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nutrition and health

  1. 1. NUTRITION AND HEALTH Dr.Aminah (post-graduate)
  2. 2.  Introduction  Diet  Types of diet  Balanced diet  Importance of balanced diet  RDA of nutrients  Good and harmful foods  Superfoods Contents
  3. 3. • Macronutrients: – carbohydrates – proteins – fats • Micronutrients: – vitamins – Minerals – Trace elements • Nutrition and dental health of children  Conclusion  References
  4. 4. Introduction When man broke from the natural food chain, he developed new energy resources and applied technologies to food processing, since then our dietary habits have undergone major changes. Both the qualitative nature of our diet and pattern of eating has changed and are changing.
  5. 5. The science which deals with the study of nutrient and foods and their effects on the nature & function of organism under different condition of age, health & disease. -NIZEL 1989 Nutrition Nutrients are defined as the constituents of food, which perform important functions in our body.
  6. 6. • Nizel (1989): Total oral intake of a substance that provides nourishment & supply. BALANCED DIET : • One providing each nutrient in the (neither deficient nor excess) needed to maintain optimum health. - Stewart Diet
  7. 7. Energy values of Foods and Nutrients : • Energy from food is made available to the body in four basic forms: Chemical : for the synthesis of new compounds Mechanical : for muscle contraction Electrical : for brain and nerve activity Thermal : for the regulation of body temperature Human are inefficient energy users because they can convert only 25% of chemical energy from the food they eat into mechanical energy (walking, typing, and so forth). Most of the energy is dissipated as heat.
  8. 8. Energy needs of the body Energy requirement = basal metabolism + physical activity + specific dynamic action Minimum amount of energy needed to regulate and maintain the involuntary essential life processes.
  9. 9. NUTRIENTS • Organic and inorganic complexes contained in food are called nutrients. They are broadly divided in to: Macronutrients: -Carbohydrates -Proteins -Fats/lipid Micronutrients: -Vitamins -Minerals Trace elements : -Calcium, phosphorous, fluorides
  10. 10. • These are organic compounds of the elements carbon, hydrogen and oxygen. • As much as 80% of energy intake is derived from the carbohydrates. CHEMISTRY & CLASSIFICATION Monosaccharides Pentoses (ribose and deoxyribose) Hexoses (glucose, fructose, and galactose) Oligosaccharides Di, Tri (sucrose, lactose, maltose) Raffinose Polysaccharides Starch, glycogen, dextran, and insulin Cellulose, pectin, agar,and carrageen. mucopolysaccharides Heparin, hyaluronic acid, and chondroitin sulfate
  11. 11. Digestion and absorption :
  12. 12. Utilization of carbohydrate
  13. 13. Functions
  14. 14. RDA of carbohydrate • The Institute of Medicine report Dietary Reference Intakes for Energy has established a Recommended Dietary Allowance (RDA) for carbohydrate of 130 g per day for adults and children.
  15. 15. Food sources include
  16. 16. Systemic complications • Diabetes mellitus • Hypoglycemia • Lactose intolerance
  17. 17. Diabetes mellitus (hyperglycemia) • Complicated metabolic disorder in which the body cannot control its level of sugar. • Beta cells in the islets of langerhans in the pancreas are unable to produce the hormone insulin in sufficient quantities to metabolize glucose. • Consequently, glucose reaches a high level in blood and cells, causing tissue damage.
  18. 18. Oral manifestations Other complications  Coronary artery atherosclerosis  Stroke  Diabetic Neuropathy  Diabetic nephropathy
  19. 19. Dietary management of Diabetes OBESE DIABETIC PATIENTS:  Restricting calories  Increasing exercise  As long as the weight is properly controlled, the amounts of dietary starch or the timing of feeding periods for this type of diabetes is not critical. LEAN DIABETIC :  Calories should not be restricted below normal levels  Coz they take insulin they must eat 5 to 6 times a day to correspond with the time-action pattern of the insulin so that they do not develop hypoglycemia.  A typical diabetic diet contains the number of calories necessary to achieve or adhere to the ideal weight.  Refined sugars are either totally eliminated or sharply limited.  Natural sugars from fruits, vegetables and milk are allowed at the 10% to 15% level  Fat limited to 25 - 35%  Protein 12 - 24%  Remaining calories 30 - 40% derived from starch high in fibres.
  20. 20. Hypoglycemia • Excessive carbohydrate intake. • Types: fasting & reactive(common) • Low-carbohydrate, high-protein diet can afford variable relief • Counseling for the emotional problem. • Also, the possibility of an underlying chemical diabetes should be investigated.
  21. 21. Lactose intolerance • Digestive problem for some people. • They may experience GI discomfort such as abdominal cramps, flatulence, watery stools or all of these when they drink milk or ingest milk products. Management
  22. 22. PROTEINS Word protein means “of prime importance”, because it mediates most of the actions of life. Essential for all body tissues: skin, tendons, bone matrix, cartilage, and connective tissue. The specific dynamic action (SDA) or the thermic effect of food (TEF) for protein (29%) is much higher than that of carbohydrate and fat (5%). Chemistry Organic compounds containing alpha amino acids united by peptide linkages. Composed of C, H, O and N2
  23. 23. Amino acids: • Building blocks of proteins. • 24 in number, 10 of them being essential amino acids which cannot be synthesized by the human body. • Among them, glutamine is termed as “anti-stress nutrient”, and is present in largest amount in plasma. • Tryptophan: also called “nature’s sleeping pill”: precursor of serotonin “provitamin B3: precursor of niacin (60mg tryptophan = 1mg niacin)
  24. 24. Digestion & absorption pepsin trypsin erepsin
  25. 25. Metabolism
  26. 26. • As much as 300g of the 10kg of body protein is replaced daily. • Some 70g of endogenous protein is secreted daily into the gut. • 20g/day of plasma proteins is released into circulation from the liver.
