Marasmus is a disease caused by a severe deficiency of protein and calories that affect infants and very young children, often resulting in weight loss and dehydration. Marasmus can develop into starvation and cause fatality caused by a lack of essential nutrients. People with marasmus appear bony with little muscle tissueKwashiorkorKwashiorkor is a disease caused by a severe deficiency of protein in diets that contain calories mostly from carbohydrates such as yams, rice and bananas. It usually affects older children. People with kwashiorkor appear puffy in the abdomen area from retention of fluid, according to the University of Maryland Medical Center. Common symptoms of both marasmus and kwashiorkor include fatigue, irritability, diarrhea, stunted growth and impairment of cognition and mental health.CachexiaCachexia is a condition that involves protein deficiency, depletion of skeletal muscle and an increased rate ofprotein degradation. Cachexia causes weight loss and mortality and is associated with cancer, AIDS, chronic kidney failure, heat disease, chronic obstructive pulmonary disease and rheumatoid arthritis, Patients with malignant cancer of the stomach, colon, liver, billiary tract and pancreas experience undernutrition from reduced intake of protein, calories and micronutrients, and have fatigue and a negative nitrogen balance as a result of loss of muscle mass from cachexia.
KetosisBody cells, especially brain cells, prefer to burn glucose for energy, and yet high-protein diets that are low in carbohydrate cause the body to burn fat instead. In the process of breaking fat into a form that the body can use, a acidic waste product called ketone bodies are produced by the body cells. The condition in the body, known as ketosis, in interpreted by your body as a starvation signal. Your body responds by slowing your metabolism, in order to respond in the most efficient way to this perceived starvation. This means you body cells use less energy, and caloric demand decreases. In other words, your metabolism slows and it becomes easier to gain weight.
Nutrients by Sumayya Naseem 2003
NutrientsL/O/G/OBy: SumayyaNaseemOptometrist (PICO), COT & COA (JCAHPO USA),MMSPH Student Abasyn University
Contents 1. Types of Nutrients 2. Good and Fair Sources 3. Daily Requirements 4. Functions of various Nutrients 5. Nutrients and Diseases
NutrientsChemical substances that constitute food and areresponsible for the functions of food and protects bodyfrom disorder.No substance can be called food unless it contains at leastone nutrient.Valuable food like milk contains a variety of nutrients andperforms about all food functions.
Types of Nutrients (Based on the amount required by the body) I. Macro Nutrients 1. Proteins 2. Carbohydrates 3. Fats 4. Water II. Micro Nutrients 5. Vitamins 6. Minerals
1. Proteins Found in membranes, enzymes, collagen, hair, nails and skins Contain Carbon, Hydrogen, Oxygen and Nitrogen – Most contain Sulphur – Some contain Phosphorus, iron, Copper and Zinc etc About 20% of total weight is proteins
Functions of ProteinsStructural Support Protection & Hormones &Growth and Energy Enzymes In Blood •Antibodies: • Proteins make •Antibodies the Hair, Nails & • Hemoglobin: A Protein with are proteins that muscles etc • Control Growth and Metabolic Iron… Oxygen bind to the • Growth and activities carrying pathogens and maintenance of function inhibit their • Speed up body tissues Biochemical activities. • Fibrinogen: • Provide energy Reactions and Helps in Blood when low calorie Digestion. Clotting & intake Healing
Sources Good Sources Fair Sources Animal Origin Plant Origin• Egg, Meat, Milk• Egg Proteins • Cereals, Pulses, Oil seeds(the best among food proteins)
Daily Requirements• One gm/kg body weight per day for adults• Additional 15 gm per day during pregnancy• Additional 25 gm during first six months of lactation and 18 gmduring 6-12 months of lactation• Protein Requirements of Infants (g/Kg) Age (months) Requirements per day 0–3 2.30 gm 3–6 1.85 gm 6–9 1.65 gm 9 – 12 1.50 gm
