Test 1 - Nutrition Flashcards
nutrition
science of food and it’s relationship with health
nutrients - role
body growth
development
maintenance
nutrient/ food factor
specific dietary constituent
dietetics
planning of meal for:
well
sick
good nutrition:
maintain nutritional status - enable
growth
good health
five sections of nutrition
dietary constituents nutritional requirement assessment of nutritional status nutritional problems in public health nutritional programme in india
vitamins and essential amino acids discovered by
1950
roots of nutrition
physiology
biochemistry
international activities in field of nutrition initiated by
League of nations
FAO
WHO
UNICEF
nutrition is associated with
infection immunity fertility maternal health family health
science of nutrition
laboratory testing
epidemiology
concepts of nutrition epidemiology
- epidemiological assessment of nutritional status of communities
- nutritional surveys
- dietary surveys
- nutritional surveillance
- nutritional and growth monitoring
- nutritional rehabilitation
- nutritional indicators
- nutritional intervention
use of epidemiological factors in
- elucidation of disease
- aetiology
- identification of risk factors for disease
planning and evaluation of nutritional programmes
cornerstone of socio-economic development
nutrition
nutritional factors affects
- education
- demography
- agriculture
- rural development
how to tackle nutritional problems
intersectoral and integrated approach of sectors of development
8 elements of primary health care (HEALTH FOR ALL)
- food supply and promotion of proper nutrition
- education about prevailing health problems and how to control and prevent them
- adequate supply of water and basic sanitation
- maternal and child health and family planning
- immunization against infectious disease
- prevention and control of endemic disease
- treatment of common infections
- essential drugs
HEALTH FOR ALL
monitored by nutritional indicators
how to promote health and nutritional status of families and communities
- integrate nutrition in primary health care systems
2. formulate national dietary goals
classification of foods - ways
- by origin
- by chemical composition
- predominant function
- nutritive values
classification of food by origin
- animal origin
2. plant origin
classification of food by chemical composition
- proteins
- carbohydrates
- minerals
- fats
- vitamins
classifications of food by predominant function
- body building foods
- energy giving food
- protective food
body building food
- milk
- meat
- poultry
- fish
- eggs
- pulses
- nuts
- oil seeds
energy giving foods
- cereals
- sugars
- roots and tubers
- fats
- oils
protective food
- vegetable
- fruits
- milk
classification by nutritive values
- cereals and millets
- pulses (legumes)
- vegetables
- nuts and oilseeds
- fruits
- animal foods
- fats and oils
- sugar and jaggery
- condiments and spices
- miscellaneous foods
nutrients
organic and inorganic complexes in the food - have specific function
number of nutrients
about 50
types of nutrients
- macronutrients
2. micronutrients
macronutrients are also called
proximate principles (because they form the bulk of food)
examples of macronutrients
proteins, carbohydrates and fats
In india - contribution of protein in total energy intake
10-15 per cent
In india - contribution of fats in total energy intake
15- 30 per cent
In india - contribution of carbohydrate in total energy intake
50-80 percent
Micronutrients
vitamins and minerals
Micronutrients- etymology
because these are required in small amounts (fraction of a milligram to several grams)
Protein - derivation
that which is of first importance
proteins - chemical structure
complex, organic, nitrogenous (carbon, hydrogen, nitrogen (16%), oxygen and sulphur- phosphorus, iron, etc)
protein % of body
20%
Amino acids
make up protein (required for synthesis of tissue protein)
number of amino acids needed by the body
20
essential amino acids -number
9
essential amino acids- definition
amino acids that the body cannot synthesize in amounts corresponding to its needs and therefore they are obtained from the dietary proteins
essential amino acids - names
leucine, isoleucine, methionine, lysine, phenylalanine, threonine, vaine, tryptphan, histidine (PVT TIM HALL)
non essential amino acids
alanine, arginine, asparagine, glutamic acid, cysteine, aspartic acid, glutamine, glycine, proline, serine
arginine
essential during development stage
tryptophan
forms niacin
methionine
methyl group donor- synthesis of
- choline
- folates
- nucleic acids
amino acids essential for premature babies