  27. 27. Estimates of Amino acid Requirements at different ages (mg per kg per day) 31 Food andAgriculture Organisation/World health Organisation, 1983
  28. 28. Funtions
  29. 29. Food and Nutrition Board recommendations 0.8 g/kg of body weight
  30. 30. Problems associated with protein in the diet
  31. 31. Effects of Protein Excess
  32. 32. KWASHIORKAR • First recognized by Prof Cicely Williams in 1933 from Gold Coast. • She observed that this was the disease of the first child when the second was on the way displacing the first child from breast feeding. • She named it Kwashiorkar, word taken from Ga language of Ghana, which means the ‘red boy’ due to characteristic pigmentary changes. • Later on, the term was interpreted as “deposed child”. • Classic signs: – Stunted growth – Hepatomegaly – Anaemia – Oedema • Grading – Grade I- pedal oedema – Grade II- I +facial oedema – Grade III – II + paraspinal and chest oedema – Grade IV- III + ascites
  33. 33. MARASMUS • Word Marasmus is derived from Greek word Marasmos, which means “wasting”. • Affected children exhibit extreme wasting. • Old man appearance to jaws and skin and bones. Grading – Grade I: wasting starting in axilla and groin. – Grade II: I + wasting in thigh and buttock region – Grade III: II+ chest and abdomen – Grade IV: buccal pad of fat • Wasting of brown fat occurs first. • Marasmic Kwashiorkar: when marasmic children develop oedema.
  34. 34. Protein nutrition in oral health and disease Effect of protein deficiency on the jaw and teeth Adequate protein diet during pregnancy has been shown to benefit significantly the bone and dental development of the child. Protein nutrition is a basic consideration in the growth and development of the oral cavity If solid, protein-rich food intake is not adequate, jaw and tooth malformations are possible. Teeth of children who suffer from protein-calorie malnutrition tend to be crowded and rotated, also delayed eruption and hypoplasia of their deciduous teeth may result. Literature shows that deficiencies of the amino acids lysine or tryptophan produced an irregular predentin layer and a number of interglobular spaces in poorly calcified dentinal matrix. Protein compounds are known to have significant anticariogenic effect (AA’s such as glycine, lysine, casein)
  35. 35. Protein deficiency and the periodontal tissue
  36. 36. • It embraces, True fats (e.g., butter, margarine, vegetable oils, and body depot fat) Substances whose molecular structure includes fatty acids or fatty acid derivatives, such as cholesterol (a sterol) Compounds present in minor amounts associated with lipids in nature , such as ergosterol (a fat-soluble vitamin) or a steroid sex hormone Visible type Invisible type
  37. 37. TRUE FATS (Triacyl glycerols)  They contain C, H and O2 as do carbohydrates but lipids contain greater proportions of C and H and much less of O2.  Complex lipids may contain additionally Phosphorus and Nitrogen Chemistry Purefatiscomposedofmoleculesof glyceroltowhich1,2or3fattyacidsare linkedrespectivelytoform Monoglycerides Diglycerides Triglycerides
  38. 38. Natural fats, as in meat, grain, and nuts are made up mostly of triglycerides. Animal fats consist primarily of triglycerides but also contain cholesterol. Processed fats, such as shortenings, contain up to 20% mono- and diglycerides.
  39. 39. Fatty acids : Classes include Fully saturated Monounsaturated Polyunsaturated  Consist of C atoms connected to H atom by a single bond.  Cannot take up any more hydrogen.  They are stable compounds.  They increase the serum cholestrol level. E.g,  Stearic acid found in beef and lard  Palmitic acid in animal fat and palm oil.  Myristic acid and lauric acid in milk and coconut oil  Contain one reactive unsaturated linkage or one double bond and no hydrogen atom.  Palmitoleic acid and oleic acid found in olive oil, peanut oil, lamb and poultry are the most common ones found in nature.  These fatty acids have no effect on serum cholestrol  They are not saturated with hydrogen atoms.  They have two, three or four double bonds per molecule. E.g,  Linoleic acid, essential fatty acid found in soyabean, cotton, cottonseed and other vegetable oils.  These FA’s lower the cholestrol levels in the serum.
  40. 40. Essential Fatty Acids (EFA) Linoleic acid Arachidonic acid Functions  It has been shown that a diet high in EFA reduces high levels of serum cholestrol.  It is recommended that 1 to 2% of the total calories consumed should be EFA
  41. 41. Food sources :Corn, Cottonseed, Peanut, Soyabean & Safflower oil.
  42. 42. Functions Deficiency
  43. 43. Trans fatty acids
  44. 44. Phospholipids
  45. 45. Sterols
  46. 46. Cholesterol
  47. 47. We absorb 50% of dietary cholesterol per day, so the ideal intake should be in the range of 100 to 300mg of dietary cholesterol.