Proteins Deficiency Diseases 5. PROTEIN-ENERGY MALNUTRITION (PEM) 5 6. SKIN RASHES, HAIR LOSS, 6 BRITTLE NAILS, SKIN ULCERS 7 7. WEIGHT LOSS 8 8. EDEMA IN SEVERE CASES
DISORDERS CAUSED BY A HIGH-PROTEIN DIET KETOSIS DIGESTIVE & AFFECTS KIDNEY MENTAL DISORDERS HEALTH
2. CARBOHAYDRATES ( Hydrates of Carbon) Mono Saccharides (Glucose, Fructose, Galactose), Di Saccharides (Sucrose, Lactose, Maltose) and Poly Saccharides (Starches, Fiber , Cellulose, Glycogen) 50 – 70 % of energy must be provided by carbohydrates. Carbohydrates and Proteins provide 4 Kcal per gm
Functions of Carbohydrates RiboseGrowth and Energy For Brain For NEAA & Fats • Carbohydrates • Ribose – are a major and • Carbohydrates are A Pentose instant source of • Essential for the essential for the Carbohydrate , energy - one development of synthesis of certain is part of RNA and gram provides 4 brain in children non-essential amino acids and DNA kcal of energy. oxidation of fats • RBCs and Brain cells use carbohydrates as energy
Daily Requirements 250 – 325 grams per day50 – 70 % of energy must be provided by carbohydratesPakistani foods in general contain 90% carbohydrates
Carbohydrates Deficiency Diseases 1. USAGE OF FAT AS FUEL SOURCE: Low carbohydrate in our diet causes the fat reserves to be used 1 as fuel source. 2. KETOSIS: In the absence of carbohydrates, the body starts using the 2 proteins and convert it to sugars . This causes ketosis which is nothing but the accumulation of ketones in the body 3 3. HYPOGLYCEMIA 4 4. UNDERWEIGHT
3. FATS • Very rich source of energy • Energy of 9 Kcal per gram of fat • Simple Lipids - Triglycerides • Compound Lipids – Phospholipids • Derived Lipids – Cholesterol • 10 – 15 % of body weight is adipose tissue
Functions of FatsProvision of energy and spares proteins from being used forenergyServe as vehicles for fat soluble vitamins like A, D, E, KSupport of viscera like heart, kidneys and intestinesProvide insulation beneath the skinMake foods palatable/ eatableEFAs decrease serum cholesterol and LDLCholesterol is a precursor of steroid hormones
Sources Good Sources Fair Sources Animal Origin Plant Origin Oil seeds like:• Ghee• Butter • Ground nut• Milk and Eggs •Sunflower• Cheese • Mustard•Fats on meat •Coconut• Fats on Fish Cereals &Pulses
Daily Requirements• 20-30% of energy must be provided by fats of which 50% should be vegetable origin.• The FDAs RDI for fats is 65 g or 30 percent of your daily calorie intake.• One Kg of adipose tissue yields 7700 kcal of energy
Fats Deficiency Diseases 1. Hair loss, cold intolerance, bruising, poor growth, poor wound healing and low body weight. 1 2 2. PHRENODERMA: Rough and dry skin due to lack of essential fatty acids 3 3. As many vitamins and antioxidants are fat soluble, therefore deficiency of fat . affects the level and activity of vitamins and can impact whole body.
DISORDERS CAUSED BY A HIGH- FAT DIET Obesity Coronary Cancer Colon Heart Disease & Breast Cancer
4. WATER •Water is a chemical compound with the chemical formula H2O. •A water molecule contains one oxygen and two hydrogen atoms Safe drinking water is essential to humans even though it provides no calories • The human body contains from 55% to 78% water. • The body requires between 1 & 7 liters of H2O per day to avoid dehydration •The precise amount depends on the level of activity, temperature, humidity, and other factors.
Functions of Water• Water is at the center of life. This is why nobody can live more than 3 to 5 days without any water intake.• Water is your bodys principal chemical component and makes up about 60 percent of your body weight.• Every system in your body depends on water. For example, water flushes toxins out of vital organs, carries nutrients to your cells and provides a moist environment for ear, nose and throat tissues.