cysteine and tyrosine
biologically complete protein
those which contain all the essential amino acids in amounts corresponding to human needs
quality of proteins depend on
pattern of amino acid
(pattern of amino acids of milk and egg are considered most suitable for humans and therefore these proteins are of superior quality)
functions of proteins
- repair and maintenance of body tissue
- body building (especially in infants and small children)
- maintenance of osmotic pressure
- synthesis of certain substances like antibodies, plasma proteins, coagulation factors, hormones, enzymes, hemoglobin
- supply energy when calorie intake is inadequate - 4 kcal per gram
protein energy malnutriton - features
CMI and bactericidal activity of leucocytes is lowered
dietary source of proteins
- animal source (complete proteins)
2. vegetable source
best food protein
egg protein
- high biological value
- high digestibility
reference protein- in nutritional studies
egg protein
main source of proteins in india
cereals and pulses - because they are cheap and easily available
cereal proteins are deficient in
lysine and threonine
pulse proteins are deficient in
methionine
limiting amino acids
if a diet is inadequate in any essential amino acids, the protein synthesis cannot proceed beyond the rate at which that amino acid is available. that amino acid is called the limiting amino acid
supplementary action of proteins
combination of food eaten together (example rice and dhal)
- their protein content supplement each other
- provide nutrition comparable to animal proteins (in respect of essential amino acids)
advantages of supplementary action of proteins - for vegetarians
he can get
- high grade proteins
- at low cost
protein metabolism
-not stored like fats
- replaced everyday
- break down and utilization occurs
turnover rate varies from tissues to tissues
- 1-2% of body protein replacement per day
- pattern of specific protein and amount of protein - maintained constant
evaluation of proteins
- amount of amino acids
- digestibility
- suitability
parameters for evaluation of proteins
- estimation of biological value
- digestibility coefficient
- protein efficiency ratio
- net protein utilization
net protein utilization
product of biological value and digestibility coefficient divided by 100
net protein utilization - definition
it is the
- proportion of ingested protein
- that is retained in the body
- under specified condition
- for the maintenance and growth of the body tissue
essentiality of nutrient is measured by the -
growth
tests to assess state of protein nutrition
- arm muscle circumference
- creatinine height index
- serum albumin and tranferrin
- total body nitrogen
best measure of state of protein nutrition
serum albumin concentration
liver’s ability to sythesise protein measured by
serum albumin and serum transferrin levels
indian medical council of medical research
recommends the daily requirement of nutrients
Fats - solid at
20 degrees celsius
oils -
liquid at 20 degrees C
Fats and oils -
concentrated source of energy
classification of fats
- simple lipids (triglycerides)
- compounds (phospholipids)
- derived (cholesterols)
fats that can be synthesised endogenously
triglyceride
cholesterol
fat storage
99% in adipose tissues as triglyceride
adipose tissue - % of body weight
10-15%
1 kg of adipose tissue =
7700 kcal of energy
fatty acids + glycerol
formed by fat hydrolysis
types of fatty acid
- saturated (hydrogenated)
2. unsaturated - have double bonds
saturated fatty acids
in animal fats
lauric, palmitic, stearic acids
unsaturated fatty acids
- monounsaturated
2. polyunsaturated
monounsaturated fatty acids
oleic acid
polyunsatured fatty acids
in vegetable oils
alpha-linolenic, linoleic acids
essential fatty acids
- linoleic acid- most important
- linolenic
- arachidonic acid
coconut and plam oils
saturated fatty acids
fish oils -
poly and mono unsaturated fatty acids
high medium chain SFA -
coconut, palm kernels, butter ghee
high SFA
palmolein
high MUFA and moderate LA
ground nut, rice bran, sesame
high LA
cotton seed, corn, safflower, sunflower
LA and ALA
soyabean, canola, mustard, flax seed
high TFA -
vanaspati
linoleic acid-
vegetable oils
- safflower
- corn oil
- sunflower
- soyabean
- sesame
- groundnut
- mustard
- palm
- cocunut
arachidonic acid
meat, eggs, milk
linolenic acid
soyabean oils
leafy greens
eichosapentaenoic acid
fish oils
essential fatty acids -
linoleic, linolenic, arachidonic, eichosapentaenoic acid
animal fats
saturated - ghee, butter, cheese, eggs, fat of meat and fish
cord liver oil and sardine - sat/unsat?