  48. 48. Lipoproteins Specific protein which carry cholesterol, triglycerides and phospholipids in the plasma. Chylomicrons Pre-β cholesterol/VLDL β cholesterol/LDL α-cholesterol/HDL ILDL Obtained from diet & cleared rapidly -Manufactured by our body - ↑,greater likelihood of developing atherosclerosis. -Manufactured by our body -”Bad cholesterol” -Manufactured by our body -Higher the level lower the risk of CVD. -“Good cholesterol” -Manufactured by our body
  49. 49. Suggested normal limits of Plasma lipid and Lipoprotein concentrations From Fredrickson, D. S. Reprinted by permission of the New England Journal of Medicine. (276; 151, 1967)
  50. 50. Hyperlipoproteinemia
  51. 51. Fat-soluble vitamins
  52. 52. Methods for Reducing Blood Lipids It is advisable to reduce the total dietary fat to about 33% of the total calories, to reduce the saturated fats by 50%, and to double the intake of PUFA. This procedure could lower the blood cholesterol by at least 15%.
  53. 53. Functions of LIPIDS Cell membrane integrity and function Phospholipids Fats in meal causes satiety Excellent source of energy (9 calories) True fats Provide EFA’s – linoleic for humans (normal growth and skin health) Lipids are carrier for & facilitates absorption Fat-soluble vitamins Maintains body temperature by insulating against the cold
  54. 54. Digestion and absorption
  55. 55. Metabolism and storage
  56. 56. Systemic effects • Atherosclerosis Definition Progression Literature Degenerative disease that produce a loss of elasticity and a hardening of the large and medium arteries. It is responsible for ischemia(a lessened blood supply). Also in coronary arteries can cause MI resulting in CHD, stroke in brain, caudication and gangrene in leg arteries, hypertension in renal arteries In men, the risk increases after age 45. In women, the risk increases after age 55. It is suggested that hyperlipidemia contributes to this disease process.  “Lipid hypothesis” suggests that elevated blood lipids, particularly cholesterol and LDL, can cause coronary heart disease.  Moreover, dietary fat, especially saturated fatty acids and cholesterol, is suggested as the main dietary factor influencing blood lipids.
  57. 57. Methods for Reducing risk of atherosclerosis Children at high risk for atherosclerosis such as those with diabetes or familial hypercholesterolemia, should be advised to lower their fat intake under close medical supervision. Since many factors contribute to CHD, the nutritional approach is only one of several that must be instituted to realize any benefits. Thus the risk of having heart attack can be lessened for the person whose diet will not increase the serum cholesterol levels, by maintaining normal weight, exercises regularly, eliminates the stress of emotional tension, doesn’t smoke and obtains medical treatment for high Bp or diabetes.
  58. 58. Fats and Oral health • There is indirect evidence that dietary fats may help prevent caries in humans and the mechanism are probably as follows: Coating of the tooth surfaces with an oily substance would mean that food particles will not be so readily retained. A fatty protective layer over plaque would prevent fermentable sugar substrate from being reduced to acids. High concentration of fatty acids may interfere with the growth of cariogenic bacteria. Increased dietary fat will decrease the amount of dietary fermentable carbohydrate necessary for organic acid formation.
  59. 59. Other effects, PAROTID ENLARGEMENT  Chronic swelling of the parotid glands can be the result of the distributed lipid metabolism that accompanies alcoholism.  Thus, the fatty deposits in the parotid glands will result in enlargement.
  60. 60. Water is a vital nutrient crucial to every bodily function and second only to oxygen in importance to the body.
  61. 61. Water requirement
  62. 62. Body fluids • These fluids consist of water, protein, and solutions of electrolytes and non electrolytes. NON-ELECTROLYTES:  Glucose  Urea
  63. 63. In a healthy person, the volume and composition of body fluids are carefully regulated and homeostasis is maintained. However during illness or after trauma or surgery, there is alteration of body fluid composition Percentage of water is normally dependent on the amount of fat in the body. The more fat, the less water. Obese person’s body nearly has 50% of the total weight, whereas the lean person’s body is about 70% of water. The extracellular fluid (interstitial fluid and the blood plasma) with sodium as major cation; chloride and bicarbonate as principal anions constitutes 40% and 60% constituted by intracellular fluids.
  64. 64. Water balance
  65. 65. Sodium • Considered as an essential nutrient. Common table salt and foods of plant and animal origin such as bread, sausages, fish, cheese, butter eggs, milk) supply Na in diet. -Maintains extracellular fluid volume and cellular osmotic pressure. -Transmission of nerve impulses -Permeability of cell membrane. -Muscular contraction. A minimum dietary intake of 200mg/day (0.5g NaCl, or salt which is 39% sodium) is necessary to maintain physiological balance in adults. A decrease in both sodium intake and excess body weight is probably necessary for most hypertensive patients to lower Blood pressure to the normotensive range.
  66. 66. Potassium (principal cation in intracellular fluid) FUNCTIONS: -control cardiac function and muscle -nerve irritability -many cellular enzymatic functions -such as glycogen synthesis -amino acid uptake -glucose degradation SOURCES : Bread, chocolate, butter, coffee, fish, fruits, milk oatmeal, vegetables. Min amt. needed is 300mEq / day. Max amt. needed is 400mEq/ day. Estimated safe range is 1875 to 5625mg.