5 Basic Functions of Water• Cell life• Chemical and metabolic reactions• Transport of nutrients• Body temperature regulation• Elimination of waste
Daily Requirements• One man consumes 3.0 liters and women 2.2 liters• Pregnant women should increase intake to 2.4 liters (10 glass) andbreastfeeding women should get 3 liters (12 glass), since anespecially large amount of fluid is lost during nursing
Water Deficiency DisordersDehydration:Lack of water can lead to dehydration, a condition that occurs when youdont have enough water in your body to carry out normal functions.Even mild dehydration can drain your energy and make you tired. It canbe fatal too.Dry mouth, sunken eyes, dry skin, cold hands and feet, weak and rapidpulse, rapid and shallow breathing, confusion, exhaustion, and coma.Seen in children with diarrhea, gastroenteritis and vomiting.
5. Minerals About 50 minerals are found in human bodyMinerals are inorganic substances that serve a variety of functions suchas cofactors in :• Enzyme-catalyzed reactions• Regulation of acid-base balance• Nerve conduction• Muscle irritability and• Structural elements in the body.Each mineral is required in specific amounts ranging from various gmper day. Some of the more important of these are calcium, phosphorus,sodium, potassium and iron.Macro minerals: The minerals, which are required in amountsgreater than 100 mg/ day.Micro minerals: The minerals, which are required in amounts lessthan 100 mg/ day.
(i) Calcium (1.5 – 2% of body weight) A major mineral element of the body (1.5 – 2% of body weight)• Functions: Formation of bones, milk and teeth, coagulation of blood, contraction of muscles and metabolism.• Sources: Milk and milk products, eggs, fish, green leafy vegetables and cereals. Absorption is increased by Vitamin D and decreased by phytates and oxalates.• Deficiency: Not clear cut even in the case of low intake. Rickets and Osteomalacia may not occur if vitamin D intake is sufficient• Requirements: Infants 500 mg per day Adolescents 600 mg per day Adults 500 mg per day Pregnancy and Lactation 1000 mg per day
(ii) Iron• Functions: Iron is essential for the production of haemoglobin, which helps deliver oxygen from the lungs to the body tissues, synthesize iron enzymes that are required to utilize oxygen for the production of cellular energy .• Sources:• Haem Iron – (bioavailability good) found in meat, poultry, liver.• Non-haem Iron – (bioavailability poor) found in chick peas, beans, cereals, green leafy vegetables and apricot etc• Cooking in iron vessels is another source.• Iron Supplements and Fortified foods.
Daily Requirements: AGE GROUP DAILY IRON NEEDED• Infants 5-12 months 0.7 mg• Children 1-12 years 1.0 mg• Males 13-16 years 1.8 mg• Females 13-16 years 2.4 mg• Adult Males 0.9 mg Adult Females• Menstruating 2.8 mg• Pregnancy 1st half 0.8 mg• Pregnancy 2nd half 3.5 mg• Lactation 2.4 mg• Post menopause 0.7 mg
• Iron Deficiency Disorders:• Anemia:Effects on Children:• Impaired motor development and coordination• Impaired IQ• Decreased physical activity• FatigueEffects on Adults:• Decreased physical work and earning and Decreased immunityEffects on pregnant women:• Increased maternal morbidity and mortality• Increased foetal morbidity and mortality• Increased incidence of Low Birth Weight
(iii) Iodine• Functions: It is known to be essential in maintaining the function of the thyroid and parathyroid glands in the human body and the production of thyroxine, a hormone associated with proper thyroid functioning. Iodine also promotes general growth and development within the body as well as aiding in metabolism.• Sources: Cod fish, Shrimps, Fish and Fortified salt.• Daily Requirements: In your entire lifetime you will need less than a teaspoon of iodine to ensure good health, we need 150 micrograms (or 20,000th of a teaspoon) to meet your daily requirement.• Deficiency Disorders: Goiter ,Cretinism and Mental Retardation.