Saturated
vegetable fats
plant seeds ground nut mustard sesame coconut
other sources - invisible fats
cereals
pulses
nuts
vegetables
invisible fats
not visible to naked eye (in cereals and pulses)
- contribute to the major portion of fat intake
visible fats
separated from their natural sources- ghee (from milk), cooking oil (from seeds)
visible fat - measurement
easy to estimate the daily intake
good source of unsaturated fatty acids
edible plant products
cereals, millets and oil seeds
linoleic
soyabean, mustard, flaxseeed
pulses, legumes, green leafy
linoleic and ALA
cholesterol source
animal foods like butter, ghee, whole milk cream, fatty cheese, fatty meats
high saturated fatty acid source
animal foods like butter, ghee, whole milk cream, fatty cheese, fatty meat
trans fatty acid - natural source
animal foods like, butter, ghee, whole milk cream, fatty cheese, and fatty meat
long chain PUFA
lean meat, poultry meat
eggs - fat content
- cholesterol
- LA
- ALA
- DHA (docosahexanoic acid)
fish - fat content
PUFA
visible fats
vegetable oils
ghee
vanaspati
commercial food is prepared in which fats?
vanaspati - PHVO
fats - function - calorie needs
- high energy foods
- 9 kcal per gram
- protein sparer
- vehicle for fat soluble vitamins
- support viscera
- insulation against cold
- palatability
fats -non calorie roles
- body growth
- structural integrity of cell membrane
- reduce platelet adhesiveness
- reduce serum cholesterol and LDL
- PUFA- forms prostaglandins
- cholesterol - component of membrane and nervous tissue, form steroid hormones and bile acids
hydrogenation of vegetable oils
- under optimum temperature
- under optimum pressure
- presence of catalyst
- VANASPATI is formed (semi solid - solid fat)
- unsaturated fatty acids are converted into saturated fatty acids
- EFA is reduced
vanaspati - fortification
vit D -175 IU per 100 gm
vit A - 2500 IU per 100 gm
advantage vanaspati
- ghee like consistency
2. keeping quality good even in humid climate
trans fatty acids
- formed by partial hydrogenation of polyunsaturated fatty acids - also remove the critical double bonds of EFA - hence harmful
- geometrical isomers of cis unsaturated fatty acids with saturated fatty acid like configuration
trans fatty acids - shelf life
increased
trans fatty acid - pathogenic potential
- atherogenic
- risk of CAD increased
- increase LDL
- decrease HDL
trans fatty acid- elimination
years
refining of oils
treatment with steam, alkali etc.
refined and deodourized oil - advantage
- improves taste and quality
- remove free fatty acid
- remove rancid materials
diseases of disturbances of fat metabolism
- obesity
- phrenoderma
- CAD
- cancer
- others like kwashiorkor
obesity (fat and disease)
30% increase in adipose tissue
phrenoderma- pathology- (fat and disease)
EFA deficiency
- rough dry skin
- horny papular erruptions- posterior, lateral aspects of limbs and back, buttocks
phrenoderma - treatment
linseed, safflower oil along with B complex
CAD - (fat and disease)
> 40% fats in the diet
especially saturated fats
cancer- (fat and disease)
colon cancer
breast cancer
kwashiorkor ? (fat and disease)?
skin lesions like in EFA deficiency
WHO/FAO expert group pf diet, nutrition and prevention of chronic diseases - endorse
qualitative composition of fats in diet - significant role in CVD pathogenesis
WHO/FAO expert consultation of fats and fatty acids on 2008 Geneva, Switzerlands
reviewed
- scientific evidence on nutrient intake values for total fats and fatty acids
- assessed the risk to adequate growth, development and maintenance of health
- provided recommendations to different groups
WHO/FAO expert consultation of fats and fatty acids- consultations and recommendations
- energy balance is critical to maintain healthy body weight and ensuring optimal nutrient intake
- 6% PUFA recommendation - lower LDL, cholesterol, and CHD risk; increasing HDL
- n-3 PUFA - prevent CHD- other degenerative diseases of aging
- no need to recommend specific n-6- n-3 ratio or LA to ALA ratio - consdiering both of them are in recommended doses
- attention for - replacement of TFA
replacing SFA with PUFA/MUFA
decrease LDL
decrease total/ HDL ratio
decrease CHD risk
replacing SFA with carbohydrate
decrease LDL, HDL
replacing SFA with TFA
decrease HDL
increase total/HDL ratio