  67. 67. Deficiency Unlikely to occur, may occur from prolonged K-free diet/ excessive loss due to diarrhea; diabetic acidosis; or use of drugs such as diuretics, steroids, and purgative. Manifestations Treatment  Supplements to be given Excess Consequences Excess will result from sudden increase in intake of about 18g of potassium by an adult
  68. 68. Chloride (predominent in extracellular fluid) • Highest conc. are found in the secretions of the GI tract and in the CSF. • Relatively low conc. in muscles and nerve tissues. Functions Food sources :  Meat  Diary products  Common salt
  69. 69. Daily chloride intake is about 2 to 3 g. Deficiency Starvation, fever, diarrhea, excessive vomiting & sweating can cause a decrease in plasma Cl. Following its deficiency, there is an accompanying increase of bicarbonate leading to alkalosis. Supplementation is needed to correct deficiency. Abnormalities of Cl metabolism are generally accompanied by abnormalities in Na metabolism
  70. 70. Acid-Base balance • Only when the blood is maintained within a narrow range of neutrality between Ph 7.35 and 7.45 is health for the human possible. • This precise equilibrium is maintained by the lungs and kidneys, to prevent shifts in electrolyte patterns. Like the other soft tissues, the oral mucosa has 80% of water content. Pt who ingest high-salt diets & retain the Na will accumulate body water. Conversely, pt on low-carbohydrate, high-fat or protein diet will lose large amt of water from the excessive oxidation of body fat.  Denture wearers : Loss of water - xerostomia; denture …loosening and discomforts  Retained water – pressure induced sore spots on the underlying swollen mucosa  Increases plaque formation  Burning sensation : roof of mouth, tongue.  Gingival irritation
  71. 71. In 1915, the vitamin B was thought to be a single substance (Mc Collum and Davis), later it was actually consisted of a number of different chemical substances with few similar properties. 11 different vitamins have been discovered and categorized to the B Complex group. Vit B complex Doz dat primarily release energy from carbohydrates & fat Doz that catalyze formation of red blood cells Vitamin important in protein and amino acid metabolism Vitamin-like compounds Based on function, Thiamine Niacin Ribofllavin Pantothenic acidBiotin Folic acid Vit B 12 Vit B 6
  72. 72. Energy-releasing B vitamins Thiamine (Vit B1)
  73. 73. -Co-enzyme in the phospho-gluconate pathway -Structural component of nervous system membranes. -Co-enzyme in the production of ribose, the sugar needed by cells for the formation of RNA and DNA. -Thiamine is needed for the metabolism of Carbohydrates, Proteins and Fats. Functions :
  74. 74. Deficiency • Severe thiamine deficiency is called Beri beri Infantile Beri-Beri First 6 months Breast milk deficient in B-1 Mother w/o symptoms Rapid onset Cyanosis, tachycardia, labored breathing Heart failure and death other types :  Cerebral beri-beri (wherein Wernicke korsakoff syndrome may be associated)  Shoshin beri beri
  75. 75. Oral manifestations of Vit B1 deficiency: RDA 0.5 mg/1000 k cal  Sensitivity of the oral mucosa  Burning tongue  Loss or diminution of taste Therapy : -a good diet & administration of 5 to 10 mg of thiamine hydrochloride 3 times a day will help the usual cases of nutritional polyneuropathy. -Vit B complex tablet supplements in a therapeutic dose may help in alcoholics and others with beri beri.
  76. 76. Niacin (Vit B 3) • Biologically active form : Nicotinamide Chemistry Properties  Slightly water-soluble  Light and heat-stable  Weak organic acid  One of the most stable vitamin but as it is water soluble may be lost in cooking water. History In 1938, Elvehjem and his group demonstrated that with nicotinic acid they could cure black tongue in dogs, a condition similar to pellagra in human. Shortly thereafter, niacin was shown to be effective in the prevention and treatment of pellagra.
  77. 77. Niacin metabolism Food sources Critical for genome stability
  78. 78. Forms active portion of coenzymes that play an essential role in supplying organ tissues, marking its presence necessary for the health of all cells. Coenzymes : NAD (nicotinamide adenine dinucleotide) & NADP (nicotinamide adenine dinucleotide phosphate) act as catalyst in cellular respiration, Carbs metabolism and fat synthesis. Normal function of the Central Nervous system Maintaining the integrity of the skin and mucous membrane. Functions of Niacin
  79. 79. Clinical deficiency : Pellagra PRIMARY (dietary inadequacy) SECONDARY (systemic factors such as GI disease, hyperthyroidism, alcoholism)  Casal’s necklace : pigmented and scaly rash forming a ring around sun exposed area of neck.  Tongue is sore, swollen, scarlet in color, and smooth.  Secondary infection with fungi or bacteria characteristic of ANUG is common.  Eating and swallowing are so painful that food is often refused.  Diarrhea due to inflammation of the mucosal lining of the esophagus, stomach, and colon.  Depression , confusion, hallucinations and delirium – degeneration of nerve and brain cells.  Cheilosis and angular stomatitis can also be evidenced
  80. 80. Therapy MILD DEFICIENCY  Administration of 50mg of nicotinamide orally three times a day. SEVERE DEFICIENCY COMPLICATED BY OTHER B COMPLEX VITAMINS  Advisable to give an additional multivitamin capsule containing 5mg thiamine, 5mg riboflavin, 5mg Vit B6, and 10 mg pantothenic acid.  Alternatively Brewer’s yeast 10 to 30 g/day can be given Niacin in excess,  Liver toxicity  Peptic ulcers  Arrhythmias  Transitory dilation of blood vessels
  81. 81. Riboflavin B2 History : Kuhn and his co- workers in 1935 reported on the synthesis of riboflavin and the relation of its activity to green fluorescence. BIOLOGICALLY ACTIVE FORMS  Flavin mononucleotide (FMN)  Flavin adenine dinucleotide (FAD) METABOLISM & ABSORPTION - It must be phosphorylated in the intestinal tract before it can be absorbed. - Absorption is best when eaten with meal. - Very little is stored and hence need to be supplied daily. - Excess excreted in the urine.
  82. 82. Functions include,
  83. 83. RDA : 1.1-1.3 mg/day
  84. 84. Deficiency : THERAPY  A good diet of meat, eggs, liver, and enriched cereal plus a special emphasis on a quart of milk daily is recommended.  Also, mutivitamin capsule containing atleast 5mg of riboflavin should be taken two or three times a day.