6. Vitamins....The Vital Amines Vitamins are classified as:• Fat Soluble Vitamins: A, D, E and K• Water Soluble Vitamins: C and B complexVitamin B Complex: – Vitamin B1 (thiamine) – Vitamin B2 (riboflavin) – Vitamin B3 (niacin or niacinamide) – Vitamin B5 (pantothenic acid) – Vitamin B6 (pyridoxine) – Vitamin B9 (folic acid) – Vitamin B12 (various cobalamins)
Vitamin AFunctions:• Contributes towards the production of retinal pigments needed for vision in dim light• Maintain normal function of glandular and epithelial tissue lining; of intestinal, respiratory tract, urinary tract, skin and eyes• Supports skeletal growth• Increases immunity – anti-infective• Protects against epithelial cancersSources:• Animal: Liver, eggs, butter, cheese, whole milk, fish and meat – cod liver oil• Plants: Green vegetables, yellow fruits, Carrot• Fortified Foods: Banaspati Ghee, Margarine, Milk, Bread
VITAMIN A DEFICIENCY - a public health problemOCULAR: (XEROPTHALMIA)• Night Blindness• Conjunctival Xerosis• Bitot’s Spots• Corneal Xerosis• KeratomalaciaEXTRA-OCCULAR:• Growth Retardation• Infections• Degeneration of myelin sheath of nerve cells• Alteration of mucosa of renal pelvis and urinary bladder predisposing to calculi• Atrophy of germinal epithelium – reproduction defectiveTOXICITY:• Excess of Vitamin A in the body may cause Nausea, Vomiting, Anorexia, Sleep Disorder, Desquamation of Skin, Papiloedema, Enlarged Liver, TeratogenesisTREATMENT:• Massive doses of Vitamin A – All children with corneal ulcer must receive Vitamin A
Vitamin KFUNCTIONS• Helps coagulation of bloodSOURCES• Green leafy vegetables like spinach, cabbage, lettuce, Milk, Eggs (Vit.K1)• Some amounts are formed by the bacterial action of intestinal flora(Vit.K2)• Deficiency usually does not occur even if not supplied in dietDEFICIENCY• May occur in liver disease• There is delay in normal coagulation time with more bleeding on slight injuryRDA• 1000 IU per day• Infants at risk must receive a single IM injection of Vitamin K after birth
Vitamin DNutritionally important forms in man are:1. Calceferol (Vitamin D2)2. Cholecalciferol (Vitamin D3)Functions:• Intestine & Kidneys: Promotes intestinal absorption of Ca and Phosphorus• Bone: Stimulates normal mineralization• Others: Permits normal growthSources:• Animal fats, Fish liver oils, Liver, Egg yolk, Butter, Cheese, Milk• Fortified foods like Ghee, Margarine, Bread, Whole Milk, Infant Foods• Exposure to UV rays of Sunlight convert cholesterol in skin to Vit. D
VITAMIN D DEFICIENCY DISORDERS• Rickets in children: A disease characterized by deformed bones• Osteomalacia in adults especially pregnant and lactating mothersTOXICITY• Excessive intake is harmful and may manifest itself as: anorexia, nausea, vomiting, thirst, drowsiness, coma and cardiac arrhythmiasRDA• Adults 2.5 mcg (100 IU)• Infants and Children 5.0 mcg (200 IU)• Pregnancy & Lactation 10.0 mcg(400 IU)
Vitamin C (Ascorbic Acid)Functions:• Plays an important role in tissue oxidation• Needed for the formation of collagen• Facilitates iron absorption from gutSources:• Fresh fruits like citrus, guava, green leafy vegetables, germinating pulses and amla.Deficiency Disorders:• Rare – Scurvy characterized by swollen and bleeding gums, subcutaneous bleeding, bleeding in to joints, delayed wound healing and anemia.RDA• 40 to 60 mg per day
Vitamin B1 (Thiamine)Functions:Maintain good appetite, normal digestion, muscle tone and healthy mental attitudeSources:• Good sources are: Soya bean, Peanuts, Whole grains, Cereals, Nuts & ground nuts.• Fairly good sources are Liver, Organ meat, Poultry, Egg yolk, Beans and Peas• Mother milk is a good source also.• Thiamine is lost during cooking due to leaching of the vitamin in to cooking water or when washed and also lost in foods having baking soda RDA Ranges between 0.5 mg – 2 mg per day
Vitamin B1 Deficiency Disorders• Wernicke’s Encephalopathy• Beri Beri – Dry Beri Beri (when nervous system is affected) – Wet Beri Beri (when there are cardiac symptoms and signs) – Infantile Beri Beri (when mothers are thiamine deficient)Prevention• Encourage people to eat thiamine rich diet• Stop Alcohol• Supplements for lactating mothers
