Full Cream Milk & Soft Boiled Eggs
  118. 118. Traffic Light of Nutrition FOOD  Pork & pork products  Crabs, shell, shrimps  Beef  Chicken  Fish  Full cream powdered milk  Soft boiled eggs  Fruits & Vegetables  Whole Grain/Cereals  Beans, nuts, legumes PROCESSING  Frying (lipid peroxides)  Baking (acrylamides)  Broiling (benzopyrene)  Microwaving (plastic)  Raw  Boiling  Steaming  Cooking in coconut milk  Cooking in curry
  119. 119. MALNUTRITION Pathologic state resulting from a relative or absolute deficiency or excess of one or more essential nutrients Under nutrition Specific deficiency Over nutrition Imbalance
  120. 120. MALNUTRITION Pathologic state resulting from a relative or absolute deficiency or excess of one or more essential nutrients Primary • Dietary inadequacy in amount or in kind • Iron deficiency, Iodine deficiency Secondary • Pathologic or physiologic condition of the body preventing adequate ingestion of food or proper metabolism of nutrients • Fever, Infection, Metabolic disease • Pregnancy, adolescence
  121. 121. MANUTRITION Etiology Pregnancy or lactation Lack of Family Planning Improper Weaning practices Lack of Immunization Poverty Congenital Diseases 2 or more children under the same household Malabsoprtion: Celiac, Lactose Intolerance, Giardiasis, Cystic Fibrosis Poverty Metabolic Incompetent/Ignorant mother Infections: TB
  122. 122. PROTEIN ENERGY MANUTRITION  the most common, most disastrous form of malnutrition in the world.  It is characterized not only by an energy deficit due to a reduction in all macronutrients but also by a deficit in many micronutrients. 3 FORMS: Dry (thin, desiccated) Wet (edematous, swollen) Combined form between dry and wet
  123. 123. PROTEIN ENERGY MANUTRITION Marasmus Kwashiorkor
  124. 124. MARASMUS PATHOPHYSIOLOGY Insufficient energy intake Body draws on its own stores Liver glycogen is exhausted within a few hours Triglyceride in fat depots are broken down into free fatty acid Fatty acids are incompletely oxidized to ketone bodies Rise Cortisol & GH Low Insulin, TH and plasma protein level Skeletal muscle for protein is used via gluconeogenesis
  125. 125. KWASHIORKOR • Protein Malnutrition • Nutritional Edema Syndrome • Etiology: Insufficient intake of good quality protein
  126. 126. KWASHIORKOR DIAGNOSTIC SIGN Edema COMMON SIGNS Hair changes Skin depigmentation Moon face Anemia OCCASIONAL SIGNS Flaky paint rash Hepatomegaly Infections
  127. 127. KWASHIORKOR CHO intake CHON intake HypoalbuminemiaDecreased visceral protein synthesis Fat mobilization and amino acid release from muscle Impaired beta lipoprotein synthesis Dependent edema hypoalbuminemia Fatty liver
  128. 128. Protein-Energy (calorie) malnutrition Kwashiorkor (edema with maintenance of some subcutaneous fat tissue) Marasmus (skin and bones appearance with little or no subcutaneous fat tissue) Moderate energy deficit with severe protein deficit Severe energy and protein deficit
  129. 129. KWASHIORKOR vs. MARASMUS KWASHIORKOR MARASMUS Primary Deficiency: PROTEIN deficiency, due to no protein in diet or inadequate absorption. OVERALL ENERGY deficiency Description: "A response to some kind of stress" "A slow adaptation to starvation" Incidence: 1-3 years 0-2 years Edema EDEMA is present -- due to lost oncotic pressure in blood vessels, in turn due to hypoalbuminemia Absent Hypo albuminemia LOW ALBUMIN is the cardinal symptom. Liver shuts down albumin production to conserve on protein which is lacking. Absent
  130. 130. OVERNUTRITION • Obesity • Weight is 20% above IBW • Etiology: – Excessive intake of food compared with its utilization – Other factors: Genetic constitution Psychic disturbances Lack of exercise Metabolic
  131. 131. OVERNUTRITION • Male % body fat >/= 25% • Female % body fat >/= 30-35% • BMI = 30 or above • Scale weight is 20% above Healthy body weight
  132. 132. OVERNUTRITION
  133. 133. OVERNUTRITION Central, apple, android Lower, pear, gynecoid
  134. 134. OVERNUTRITION
  135. 135. OBESITY IS RELATED TO MANY DISEASE ENTITIES • Osteoarthritis O • Breathlessness B • Endocrine disorders E • Stroke S • Increased lipid/ • Cholesterol levels I • Tumor/ CancerT • hYpertensionY