  85. 85. Pantothenic acid (Vit B5) HISTORY The discovery of pantothenic acid stemmed from investigation of yeast growth factor and a live filtrate factor. by R. J. Williams in 1938 PROPERTIES  Easily destroyed by heat.  The calcium pantothenate, form in which it is generally available crystallizes readily.  Soluble in water RDA Children : 3 to 4 mg Adults : 4 to 7 mg daily.
  86. 86. Functions Food sources
  87. 87. Deficiency  Fatigue  Sleep disturbances  Headaches  Malaise  Nausea  Abdominal stress  Burning, paresthesia of the hands and feet  Cramping of the leg muscles  Impaired coordination Therapy  No definitive therapeutic regimen  A balanced , adequate diet meets RDA  Multivitamin B complex preparations may help.
  88. 88. Biotin (B7) • BIOLOGICALLY ACTIVE FORM  Binds to lysine residue of enzyme • FUNCTION  Cofactor in carboxylation reactions,  Carrier of CO2 (acetyl-CoA to malonyl-CoA, synthesis of fatty acids)  Regulation of gene expression • SOURCES  Almost all food, esp. milk, egg yolk, tomato, almond, peanuts, avocado, mushroom.  Also synthesized by intestinal bacteria • RDA (30 mg/day)
  89. 89. DEFICIENCY Does not occur naturally unless eat 20 raw egg whites per day. Characterized by,  Inflammation of skin and the tongue(dermatitis and glossitis)  Loss of appetite and sleep  Nausea  Muscular pains increased skin sensitivity (hyperesthesia)  Parasthesia THERAPY Inj of a concentrated preparation (0.15 to 0.3mg) biotin daily
  90. 90. Vitamin B6 Not a single vitamin but rather a group of metabolically and functionally interrelated pyridines. pyridoxine pyridoxamine pyridoxal occur in animal pdtsoccur in plant pdts occur in animal pdts RDA Infant upto 1 year : 0.3 to 0.6 mg Children : 0.9 to 1.6 mg Adolescent : 1.8 to 2.0 mg/day Pregnancy and lactation : 2.5mg/day
  91. 91. Functions
  92. 92. Deficiency Also, Therapy :  Primary deficiency, a daily dosage of 10 mg is given.  In iron-resistant hypochromic anemia, dose upto 100 mg/day has to be given.  Certain medications such as isoniazid and penicillamine produce a need for a supplement of Vit B6  Toxicity has been reported when used in excess by the alcoholics.  Sensory nervous system dysfunction Toxicity
  93. 93. HEMATOPOIETIC B Vitamins • Folacin (Folic acid) BIOLOGICALLY ACTIVE FORM Tetrahydrofolate (THF) RDA 400 mg/day, more during pregnancy and lactation SOURCES Green leafy veggies (“foliage”), organ meats, legumes, okra, whole grain cereals Functions
  94. 94. Folic acid deficiency
  95. 95. Vit B 12 (cobalamine) Chemistry
  96. 96. Functions of cobalamine
  97. 97. Deficiency – Caused by pernicious anemia – Methylmalonic acidemia (MMA)
  98. 98. Vitaminlike compounds  Choline  Myo-inositol  Coenzyme Q (ubiquinone)  Lipoic acid  P-amino benzoic acid  Bioflavonoids These fail to meet one or more criterias for a vitamin and presently not considered as vitamin.
  99. 99. Vitamin C (Ascorbic acid) The discovery of vitamin C was the result of a search for a cure for scurvy by Lind on the ship Salisbury on 12 sailors who described their signs and symptoms as hemorrhagic spots, anemia, bleeding gums and weakness in the knees. • Water soluble • Strong reducing properties • Humans, other primates, guinea pigs cannot synthesis ascorbic acid thus daily dietary source is needed History Chemistry
  100. 100. Digestion, absorption and storage
  101. 101. Functions
  102. 102. Food sources
  103. 103. Deficiency  In infants, often seen in those who are fed almost exclusively on heat-treated cow’s milk.  In young children the symptoms include faiure to grow, weakness, restlessness, irritability and swollen joints.  Small hemorrhages, bone changes, scurvy lines on tibia and femur. Gums of erupted teeth will be swollen,tendon,hemorrhagic.
  104. 104. Oral signs of vitamin C deficiency • Enlargement of the marginal gingivae. • The gingivae are bluish red, soft and hemorrhagic spontaneously or with slight provocation. • Secondary infection resulting in Vincent’s infection. ( punched-out, membranous interdental papilla and fetid breath) • Lack of periodontal support (falling out appearance) • Interruption of lamina dura • Sulcular epithelium becomes almost doubled. Teeth :  Odontoblast atrophy  Either irregular dentin or no dentin at all.  Engorged pulp and dilated
  105. 105. Therapy • Infantile scurvy, 50 to 100 mg of ascorbic acid four times daily added to milk. • Adult scurvy, 250mg four times daily for a week and then decreased to 50mg to 100 mg four times until normal plasma levels are attained. • Pt with wound disruption should receive 250mg of ascorbic acid four times daily until healing is complete.
  106. 106. Minerals
  107. 107. Calcium Distribution:  The adult human body contains approximately 1100g (27.5mol) of calcium.  99% of the calcium is in bone.  Blood calcium levels are normally 9-10.2mg/dL  Of the total amount, 50% is free ionized calcium, 9% is combined with various anions (including bicarbonate, citrate, phosphate, lactate and sulphate) and the remaining 41% is bound to serum proteins mainly albumin.  Young bone contains primarily amorphous tricalcium phosphate, whereas mature bone contains primarily crystalline apatite.  The calcium not in the bones and teeth is found in the ECF and the soft tissue as a part of various membrane structures.