replacing carbohydrates with MUFA
increases HDL
minimum intake levels of LA
2.5% E
minimum intake levels of of ALA
0.5 % E
choice of cooking oil
- limit butter/ghee use
- avoid PHVO/ use its replacment
- correct combination of oils
oil containing LA + oil containing both LA and ALA
- groundnut/sesame/rice bran/cottonseeds +mustard/rapeseed
- groundnut/sesame/rice bran/cottonseeds + canola
- groundnut/sesame/rice bran/cottonseeds + soyabean palmolein + soyabean
- safflower/sunflower + palm oil/ palmolein + mustard/rapeseeds
oil containing high LA + oil containing moderate to low LA
- sunflower/safflower + palmolein/palm oil/olive
2. sunflower/safflower + ground nut/sesame/rice bran/ cotton seeds
frying oil - home- single
high thermal stability - palm oil/palmolein, sesame, rice bran, cotton seeds
frying oil- commerical - blends
palm oil/palmolein, sesame, rice bran, cotton seeds
RDA fats - takes in account
- total fat
- individual fatty acids
- health promoting non glyceride components
- age group and condition like foetus, pregancy, lactation, energy deficiency and non communicable diseases
main source of energy
carbohydrate (4 kcal per gram)
functions of carbohydrate
- source of energy
- oxidation of fats
- aa synthesis
sources of carbohydrate
sugar, starch, cellulose
starch source
- cereals
- roots
- tubers
sugars - types
monosacchride
disaccharide
carbohydrate reserve
500g
sources other than carb reserve for glucose homeostasis
protein, glycerol
glycaemic index
AUC - area under two hour blood glucose response curve following 50 g test carbohydrate as a % of AUC of the standard (white bread/glucose)
sugar
soluble
easily assimilate
high glycaemic foods
readily digestible
absorbable sugar
low glycaemic foods
foods favouring slow release and absorption of sugar in small intestine (reduced peak, prolonged action)
low GI- 55 and less
most fruits and vegetables whole grains pasta beans lentils
medium GI -
56-69
sucrose
basmati rice
brown rice
high GI
70 or more corn flakes jasmine rice baked potatoes white bread candy bars syrupy foods
dietary fibers
- remnants
- of edible parts of plants
- and analogous carbohydrates
- that are resistant to digestion and absorption in the human small intestine
- with complete or partial fermentation in the human large intestine
dietary fibers - examples
- oligosaccharides
- polysacchrides
- lignin
- organic acid (butyric acid)
- polyols (sorbitol)
dietary fibers- function
- laxative - softening, increased bulk, frequency, regularity
- blood cholesterol and glucose attenuation
- promotes interactions between nutrients
- changes pattern of bacterial colonies and thus, the fermentative products
- favours satiety
- increses transient time in the gut
- substrate for organic acids and nutraceuticals in gut
dietary fibers - classification
source - cereal, vegetable, fruits
solubility in water- soluble (partially/ fully), insoluble
part of energy from resistance starch made available by
bacterial fermentation
digestibility of dietary fibers depend on
- physiochemical and structural properties of the fiber
- process used for digestion
- enzymes
dietary/ crude fiber - old concept
all that was insoluble in boiling water, dilute acid and alkali
- has digestibility
- can hold water
dietary fibers - advantages
- decrease CAD (bind to bile salt- decrease its reabsorption - decrease cholesterol)
- pectin and gum - reduce post prandial glucose in blood
most effective gum
fenugreek seed - 40% gum - reduce cholesterol and glucose
disadvantage of fibers
may decrease vitamin and mineral (Ca, Mg, Iron, Zn) absorption
vitamins
essential nutrients
- fat soluble- A, D, E, K
- water soluble
vitamin A- constitute of
retinol pre-formed v
beta carotene - pro-v - converted to retinol in intestinal mucosa
retinol term introduced in (for vitamin A-1 - crystalline form)
1960
international units for vitamin A
- 3 micro gram of retinol
0. 55 micro gram of retinol palmitate
1mcg of retinol
1 Retinol equivalent
1 mcg of beta carotene
0.167 mcg of Retinol equivalent
1 mcg of other carotenoids
0.084 mcg of Retinol equivalent
1 Retinol equivalent =
3.333 IU of vitamin A
functions of vitamin A
- retinal pigment- vision in dim light
- glands and epithelial tissue functioning
- growth esp. skeletal
- anti-infective
- may protect from bronchial cancer
vitamin A - sources