  136. 136. OVERNUTRITION THE WEIGHT LOSS TRIAD Control Energy Intake Control Problem behaviors Perform regular physical activity
  137. 137. BREAST FEEDING Optimal method of feeding infants Gold standard Most appropriate form of nutrition for infants Better than bottle feeding Complete food for infants up to 6 months of life
  138. 138. BREAST FEEDING MILK LET-DOWN REFLEX Prolactin – produces milk Oxytocin – release milk
  139. 139. BREAST FEEDING • Factors affecting composition of breast milk: – Time of day – Diet of mother – Mother’s emotional state – Foremilk or hindmilk – Drugs – smoking
  140. 140. BREAST MILK Colostrum • Secretion of breast during the first 2-4 days post-partum • Deep yellow in color Colostrum Nutritional factors Energy, protein, vitamins, minerals, carbohydrates, fats Immune factors IgA, IgG, IgM, IgD, IgE, lactoferrin, polypeptide, oligosaccharides, cytokines, lactoalbumin, lysosomes Growth factor PDGF, EGF, IGF1, VEGF,TGF
  141. 141. BREAST MILK FOREMILK HINDMILK First milk obtained during a nursing period Last milk obtained during a nursing period Clear, thin bluish Thick, cream-white
  142. 142. BREAST MILK Storage
  143. 143. BREAST MILK Typical contents of 100 ml breast milk produced on days 1-5 (colostrum) and more than 15 days (mature milk) post-partum CONTENTS COLOSTRUM MATURE MILK Energy (kcal) 55 67 Fat (g) 2.9 4.2 Lactose (g) 5.3 7.0 Protein (g) total 2.0 1.1 IgA 0.5 0.1 Lactoferrin 0.5 0.2 Casein 0.5 0.4 Calcium 28 30 Sodium 48 15 Vit A 151 75 Vit C 6 5
  144. 144. BREAST MILK Composition NUTRIENT COMPOSITION Carbohydrates Lactose Fats More than 98% TAG - Oleic and palmitic acid - Linoleic acid and Linolenic acid Functions: brain development Proteins 75% of breastmilk composition - micellar casein (beta casein) - acqueous whey (a-lactalbumin, lactoferrin, secretory IgA, and serum albumin)
  145. 145. BREAST MILK Composition ANTIMICROBIAL FACTORS secretory IgA, IgM, IgG lactoferrin lysozyme complement C3 leucocytes bifidus factor lipids and fatty acids antiviral mucins, GAGs oligosaccharides GROWTH FACTORS epidermal (EGF) nerve (NGF) insulin-like (IGF) transforming (TGF) taurine polyamines CYTOKINES/ANTI-INFAMMATORY tumour necrosis factor interleukins interferon-g prostaglandins a1-antichymotrypsin a1-antitrypsin platelet-activating factor: acetyl hydrolase DIGESTIVE ENZYMES amylase bile acid-stimulating esterase bile acid-stimulating lipases lipoprotein lipase
  146. 146. BREAST MILK Composition HORMONES feedback inhibitor of lactation (FIL) insulin prolactin thyroid hormones corticosteroids, ACTH oxytocin calcitonin parathyroid hormone erythropoietin TRANSPORTERS lactoferrin (Fe) folate binder cobalamin binder IgF binder thyroxine binder corticosteroid binder POTENTIALLY HARMFUL SUBS viruses (e.g., HIV) aflatoxins trans-fatty acids nicotine, caffeine food allergens PCBs, DDT, dioxins radioisotopes drugs OTHERS casomorphins d -sleep peptides nucleotides DNA, RNA
  147. 147. BREAST MILK Composition HUMAN MILK COW’S MILK Water Same Same Kcal/ 100 ml 71 66 Proteins (g/100 ml) Casein Whey 1-1.5 % 35 % 65 % 3.3 % 82% 18% Lactose (g/100 ml) 6.5-7 % 4.5 % Fats (g/100 ml) 3.8 % 3.7 % Mineral .15-.25 % .70-.75 % Vitamins Adequate Vit C/D Low vit. C/D Digestibility More digestible Less digestible
  148. 148. BREAST MILK Composition
  149. 149. BREAST MILK Attributes INFANT • Bacteriologically safe • Always fresh and ready to go • Contributes to maturation of GIT • Reduces risk of food allergies • Establishes habit of eating in moderation • Contributes to proper development of jaws and teeth • Decreases ear infections • Facilitates bonding with mother
  150. 150. BREAST MILK Attributes • Proper quality and quantity of nutrients • Anti-infective properties are universally effective • Prevents hypersensitivity or allergy • Psychological advantages • Contraceptive effects • Safe, convenient, and always available
  151. 151. • Lack of motivation and preparation • Aesthetic reasons • Working mothers • Fear of pain • Anxiety • Chronic diseases • Intake of medications BREAST MILK Unsuccessful
  152. 152. Thanks you for listening.

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