  108. 108. Functions
  109. 109. Regulation of Ca balance
  110. 110. Absorption • Two mechanisms have been proposed- -Simple passive diffusion -Active transport- involving energy and calcium pump. • Vitamin D is important for the active process. • Active calcium transport depends on the presence in the intestinal cell of calbindin protein , the biosynthesis of which is totally dependent on vitamin D. Intestinal absorption  30-80% of ingested calcium is absorbed, primarily in the upper small intestine.  Absorption is related to calcium intake.  If intake is low, active transcellular calcium transport in the duodenum is increased and a larger proportion of calcium is absorbed by the active process compared with the passive paracellular process that occurs in the jejunum and ileum.
  111. 111. • Passive absorption in the jejunum and ileum predominates when dietary calcium intake is adequate or high. • Calcium reaching the large intestine is absorbed by active and passive processes. • Usually, not more than 10% of total absorption takes place in the large intestine, but this ….site becomes nutritionally important in conditions of significant small bowel resection. • In a balanced diet, roughly 1000 mg of Ca is ingested each day and about another 200 mg/day is secreted into the GI tract in the bile and other GI secretions. • Depending on the concentration of circulating vitamin D, particularly 1,25(OH)2D (1,25 Dihydroxycholecalciferol, Calcitriol, or active vitamin D, roughly 200 to 400 mg of Ca is absorbed from the intestine each day. • The remaining 800 to 1000 mg appears in the stool. • Ca balance is maintained through renal Ca excretion averaging 200 mg/day.
  112. 112. Factors affecting absorption • Factors favoring calcium absorption  An acidic pH.  Presence of sugar acids, organic acids and citric acid High protein diet- Lysine and Arginine cause maximal absorption.  Presence of vitamin D.  Ca : P ratio- A ratio of dietary Ca: P not more than 2:1 is adequate for optimal absorption, ratio of less than 1:2 reduces absorption.  State of health and intact mucosa- A healthy adult absorbs about 40% of dietary calcium.  PTH (Parathormone) stimulates the activation of vitamin D, thus indirectly increases absorption of vitamin D.
  113. 113. • Factors inhibiting absorption – Alkaline pH – High fat diet – Fatty acids form calcium soaps that can not be absorbed – Presence of Phytates and oxalates – Insoluble calcium salts are formed – Dietary fiber in excess inhibits absorption – Excess phosphates, magnesium and iron decrease absorption – Glucocorticoids reduce intestinal absorption of calcium – Calcitonin reduces calcium absorption indirectly by inhibiting the activation of vitamin D – Advancing age and intestinal inflammatory disorders
  114. 114. Storage
  115. 115. Excretion Dietary intake : 1000 mg of calcium  700 -800mg is excreted in the feces which is mostly unabsorbed Ca from food.  When serum Ca level or dietary level is low, absorption is efficient and thus less is excreted.  During lactation mother loses between 150 to 300 mg of Ca daily in her milk which is replenished from food or bone reserves.  After the bone and soft tissues have taken up all the calcium they can hold, excess is excreted in the urine.  Also Ca is lost via bile and digestive secretions into digestive tract and then excreted.
  116. 116. Food sources RDA
  117. 117. Calcium deficiency Hypocalcemia is total serum Ca concentration < 8.8 mg/dL
  118. 118. Toxicity • Hypercalcemia : excess Ca in blood • Hypercalciuria : excess Ca in urine • Hyperparathyroidism • Kidney stones High levels of Ca in the serum and urine or calcification of soft tissues. Milk-alkali syndrome caused by prolonged and excessive intake of milk and antacid tablets, produces hypercalcemia. total serum Ca concentration > 10.4 mg/dl
  119. 119. Therapy • Oral PO4 for serum Ca < 11.5 mg/dL with mild symptoms and no kidney disease • IV saline and diuretic (furosemide) for more rapid correction for serum Ca < 18 mg/dL • Bisphosphonates or other Ca-lowering drugs for serum Ca < 18 mg/dL and > 11.5 mg/dL or moderate symptoms. • Hemodialysis for serum Ca > 18 mg/dL • Surgical removal for moderate, progressive primary hyperparathyroidism and sometimes for mild disease • PO4 restriction and binders and sometimes Calcitriol for secondary hyperparathyroidism
  120. 120. Most essential elements of the body which is available in all food of plant and animal origin.
  121. 121. Absorption and metabolism
  122. 122. Food sources RDA 800 to 1200mg of P daily
  123. 123. RicketsCause : Defective mineralization or calcification of bones before epiphyseal closure in children due to deficiency of Vit D, Ca and PO4. Characterized by: Delayed growth, bow legs, weakness and pain in the spine, pelvis and legs. Laboratory findings: Low levels of calcium and serum phosphorus Serum alkaline phosphatase may be high. Treatment: Increasing dietary intake of calcium, phosphates and vitamin D. Exposure to ultraviolet B light . 400 (IU) of vitamin D a day for infants and children.
  124. 124. Osteomalacia Cause : Deficiency of Vit D, Ca and PO4 in adults. Clinical manifestations include: General weakness Aching Laboratory findings: Low serum Ca, PO4 Elevated alkaline phosphate Treatment : Dietary Ca and Vit D Results in : Excessive uncalcified osteoid Abnormal bone mineral composition.