animal- retinol
palnt - carotene
retinol in
- liver
- eggs
- butter
- cheese
- whole milk
- fish
- meat
- FISH LIVER OILS (used as supplement - richest source)
carotene
- spinach
- amaranth
- green, yellow fruits
- carrots
conversion of carotene to retinol
hindered in malnourishment and diarrheal diseases
storage of vitamin A -
retinol palmitate - in liver - reserve 6-9 months
retinol is toxic - how is it transported in blood
by binding to a retinol binding protein (produced by liver)
vitamin A deficiency causes -
xeropthalmia - dry eye
- night blindness
- conjunctival xerosis
- bitot’s spot
- corneal xerosis
- keretomalacia
night blindness
failure to dark adaptation
conjunctival xerosis
- conjuctiva - dry, non wettable, muddy, wrinkled (normal is smooth and shiny)
EMERGING LIKE SAND BANKS AT RECEDING TIDES when child ceases to cry
bitot’s spots
- triangular
- pearly white or yellowish, foamy, either side of cornea
- bilateral
corneal xerosis
cornea - dry, dull, non wettable, eventually opaque
ulceration, corneal scar
keratomalacia
liquefaction of cornea
- cornea is soft - may brust
extra ocular manifestation of vitamin A deficiency
- child mortality
- infections
- follicular hyperkeratosis
- anorexia
- growth retardation
treatment - vitamin A deficiency
200,000 IU or 110 mg of vitamin A orally on two successive days
- vitamin A given to children with corneal ulcers (regardless of vit A deficiency diagnosis)
prevention of vitamin A deficiency
- nutrition education
- improving diet
- reducing frequency and severity of associated conditions
National institute of nutrition at hyderabad - intervention against nutritional blindness (immunisation against xeropthalmia)
100,000 IU to children between the age of 6 months to 1 year -
200,000 IU 6 monthly to children between the age of 1 - 6 years -
Assessment of vitamin A deficiency
- population survey (6 months to 6 years - special risk groups)
- clinical and biochemical criteria
criteria for assessing xeropthalmia
night blindness bitot's spots corneal xerosis/ corneal ulceration/ keratomalacia corneal ulcer serum retinol less than 10 mcg/dl
prevalence of xeropthalmia features in preschool and children upto 6 years
night blindness - >1 % bitot's spots- > 0.5% corneal xerosis/ corneal ulceration/ keratomalacia - > 0.01% corneal ulcer - > 0.05% serum retinol less than 10 mcg/dl- >5%
RDA of vitamin A
adults- 600 mcg
> 50% from animal sources
conversion ratio of carotene to retinol
1:8 - current
older - 1:4
RDA - retinol - man
600 mcg
RDA - retinol - woman
600 mcg
RDA - retinol - pregnancy
800 mcg
RDA - retinol- lactation
950 mcg
RDA - retinol - infant
350 mcg
RDA - retinol 1-6 years
400 mcg
RDA - retinol - 7-9 years
600 mcg
RDA - retinol - 10- 17 years
600 mcg
Vitamin A (retinol) toxicity
- nausea
- vomiting
- anorexia
- sleep disorders
- skin desquamation
- enlarged liver
- papillar edema
- teratogenic
Vitamin D forms
- calciferol (ergosterol from plants)
- cholecalciferol (animal, fish, liver oils) - also made by body (UV lights - five mins per day)
Vitamin D storage
in fat deposits
liver
vitamin D - active metabolites
25 HCC
1,25 DHCC
bound to proteins
target tissue of vitamin D
bone
intestine
vitamin D
kidney hormone
- not required in diet
vitamin D function
- promotes Ca and phosphorous gut absorption
- reabsorbs phosphates from kidney
- variable effect on Ca (kidney)
- bone mineralisation, reabsorption, collagen maturation
- growth
sources
sunlight (UV light act on 7DHC of skin) foods- liver, egg yolk, butter, cheese, some fish, fish liver oil human milk - fortified milk margarine vanaspati infant food
deficiency
- rickets
2. osteomalacia
prevention
- nutritional education
- sunlight exposure
- prophylaxis with vitamin D
- fortification
daily requirement
ICMR
400 IU or 10 mcg - in case of minimal exposure
toxicity - due to hypercalcemia
nausea vomiting anorexia thirst drowsiness cardiac arrhythmias renal failure coma
rickets
vitamin D deficiency 6 months - 2 years - affected age group - hypocalcemia 1. growth failure 2. bone deformity- curved legs, deformed chest, harrison's sulcus, rickety rosary, kyphoscoliosis 3. muscular hypotonia 4. tetany 5. convulsions - elevated ALP - milestones like walking and teething - delayed
osteomalacia
vitamin D deficiency
in women
esp pregnant or lactating