Vitamin B2 (RiboFlavin)Functions:• Plays an important role in cellular growth• It is a cofactor involved in a number of enzymes involved in energy metabolismSources:• Rich sources are eggs, liver, green leafy vegetables, milk & Products• Fair sources are wheat and pulses – Meat and fish contain small amounts• Losses are due to leaching of this vitamin in to cooking waterRDA• 0.7 to 2.2 mg per day
Vitamin B3 (niacin or niacinamide)Functions:• Essential for Carbohydrates, fats and proteins metabolism• Essential for the normal functioning of skin, intestines and nervous system• An essential amino acid tryptophane serves as its precursorSources:• Coffee, Peanuts, Liver, Kidney, meat, poultry, fish, legumes and ground nuts• Milk is a poor source but a rich source of tryptophane• In maize niacin is in bound form and not available to body
Vitamin B3 Deficiency Disorders• Pellagra: characterized by Diarrhea, Dermatitis and Dementia (occurs in maize eating communities)• Glossitis and Stomatitis (Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve the cheeks, gums, tongue, lips, throat, and roof or floor and Glossitis: Tongue Inflammation)RDA• 0.7 to 2.2 mg per day
Vitamin B5 (Pantothenic acid) Functions: Metabolism Sources:• Major source is meat. The most significant sources of pantothenic acid in nature are coldwater fish ovaries and royal jelly.• It is found in nearly every food, with high amounts in whole grain cereals, legumes, eggs, meat, royal jelly, avocado, and yogurt.• Whole grains are another good source of the vitamin, but milling removes much of the pantothenic acid, as it is found in the outer layers of whole grains• Pantothenic acid is an ingredient in some hair and skin care products
Vitamin B5 Deficiency Disorders• Impaired energy production, due to low CoA levels, which could cause: irritability, fatigue, and apathy. Neurological symptoms can also appear in deficiency. They include numbness, paresthesia, and muscle cramps and Hypoglycemia.• Additional symptoms could include restlessness, malaise, sleep disturbances, nausea, vomiting, and abdominal cramps.• In a few rare circumstances, more serious (but reversible) conditions have been seen, such as adrenal insufficiency and hepatic encephalopathy.• One study noted painful burning sensations of the feet were reported in tests conducted on volunteers. Deficiency of pantothenic acid may explain similar sensations reported in malnourished prisoners of war. RDA RDA: 6 mg/day
Vitamin B6 (PYRIDOXINE) Functions: Plays an important role in the metabolism of carbohydrates, fats and proteins Sources: Widely distributed in food e.g. milk, liver, meat, egg yolk, fish, whole grain cereals, legumes, and vegetables. Deficiency:• Rare but occurs with niacin deficiency• Peripheral neuritis• INH (Isoniazid for TB) is a known antagonist and patients on INH must get 10 mg pyridoxine per day RDA• 2 mg per day – In pregnancy and lactation 2.5 mg per day
Vitamin B9 (Folic Acid)Functions:Plays an important role in the synthesis of nucleic acidsNeeded for the normal development of blood cells in the bone marrowSources:Leafy vegetables, dairy products, Milk, eggs, cerealsDeficiency Disorders:Megaloblastic anemia, glossitis, chielosis , GI disturbances like diarrhea.Severe deficiency may cause infertility and sterility.Folic acid antagonists like alcohol, pyramethamine and cotrimoxazole may cause abortion, congenital malformationsRequirements are greatest when rapid cell multiplication like growth & pregnancyRDA• Healthy adults and children 100 mcg per day• Pregnancy 400 mcg per day• Lactation 150 mcg per day
Vitamin B12 CobalaminsFunctions:Cooperates with folates in the synthesis of DNA and helps in Synthesis of fatty acids in myelinSources:• Liver, kidney, meat, fish, milk cheese• Not found in vegetables• Synthesized by bacteria in colonDeficiency Disorders:• Rare and usually in vegetarians• Megaloblastic anemia (Pernicious Anemia)• Demyelinating neurological lesions in the spinal cordRDA• Infants and children 0.2 mcg per day• Adults 1 mcg per day• Pregnancy and Lactation 1.5 mcg per day