  125. 125. Phosphates and dental caries
  126. 126. Magnesium • Major Cation in plant and animal tissues. • Essential constituent of bone and soft tissues. • Essential ion in fundamental enzymatic reactions and in protein synthesis. Distribution:  Adult human body contains 20 to 35 g of magnesium, about 60% present as phosphate and carbohydrates in bone.  Remainder found in the cells and soft tissue (muscles , body fluids as well)  Mg third most abundant mineral in teeth.
  127. 127. Absorption and excretion Significant amt. lost during prolonged vomiting or diarrhea.
  128. 128. Functions
  129. 129. Food sources Normal adults : 350mg (males) and 300 mg (females) RDA
  130. 130. Deficiency
  131. 131. Magnesium and Dental health Mg is present in both Enamel and Dentine, but its conc. in dentine is twice that in enamel. Dietary deficiency produces degenerative changes in ameloblasts and odontoblasts. Also it can adversely affect the periodontal structures by producing a lower rate of alveolar bone formation, widening of PDL and gingival hyperplasia.
  132. 132. Trace elements/Micro-minerals All these can be toxic at a small increase over usual intakes therefore supplements should be used only at RDA levels.
  133. 133. Iron Over 65% of body iron is found in hemoglobin, up to about 10% is found as myoglobin. Heme iron is derived mainly from hemoglobin and myoglobin and thus is found in animal products especially meat, fish, and poultry. Nonheme iron is found primarily in plant foods (nuts, fruits, vegetables, grains, tofu) and dairy products (milk, cheese, eggs) Sources Metabolism RDA Adults :10 to 15 mg/day Pregnant women : 18 mg/day
  134. 134. Zinc Body contains 2 to 3 g of zinc Concentrated in the eyes, liver, bones, prostatic secretions. 85% in RBC WBC has about 25% more Zn than each RBC
  135. 135. RDA : Adult : 15mg Pregnancy and lactation : 20-25mg/day Infant under 6 months : oly 3 mg/day 6 months to 1 year : 5mg/day 1 to 10 years : 10mg/day FOOD SOURCES
  136. 136. Supplementation : Excessive amount of Zinc may increase the risk of CVD, bcoz HDL which protects against heart disease is loweredand LDL which can lead to cardiac problems increase. Common level of Zinc in popular vitamin/mineral preparation is 15 mg, safe. Clinical significance: Zinc sulfate : decrease wound healing time significantly Zinc peroxide powder : topically on acute gingival lesion in ANUG
  137. 137. Copper Deficiency symptoms RDA 2 to 3 mg in adults. Wilson’s disease, neurological degeneration, cirrhotic liver changes Treatment -chelating agents (penicillamine, 300mg thrice daily oral) to mobilize copper from tissue and promote excretion.
  138. 138. Selenium • At physiological levels, it performs an antioxidant function. • Essential component of the enzyme that calatyzes oxidation of glutathione which protects RBC. • Selenium supplements are effective in reducing Keshan disease (abnormalities of heart muscles in children) • RDA ; 0.05 – 0.2mg (less for infants) • Food sources : animal protein • It has Cariogenic property
  139. 139. Chromium Biologically active form : Trivalent Chromium Functions : - May act as cofactor in insulin - Stimulates the synthesis of fatty acids and cholesterol in the liver. Toxicity : not known (excesses are rapidly excreted) For adults the estimated safe and adequate daily dietary intake is 0.05 to 0.2mg.
  140. 140. Cobalt • Considered as an essential trace element coz it is part of the Vit B12 molecule. Function :  Involved in the metabolism of sulfur-containing AA’s Deficiency :  Megaloblastic anemia  Neurological disorders  Infants can have developmental delay and failure to thrive. Toxicity : polycythemia Increased hemoglobin levels. No danger of dietary shortage of this mineral as it may appear in many foods and the needed amt. is very small
  141. 141. Manganese • Essential nutrient • Functions: – Needed for normal bone structure – for reproduction, and for the normal functioning of CNS – Important catalyst – Component of many enzymes in the body (pyruvate carboxylase, superoxide dismutase) • Sources : – Nuts, seeds, whole grains, fruits and vegetables. – Conc. In tea is exceptionally high • RDA: – 2.5-5mg Deficiency : -Skeletal abnormalities -Cartilage defect Excess : -neurological disturbances similar to Parkinson’s disease
  142. 142. Iodine RDA 0.15mg daily
  143. 143. Effect of Iodine imbalance : • Hypothyroidism Pathological conditions : Cretinism and Myxedema (Also, enlarged tongue, thick lips, arrested skeletal development, low BMR, severe mental retardation) Treatment : administration of thyroid hormone until a euthyroid state is achieved. • Hyperthyroidism Increased pulse rate, temperature and Bp, with extreme nervousness, irritability, sweating, weight loss and tiredness, exopthalmos. Oral effects of imbalance :  In hypothyroidism, the jaws are small and rate of tooth eruption is retarded, predisposition to root resorption  In hyperthyroid patients, caries occurance may be more as the possible use of excessive sugars is increased.
  144. 144. Trace elements and dental caries
  145. 145. Nutrition and dental health in children • Pregnancy and neonatal period Neither malnutrition in mother during pregnancy nor in the child after birth are likely to have any appreciable effect on the susceptibility to decay. Only in severe calcium, protein or vitamin deficiency during tooth development might significantly affect the incidence of decay in later life. In areas with a high prevalence of malnutrition, enamel formed before birth is adversely affected, with higher occurrence of hypoplasia which is positively related to caries experience. Vit D supplements remains desirable for all pregnant and lactating women. (Dept of Health and Social Security.) Excessive ingestion of F can result in “fluorosis” of enamel formed prenatally. Nutritional deficiencies or excess have not been associated with intra-oral congenital abnormalities.
  146. 146. Infancy and weaning • Diet and nutrition are relevant to dental health during 1st year of life in two ways . Pre-eruptive effect Malnutrition (particularly Vit D, protein deficiencies) cause formation of hypoplastic enamel and increase susceptibility to DC. Eruptive effect The duration and frequency of sugar exposure to newly erupted teeth is very important for caries formation. Strong association seen with addition of sucrose to milk in bottles, use of reservoir feeders and comforters containing sugary fruit flavour drink and rampant caries upto 6 yrs. Fluoride will help forming teeth as well as just erupted teeth only if drinking water conc is less. Apple, carrot slices and sugar-free rusks are beneficial for teething in infants. During weaning, increasing frequency of sugar consumption is seen and the problem arises when sugary foods are given inbetween meals. Hence a healthy snaking habit has to be advocated by mothers to pacify the child.
  147. 147. Pre-school child • Dept. of health and social security, reported that ‘added sugars’provide one-fifth of the total energy in diet. • Most of them have snacks at mid-morning, mid-afternoon with sweet biscuits, fruit squash or milk. • Snacking and drinks between meals are a regular part of eating pattern among young children which significantly promotes DC. • Many permanent teeth are forming in this age group and F (brushing with fluoride-containing tooth paste) and Vitamin supplements can provide a useful pre-eruptive effects in these teeth.
  148. 148. The schoolchild and adolescent • Between 6 to 12 years: period of mixed dentition • Local intra-oral effect of dietary sugars is of greatest importance in this age group. • Vit D supplements are found to be very beneficial. • Fluorides continue to be important throughout the years of childhood and adolescence. (either in drinking water, salt, milk or dietary supplements, or topical F agents but in cautious quantity.) • There are little data on diets of schoolchildren aged 5-10 years. • Adolescence : time of rapid growth, independent food choices. A fairly comprehensive account of the sugar (‘natural’ or ‘added sugars’) intake have been documented. • Principal targets at this age must be confectionery, soft drinks(erosion), biscuits, cakes, sugar added to tea or coffee and the ‘Saturday sweets’.
  149. 149. Conclusion Accurate, sound knowledge on nutritional information and its association with benefits and risks of oral health among us as pedodontist is very much needed to ensure uniformity of advice and reassessment if necessary to the child as well to their parents bcoz correct nutrition plays a key role in ensuring good oral health maintenance for children.
  150. 150. References  Textbook on Nutrition - Nizel and papa  Nutrition and Dental health – Rugg Gunn  Nutrition in Clinical Practice: A Comprehensive, Evidence-Based Manual for the Practitioner, 2nd Edition by Dr. David L. Katz  Therapeutic Pediatric Nutrition - 2011 by Sharma  Krause’s Food & Nutrition therapy, 12th Edition, L.Kathleen Mahan Sylvia Escott-Stump.  Dentistry for the child and adolescent – Mc Donald, Avery, Dean

Editor's Notes

  • Monosaccharide : simplest carbohydrate, pentose 5 C, hexoses 6 C, oligosaccharide on hydrolysis yields 2 to 10 mono, poly : complex carbohydrate (more than 10 ). Starch nutrionally most important Ca providing 50% of total carbohydrate intake. Dextran substrate for dental plaque., agar is a food additive. Cirrageen which includes alginic acid and lignin. Mucopolysacharride contain hexosamine. Heparin is an anti-coagulant, chondroitin sulfate and hyaluronic acids are found in connective tissue.
  • The primary purpose of glucose in metabolism is to furnish energy.
  • Some of these are water insoluble and hence they are difficult to be expelled in urine. Body converts them into glucouronyl conjugates using the glucouronyl moiety derived from carbohydrates.
  • Casein is a Phospho protein
  • Butter, lard, margarine, vegetable shortening and salad oils are visible fats.
    Marbleized fat in roast beef, the butterfat in milk,or the oil in avocados. Also in ice cream, peanut butter, potato chips and many highly processed food products.
  • Consist of a core of triglycerides and cholestrol surrounded by shell of protein, phospholipids and cholesterol. Phospholipids orient themselves with their fat- soluble tail towards inisde and water soluble head outside.
  • Arachidonic acid EFA’s for animals
  • Fatty acid metabolism consists of catabolic processes that generate energy, and anabolic processes that create biologically important molecules (triglycerides, phospholipids, second messengers, local hormones and ketone bodies). 
  • Besides mechanically blocking the b;lood vessels, it can rupture leading to catastrophic vessel thrombosis, weakening the underlying media leading to aneurysm.
  • Niacin and its derivative nicotinamide are dietary precursors of nicotinamide adenine dinucleotide (NAD), which can be phosphorylated (NADP) and reduced (NADH and NADPH). NAD functions in oxidation-reduction (redox) reactions and non-redox reactions. NAD is the sole substrate for PARP enzymes involved in DNA repair activity in response to DNA strand breaks; thus, NAD is critical for genome stability. 
  • Three principal hormones are involved in calcium homeostasis • Vitamin D, • Parathormone and • Calcitonin Acting at three target organs, • Intestine, • Bone and • Kidneys
  • Like Ca the phosphorus balance is reguklated by the metabolic and homonal factors Vit D, calcitonin, parathyroid hormone. Also, its in dynamic equilibrium.
    Hydrogen phosphate and dihydrogen phosphate.
  • Unlike Ca less is absorbed in intestine.